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For the last two days, we've been talking about how to take the smoking out of nicotine. How about taking the nicotine out of smoking? Can it be done?
Actually, scientists are already beginning to do it. The latest report, by Kazufumi Yazaki and colleagues, appears in this week's Proceedings of the National Academy of Sciences. They identify a gene, Nt-JAT1, that controls nicotine distribution in tobacco plants. "We will proceed now with experiments to raise tobacco plants that have no nicotine in their leaves," Yazaki tells the Daily Telegraph.
Great. But wait a minute. What exactly will this accomplish?
"There are a lot of people who want to quit and have tried to stop, but say they miss the sensation of having a cigarette in their mouth," Yazaki argues. Tobacco modified to block or eliminate the key transporter gene could produce nicotine-free cigarettes. These would give you the smoke you crave without further addicting you to nicotine. Yazaki thinks this will help people quit.
Really? Low-tar, low-nicotine cigarettes have been around for a long time. Smokers are now suing tobacco companies for marketing these cigarettes as relatively safe. The suit says that to get the same nicotine fix from low-nicotine cigarettes, smokers "unconsciously engage in compensatory behaviors" such as smoking more sticks, inhaling more deeply, or delaying exhalation. So nicotine reduction doesn't end up reducing the damage. And remember, these cigarettes are low-nicotine and low-tar. A low-nicotine, regular-tar cigarette would, on this theory, cause even greater damage, since you'd have to inhale more carcinogens to get the same fix.
On the other hand, there's some evidence that smokers wouldn't compensate this way. And, as we discussed yesterday, nicotine replacement therapy operates on the principle that some addicts can gradually reduce their nicotine consumption till they're off the drug altogether. But nicotine replacement products don't just deliver the drug. They change the delivery system. They get rid of the cigarette.
That's where the nicotine-free tobacco project really breaks down. Yazaki's team thinks "it would also be good for nonsmokers if tobacco smoke did not contain nicotine." Well, maybe. But what really endangers and angers nonsmokers is the smoke, not the nicotine. If you just block the nicotine gene in tobacco plants, you aren't touching the delivery system or the carcinogens. Smokers are still smoking, the rest of us are still inhaling the smoke, and we're still getting sick. It's great that you're taking away the product's chemical addictiveness. But that's just another reason to ban smoking everywhere, as we're already doing. Smokers won't need it, and the rest of us can't stand it.
In short, nicotine-free cigarettes don't make sense as a business plan. Yazaki says that his research grant is about to run out and that he's thinking of asking Japan Tobacco to sponsor him. Good luck with that. Addiction is what makes tobacco such a profitable business. Eliminate the nicotine, and the pusher loses his grip on the "consumer." That's why tobacco companies are trying to do exactly the opposite: keep the nicotine while eliminating the cigarette.
Nicotine-free tobacco may end up doing the world a lot of good. But if so, that good won't come from cigarette production. It'll come from the use of tobacco plants to make medical products such as insulin and vaccines. Take out the nicotine, take out the carcinogens, and tobacco is a different animal—or, rather, a different plant—altogether. Put that in your pipe. And don't smoke it.
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Yesterday we talked about the tobacco industry's escape from the anti-smoking movement. The escape relies on two factors: that tobacco can be engineered into new, smokeless forms, and that the core of the tobacco business is addiction, not cancer.
One way to defeat the industry is by using the same factors. You isolate tobacco's addictive ingredient, nicotine, and engineer it into new forms. But instead of engineering the dose to sustain addiction, you design it to gradually liberate the addict.
Case in point: Barack Obama. Last week in the Wall Street Journal, Melinda Beck advised him to break his cigarette habit by turning to alternative nicotine products.
Nicotine soothes the primitive fight-or-flight response while focusing attention, and it releases dopamine like a pleasurable reward. Nicotine withdrawal can make it harder to think, concentrate and remember, as well as causing irritability, impulsiveness and aggressiveness. ... Nicotine-replacement therapy—with gum, lozenges, a patch or an inhaler—can alleviate those withdrawal symptoms, provided you're getting enough. You've been chewing nicotine gum for months now, but researchers have found that some smokers need more nicotine replacement than others to stop their cravings.
Nicotine alone is better than any tobacco product with residual carcinogens. As Beck points out: "Overdosing on nicotine replacement can make you feel nauseous and light headed and raise your heart rate, but it doesn't appear to cause cancer; it's the tar and various additives in tobacco that do that."
Does nicotine replacement work? Sometimes yes, sometimes no. A study of 3,300 smokers, published in the February issue of the American Journal of Preventive Medicine, found that quitting rates were low but that nicotine gum helped significantly. The study was double blind, randomized, and placebo-controlled.
Subjects were instructed to gradually reduce their smoking while increasing their gum use over the course of up to 8 weeks. Once they had achieved initial abstinence (no smoking for 24 hours), gum was to be used in accordance with the current FDA-approved directions for cessation. The study was conducted under over-the-counter conditions, with no counseling provided.
The results:
Though most study participants failed to quit completely, those who used the nicotine gum were more successful—with 26 percent achieving total abstinence within eight weeks of treatment, compared with 18 percent in the placebo group. Among those quitters, nicotine-gum users were more than twice as likely to stay continuously abstinent for a month afterward—10 percent, versus 4 percent of those in the placebo group. ... Six percent of nicotine-gum users were continuously abstinent for six months, while the same was true of 2 percent of smokers in the placebo group.
Guess who funded the study? GlaxoSmithKline. Why? Because it engineers and sells nicotine replacement products. This is the drug war of the future: the addiction industry vs. the pharmaceutical industry. Both sides sell drugs. Both design their drugs to work with the physiology of addiction. If we're lucky and the tobacco industry continues to move away from cigarettes, the nicotine war won't be about cancer anymore. It'll be about liberation from addiction.
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The war on tobacco is advancing. Smoking is losing. But tobacco is escaping.
How? Look at two articles published yesterday. A front-page story in the New York Times examined a new smoking ban in Belmont, Calif., which forbids lighting up even in your own apartment. The rationale: Smoke from your apartment drifts into your neighbors'. Studies have shown that secondhand smoke harms others. Science is dissolving the distinction between your space and mine.
So tobacco is doomed, right?
Wrong. Smoking may be doomed, but tobacco is evolving into more elusive prey. Or, perhaps I should say, a more elusive predator. As Kevin Helliker reports in the Wall Street Journal, the industry is going smokeless.
Altria Group Inc., the nation's largest cigarette maker, this month completed its $10.3 billion purchase of UST Inc., the biggest smokeless-tobacco maker and owner of the Copenhagen and Skoal brands. Reynolds American Inc., which owns Conwood Co., a discount smokeless purveyor, this month announced that the Camel Snus brand has performed well enough in test markets to warrant national distribution.
Consumers—heck, let's just call them what they are, addicts—seem to be going with the transition. According to Helliker:
[M]ore Americans are continuing to give up smoking, helping to push cigarette consumption down about 3% each year. ... Morgan Stanley estimates that U.S. consumers spent $4.77 billion on smokeless tobacco in 2007 versus $78 billion on cigarettes. Smokeless-tobacco sales have been increasing about 5% or more a year. ... "There are probably in excess of 400,000 adults switching to smokeless each year," says Seth Moskowitz, a spokesman for Reynolds American.
Two months ago, I called smokeless tobacco "carcinogenic, addictive, and gross." But guess what? It's becoming less gross:
For many people, smokeless tobacco conjures up an image of a wad of chewing tobacco bulging from the cheeks of users who spit brown juice. Instead, recent products consist of dissolvable pellets or tiny pouches of tobacco that reside invisibly in the mouth and induce no spitting.
And it's becoming less carcinogenic:
One recent study showed that some newer brands, with names like Ariva, Camel Snus and Marlboro Snus, have sharply lower levels of a dangerous carcinogen than do older varieties of smokeless tobacco, such as Copenhagen and Skoal. Britain's Royal College of Physicians, which sets health standards in the United Kingdom, has said smokeless tobacco is between one-tenth and one-one thousandth as hazardous as smoking, depending on the specific product.
So now we're down to addictiveness. And that, too, is adjustable:
The December study also found that Marlboro Snus contained a very low level of nicotine. By contrast, Camel Snus offers a jolt of nicotine that "has the potential to satisfy those smokers who are looking for a substitute to smoking, and to keep them addicted to this product," the authors said.
Which leaves us with two very tough questions. First, does society have any business restricting tobacco products purely on grounds of addiction? New regulations in Boston protect "the younger population" by forbidding the sale, at colleges and professional schools, of "any substance containing tobacco leaf, including but not limited to cigarettes, cigars, pipe, tobacco, snuff, chewing tobacco and dipping tobacco." Does that make sense, even when the products are dissolvable pellets increasingly purged of carcinogens? And if addiction per se is evil, what about caffeine?
Second, should we even want to purge the nicotine from tobacco? The aforementioned study (which, according to Helliker, was federally funded and performed by scientists with no financial connections to the tobacco industry) implies, sensibly, that the less nicotine you put in a smokeless product, the less likely it is to "satisfy" nicotine addicts and lure them away from cigarettes. We permit and even encourage the use of nicotine gum and lozenges to wean people from smoking. What exactly is the moral difference between a lozenge and a pellet?
Tobacco is evolving and escaping for two fundamental reasons. One is that it can be engineered into new forms. The other is that the problem targeted by legislation—the weed's tendency to cause cancer—isn't essential to the tobacco business. What's essential to the tobacco business is addiction. Addiction is a nasty business, deliberately enslaving people while pretending that they "choose" the product. But if you're going to target that practice, then you'd better come and take all the coffee and Diet Coke from Slate's Washington office. We have some "younger" folks here.
Slate V's Grand Unified Weekly: A NASA scientist's dire warnings, prenatal screening for autism, and measuring virtual gravity
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What's worse than an 11th-century theocracy running a 21st-century country? A theocracy that enforces its edicts with the help of 21st-century technology.
The country is Iran; the religion is fundamentalist Islam; the technology is cell phone cameras. The report comes from an Iranian newspaper, Vatan-e-Emrooz, via the Associated Press:
The first mixed soccer game—females vs. males—since the 1979 Islamic revolution led to swift punishment Monday, as an Iranian soccer club said it had suspended three officials involved and handed out fines of up to $5,000. Iran's strict Islamic rules ban any physical contact between unrelated men and women, and Iranian women are even banned from attending soccer games when male teams play. ... [The club] said its disciplinary committee suspended two officials for a year while a third was suspended for six months.
How were the women's libbers behind this outrage caught? Allah be praised, by modern handheld electronics.
The officials—a coach and two managers—first denied the game took place, but video clips on cell phones of the game were used as evidence against them, the daily newspaper reported.
For much of the past century, there's been a running debate over whether economic liberalization leads to political liberalization. Then the globalization and democratization of communications technology were supposed to help. Last year, President Bush authorized exports of cell phones to Cuba, thinking this would loosen the regime's grip. "If the Cuban people can be trusted with mobile phones, they should be trusted to speak freely in public," he argued.
It's a nice thought. But as the Iranian case illustrates, democratized technology can be used just as easily to enforce tyranny as to challenge it. Devices won't point us in the right direction. We'll have to be the ones who point them.
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Do some women fantasize about rape? Do some become aroused during rape? If so, what does it mean?
Daniel Bergner, a contributing writer for the New York Times Magazine, raises those questions in the magazine's current issue. Obviously, Bergner's a guy. So am I. But the evidence and theories in the article come from women who have been researching female sexuality. For instance, Meredith Chivers, a psychology professor at Queen's University,
has confronted clinical research reporting not only genital arousal but also the occasional occurrence of orgasm during sexual assault. And she has recalled her own experience as a therapist with victims who recounted these physical responses. She is familiar, as well, with the preliminary results of a laboratory study showing surges of vaginal blood flow as subjects listen to descriptions of rape scenes.
Moreover,
According to an analysis of relevant studies published last year in The Journal of Sex Research, an analysis that defines rape as involving "the use of physical force, threat of force, or incapacitation through, for example, sleep or intoxication, to coerce a woman into sexual activity against her will," between one-third and more than one-half of women have entertained such fantasies, often during intercourse, with at least 1 in 10 women fantasizing about sexual assault at least once per month in a pleasurable way.
How could anyone want something done to her against her will? Isn't that self-contradictory? And if she doesn't want it, why would she become genitally aroused?
The answer, some of these researchers propose, is that women's sexuality is split. In one of Chivers' studies, for example, "men's minds and genitals were in agreement" while watching sexual videos. But among women, genital blood differed sharply from self-reported arousal: "During shots of lesbian coupling, heterosexual women reported less excitement than their vaginas indicated; watching gay men, they reported a great deal less; and viewing heterosexual intercourse, they reported much more." Even lesbians, while watching videos of men, "reported less engagement than the [blood-flow monitors] recorded."
Chivers speculates that female sexuality might be split between "physiological" and "subjective" systems. This could explain the rape data:
[T]o understand arousal in the context of unwanted sex, Chivers, like a handful of other sexologists, has arrived at an evolutionary hypothesis that stresses the difference between reflexive sexual readiness and desire. Genital lubrication, she writes in her upcoming paper in Archives of Sexual Behavior, is necessary "to reduce discomfort, and the possibility of injury, during vaginal penetration. ... Ancestral women who did not show an automatic vaginal response to sexual cues may have been more likely to experience injuries during unwanted vaginal penetration that resulted in illness, infertility or even death, and thus would be less likely to have passed on this trait to their offspring." Evolution's legacy, according to this theory, is that women are prone to lubricate, if only protectively, to hints of sex in their surroundings.
In other words, part of the female arousal system is designed for self-protection and is particularly well-suited to what we now regard as abuse. Sounds horrific, right? But Marta Meana, a psychology professor at the University of Nevada, offers an arguably more disturbing theory. She points to research suggesting that 1) "in comparison with men, women's erotic fantasies center less on giving pleasure and more on getting it"; 2) "as measured by the frequency of fantasy, masturbation and sexual activity, women have a lower sex drive than men"; and 3) "within long-term relationships, women are more likely than men to lose interest in sex." These and other findings fit her theory that female desire is driven by "being desired."
So does reproductive logic, according to Chivers:
[O]ne possibility is that instead of it being a go-out-there-and-get-it kind of sexuality, it's more of a reactive process. If you have this dyad, and one part is pumped full of testosterone, is more interested in risk taking, is probably more aggressive, you've got a very strong motivational force. It wouldn't make sense to have another similar force. You need something complementary.
And here's where it gets icky.
A symbolic scene ran through Meana's talk of female lust: a woman pinned against an alley wall, being ravished. Here, in Meana's vision, was an emblem of female heat. The ravisher is so overcome by a craving focused on this particular woman that he cannot contain himself; he transgresses societal codes in order to seize her, and she, feeling herself to be the unique object of his desire, is electrified by her own reactive charge and surrenders. ... [Meana] spoke about the thrill of being wanted so much that the aggressor is willing to overpower, to take.
Does this mean women want to be raped? No. Both theories assume the opposite. And that's a pretty safe assumption, given the logical impossibility of willing a violation of your will. The challenge is to explain the data on rape fantasies and arousal from sexual assault, given that nobody literally wants to be raped. What part of rape or the idea of rape is arousing? And what part of the woman is aroused?
The first theory, lubrication, suggests that rape-related arousal is purely physical and reflexive, leaving the will untouched. Your vagina says one thing, your brain says another, and (this is the crucial part for men to understand, morally and legally) your brain is what matters. But that doesn't explain the data on rape fantasies. Fantasies imply brain arousal. And that, in turn, implies that we should be asking not which part of the woman is aroused, but which part of the rape fantasy is arousing.
The second theory, which Meana frankly calls narcissism, posits a clear answer. We generally define rape as sex against the victim's will. But a woman mentally aroused by a sexual assault fantasy isn't thinking about the victim's will. She's thinking about the perpetrator's. She's imagining being wanted. That's what she wants—and the fact that she wants it exposes the fantasy, by definition, as not really rape. The imaginary act arouses her not because the woman in the scenario doesn't want it, but because the man does.
But if that's what these fantasies are—one person drawing her will from the will of another—what does it say about us? If derivativeness of will is, as some of these researchers posit, a fundamental difference between male and female arousal, what does it say about equality between the sexes? Are women, in this sense, inherently less autonomous?
(Update: My colleagues at the XX Factor, who actually have the relevant equipment, are discussing this topic right now. Meghan O'Rourke has flagged the same question about whether female sexuality is reactive. I'll be interested to see other comments from the focus group.)
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New president, same war.
Saturday's Washington Post brings the latest report from Pakistan:
Two remote U.S. missile strikes that killed at least 20 people at suspected terrorist hideouts in northwestern Pakistan yesterday offered the first tangible sign of President Obama's commitment to sustained military pressure on the terrorist groups there. ... It remained unclear yesterday whether Obama personally authorized the strike or was involved in its final planning, but military officials have previously said the White House is routinely briefed about such attacks in advance. At his daily White House briefing, press secretary Robert Gibbs declined to answer questions about the strikes, saying, "I'm not going to get into these matters."
Why is Obama sticking with Bush's drone war? Because it's doing its job, grimly and quietly. Reuters has the body count:
The United States carried out about 30 attacks on suspected militants with missiles fired by pilotless drones in 2008, according to a Reuters tally, more than half after the beginning of September. The attacks killed more than 220 people, including foreign militants, according to a tally of reports from Pakistani intelligence agents, district government officials and residents.
That's roughly equal to the body count from the first day of Israel's December assault on Gaza. But the outcry is nowhere near as loud. In fact, the Post notes,
The Pakistani government, which has loudly protested some earlier strikes, was quiet yesterday. In September, U.S. and Pakistani officials reached a tacit agreement to allow such attacks to continue without Pakistani involvement, according to senior officials in both countries.
Pakistan finally piped up today, meekly expressing its "sincere hope that the United States will review its policy and adopt a more holistic and integrated approach."
Why the comparative silence? Because the drones aren't human -- technically, U.S. forces aren't in Pakistan -- and because they pick off their targets a few at a time, not in a massive blitz. They can hover, study, track, and wait for hot intelligence from the ground. That's one reason why they're killing a high ratio of bad guys to civilians.
Regional and intelligence experts say the strikes have improved in precision and have hit several top insurgent commanders in recent months. The notable change in tempo and reported accuracy could be partly attributed to a growing sense of urgency inside the Bush White House as the progress in the seven-year long war in Afghanistan stalled during the waning days of the administration. Samina Ahmed, director of the International Crisis Group in Pakistan, attributes some of the change to increased cooperation between the United States and Pakistan. "Given the fact that the past few strikes have actually gotten their targets with minimal or no civilian casualties, there is obviously better cooperation between the U.S. military and Pakistan," Ahmed said.
Remember, Israel's worst mass killings of civilians in Gaza happened when Israeli forces returned fire. But a drone doesn't need to return fire. It can listen, watch, and wait until it has the bad guys in its sights with few civilians in the way.
If I'm a new U.S. president who needs to hunt, kill, and deter terrorists without invading or occupying countries, this is the kind of war I want.
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Does science support our laws against incest and cousin marriage? If so, does it also support other laws that would restrict sexual or procreative freedom in the name of genetic health?
To longtime readers of Human Nature, this question should be, if you'll pardon the term, familiar. A few years ago, we looked at the science and ethics of "The Love That Dare Not Speak Its Surname." Then we examined the prevalence of inbreeding in nature. Then we considered the awkward question of why, if incest is too genetically risky to permit, maternity in your 40s isn't.
Now biologist Hamish Spencer and political scientist Diane Paul, writing in PLOS Biology, have reviewed the history of U.S. laws against cousin marriage, along with their scientific basis. And again, the evidence raises unsettling implications.
They start with the statistical case against restricting cousin marriages:
[T]he National Society of Genetic Counselors (NSGC) convened a group of experts to review existing studies on risks to offspring and issue recommendations for clinical practice. Their report concluded that the risks of a first-cousin union were generally much smaller than assumed—about 1.7%-2% above the background risk for congenital defects and 4.4% for pre-reproductive mortality—and did not warrant any special preconception testing. In the authors' view, neither the stigma that attaches to such unions in North America nor the laws that bar them were scientifically well-grounded.
But Paul and Spencer point out that the data aren't clear-cut. First, "statistics on the risks associated with cousin marriage are necessarily averages across many traits, and they are likely to be different for different populations." And second, it's
inappropriate to extrapolate findings from largely outbred populations with occasional first-cousin marriages to populations with high coefficients of inbreeding and vice-versa. Standard calculations, such as the commonly cited 3% additional risk, examine a pedigree in which the ancestors (usually grandparents) are assumed to be unrelated. In North America, marriages between consanguineal kin are strongly discouraged. But such an assumption is unwarranted in the case of UK Pakistanis, who have emigrated from a country where such marriage is traditional and for whom it is estimated that roughly 55%-59% of marriages continue to be between first cousins. Thus, the usual risk estimates are misleading: data from the English West Midlands suggest that British Pakistanis account for only ~4.1% of births, but about 33% of the autosomal recessive metabolic errors recorded at birth.
In other words, the American calculations understate the risk for an already inbred population such as British Pakistanis. And calculations based on British Pakistanis overstate the risk for most American cousin couples. You can't draw a uniform line against cousin marriages based on science. Arguably, for the same reasons, you can't draw a uniform line against sibling incest.
The same case can be made against a uniform age of sexual consent. The authors point out,
Beginning in the 1860s, many states passed anti-miscegenation laws, increased the statutory age of marriage, and adopted or expanded medical and mental-capacity restrictions in marriage law. Thus, laws prohibiting cousin marriage were but one aspect of a more general trend to broaden state authority in areas previously considered private.
As Human Nature has noted before, the age of actual maturity varies considerably depending on the person and the type of maturity (sexual, cognitive, emotional) involved. Granted, lawmakers have to draw lines somewhere. But let's not pretend such consistent lines are consistently apt.
Moreover, Paul and Spencer raise a far more troubling problem: The increase in genetic risk caused by cousin marriages among British Pakistanis may actually be overstated, for a curious reason.
[F]or a variety of reasons (including fear that a cousin marriage would result in their being blamed for any birth defects), UK Pakistanis are less likely to use prenatal testing and to terminate pregnancies. Thus the population attributable risk of genetic diseases at birth due to inbreeding may be skewed by prenatal elimination of affected fetuses in non-inbred populations.
In other words, many of the birth defects cited by British politicians as grounds for restricting cousin marriages may actually be the result not of cousin marriage, but of failure to screen and abort defective fetuses. So, in addition to maternity in your 40s, we now have a second logical target for genetic regulation: If inbreeding is too dangerous, what about "inflicting" maladies on your children by failing to screen the embryos? If you know you carry bad genes—and particularly if you're at higher risk of passing down a serious disease than most sibling couples would be—shouldn't we police your procreation just as carefully?
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People in a democratic country wouldn't let their government restrict family size ... would they?
Yes, they would. Agence France Presse reports:
More than 80 percent of Filipinos support family planning and almost half believe the government should limit the number of children a couple can have, according to a survey released here Monday. ... 44 percent believed that "the government should pass a law specifying the number of children."
Why would Filipinos say this? "The Philippine population now stands at around 90 million, with an annual growth rate of 2.04 percent, one of the highest in Asia," the article explains. And guess who's behind the high birth rate?
The findings come despite a widespread campaign by the dominant Roman Catholic Church opposing a draft law that would make family planning services more widely available in the Philippines. ... The Catholic Church, which counts over 80 percent of Filipinos as followers, has said the reproductive health bill, which has been pending in Congress for months, is headed for defeat after a high-pressure campaign by bishops.
What a mess. On one side, we have the Catholic bishops, who are so adamantly opposed to contraception that they're blocking the provision of birth control for voluntary use. On the other side, we have an emerging near-majority of the population that now favors coercive limits on family size. Do the math: The Church claims to represent 80 percent of the population, yet more than 80 percent reject its teachings on contraception, and 44 percent think the government should impose laws in precisely the opposite direction. It looks as though the bishops' anti-contraceptive absolutism is driving their own flock into the arms of a totalitarian remedy.
But in a modern society, no government could really enforce a cap on family size, could it?
Sure it could. Look next door at China, which uses state-controlled subsidies to punish couples who bear more than one child. It's quite effective. And here's what's really scary: The Chinese government has learned to treat children like any other state-allocated resource. It doesn't just impose a quota. It does what it can to guarantee your share. This helps the population accept the system.
In effect, China provides a "warranty" on children: You're limited to a state-prescribed quota, but you can refill the quota if you lose your child under specified circumstances, such as last year's earthquake. And what a warranty! The central planners don't just offer you the right to have another kid. They really deliver. Here's the report from Xinhua:
Officials of the National Population and Family Planning Commission told a conference here Friday that 757 Chinese mothers who lost children in the May 12 quake have become pregnant again, reflecting special exceptions to national and local population policies. As of Dec. 31, the officials told the agency's annual work conference, 5,724 bereaved mothers had received free reproduction services, including counseling, guidance, health exams, sterilization reversals and fertility treatments.
This is exactly what the government promised seven months ago. And, sure enough, according to the New York Times, the regime has "sent teams of doctors to carry out reverse sterilization operations." Now, that's what I call service. The state uses financial penalties to close up your reproductive system. Then, if you end up below quota, the state reopens you for business. In fact, if necessary, it does the business itself. Even the fertility treatments are free.
But state manipulation of family size is just an Asian thing, right? It couldn't happen here.
Think again. Guess which country now has Europe's highest birth rate? France. How has it achieved this? "State-provided child care and family support payments," including "nanny subsidies." Australia has "cash payments for newborns." Spain pays "2,500 euros per new child." Austria offers "monthly payouts of $547 for the youngest child until the age of 3, and additional monthly checks ranging from $132 to $192."
These are governments that think they need more births. Most governments think they need fewer. If their citizens decide to support state-enforced limits on childbearing, and if agencies help each family fill its allotment, it's easy to envision a world where population growth is finally brought under control by the financial power of the state.
Slate V: Wall Street's big swinging digits and other science news from Grand Unified Weekly:
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Should parents go to jail for believing so devoutly in faith healing that they don't seek lifesaving medical treatment for their children?
Leilani and Dale Neumann of Wausau, Wis., will soon find out. Their 11-year-old daughter died of diabetic complications after they relied on prayer rather than doctors to heal her. Now they face trial for reckless endangerment and a potential prison sentence of 25 years. They're the third couple slapped with criminal charges in the last year for failing to seek treatment for a child. In today's New York Times, Dirk Johnson reports:
About 300 children have died in the United States in the last 25 years after medical care was withheld on religious grounds, said Rita Swan, executive director of Children's Health Care Is a Legal Duty ... Criminal codes in 30 states, including Wisconsin, provide some form of protection for practitioners of faith healing in cases of child neglect and other matters ...
Swan lost her own son after failing to seek prompt medical attention. She says she waited, catastrophically, because she thought "once we went to the doctor, we'd be cut off from God." The Neumanns seem to have been under the same impression. Johnson reports that they're "followers of an online faith outreach group" (on the Web here) that includes, among other things, an essay preaching that "Jesus never sent anyone to a doctor or a hospital. Jesus offered healing by one means only! Healing was by faith."
I don't know how the case will turn out. But the more important thing to communicate to parents is that this is bad religion. Science is a way of grappling with what we can know empirically. Religion is a way of grappling with what we can't. Each of these disciplines must recognize its limits and defer, beyond that, to its counterpart. Properly understood, there's nothing unscientific about religion, and there's nothing irreligious about science.
I'm not saying the distinction is perfectly clean. It isn't. Sometimes religion and science have to work together. But it's crucial to ask which kind of question you're facing. Healing is a physical phenomenon. Can faith influence it? Yes. Look at the latest study on acupuncture: It sometimes works, apparently because patients believe in it. But what happens when people pray for your recovery without you knowing about it? Answer: Nothing. Belief, not God, is the medically salient factor.
That's how science, at its best, works with religion. It doesn't claim to disprove God's existence. It can't. It addresses only empirically testable ideas, including faith healing. And it reports whatever its methods find. Instead of laughing at acupuncture, it looks at the evidence, admits that acupuncture sometimes works, and tries to figure out why.
Religion, at its best, needs the same humility. God isn't stupid. He doesn't give you a hammer and insist that you bang nails with your head. If this is his world, then so are the tools he has given you: doctors, medicine, and your brain. In the time of Jesus, most people died in childhood. Do you want to go back to that? Do you think that those deaths were God's will—but that today's long lives, made possible by modern medicine, aren't?
As medicine advances, difficult moral questions will arise. If failure to seek available treatment is reckless endangerment, what happens when the available treatment comes, for example, from destroying embryos to get stem cells? Can you be jailed for refusing to give your daughter treatment that's based on what you regard as killing? Or take embryo screening: Already, it has advanced to the point where parents who make babies the old-fashioned way, with all its risks, are seen as "inflicting" genetic maladies on their kids.
But taking your gravely ill child to the doctor isn't one of those tough calls. God doesn't hate doctors. He made them. Want to show your faith? Use what he gave you.
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When I left the political beat to start writing about science and technology, I had hoped to get away from the polarization, oversimplification, and shouting that infests much of the blogosphere. So it's disappointing to see those bad habits creeping into technology journalism, particularly in a Slate family publication.
Last week, three people at Slate researched possible technological means of detecting and blocking tunnels between Gaza and Egypt. We put together a summary of the options with their pros and cons.
The next day, our sister publication, Foreign Policy, published a blog post ridiculing the list as "really terrible advice—almost a parody of the worst sort of technocentric thinking that military reformers like H.R. McMaster have been fighting against for decades." The post, by FP's Web editor, Blake Hounshell, went on:
There's a sad history of people who don't understand—or, for political reasons, pretend not to understand—why technology won't solve their political, economic, and social problems. Take Robert McNamara, who in 1967 announced plans for a massive, ill-conceived "electronic anti-infiltration barrier" to stop inflitration [sic] of men and materiel from North Vietnam. Or take the moronic "virtual fence" that some in the U.S. government concoted [sic] to address illegal immigration ...
Terrible, parody, worst, moronic. This is the way many bloggers write today, especially when they don't understand or don't wish to acknowledge the complexity of the subject. They come to each item of news or analysis with a preconceived agenda—in this case, the perils of "technocentric thinking"—and treat the item before them as an occasion to repeat their shtick.
What gets lost in the shtick is the actual material at hand. The Slate article can't be "really terrible advice," since it recommended no particular approach. Nor can it be "the worst sort of technocentric thinking," since it said nothing about whether technology was preferable to political or economic proposals for resolving the Gaza conflict. The exact sentence that introduced our list of ideas was: "Here are some of the options."
Hounshell thinks economic remedies make more sense. You can't shut down the tunnels, he argues, "until you permit free trade in and out of Gaza, end the Israeli-Palestinian conflict, raise income levels in northern Sinai, and pay Egyptian officials high enough wages such that they don't feel the need to take bribes. There is no technological solution, so best of luck with the rest of it."
There's no contradiction, of course, between closing the tunnels and opening the borders to trade. To me, that's the logical combination. People in Gaza need and deserve the same goods as people anywhere else. What they don't need is missile parts. For the last couple of years, missile parts going into Gaza have brought nothing but grief, first to Israelis, and now to Gazans. The best way to separate Gaza's consumer-goods traffic from its weapons traffic is to bring the former to the surface, out of the tunnels. But that alone won't stop the weapons traffic. Hamas wants weapons and has the money and sponsors to get them. If it can't smuggle them in by surface routes, it will seek them underground. To patrol and block the underground channels, technology has to be part of the solution.
That's how technology fits a messy problem like Gaza. It's seldom the whole answer, but it's usually part of the answer. Just ask Israelis about their "security fence" against suicide bombers from the West Bank. It's not a solution by itself—lasting peace requires political and economic progress for Palestinians—but it has sharply reduced the bombings. And reducing the bombings has improved prospects for political progress between Israel and the Palestinian Authority.
So let's ease up on the invective against technocentrism. Technology is more complicated than that. At its best, so is journalism.
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Gaza is riddled with tunnels. Some are for smuggling; others are for transporting weapons; others are for hiding or ambushing Israeli troops. The crucial passageways—400 to 600, by recent estimates—run from Gaza to Egypt, circumventing the closed border. That's how Hamas gets parts and material for the missiles it fires into Israel. Any deal to end the current fighting has to include "an effective blockading" of that border, "with supervision and follow-ups," according to Israel's prime minister. To stop the war—and to keep it stopped—you have to figure out how to stop the tunnels.
But how? Here are some of the options.
More here.
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Here's the theory: Old people are bad drivers. And we're living longer, so there are more old people on the road, so they're causing more accidents. And they're already fragile, so they're killing more people, including themselves. Right?
Wrong. According to the latest data from the Insurance Institute for Highway Safety (flagged by Tara Parker-Pope of the New York Times), it's true that "older people now hang onto their licenses longer, drive more miles, and make up a bigger proportion of the population than in past years as baby boomers age." It's also true that "per mile traveled, crash rates and fatal crash rates increase starting at age 70 and rise markedly after 80," possibly because "physical, cognitive, and visual declines associated with aging may lead to increased crash risk."
That's what makes the bottom-line findings so surprising:
Despite growing numbers on the road, fewer older drivers died in crashes and fewer were involved in fatal collisions during 1997-2006 than in years past. ... Crash deaths among drivers 70 and older fell 21 percent during the period, reversing an upward trend, even as the population of people 70 and older rose 10 percent. Compared with drivers ages 35-54, older drivers experienced much bigger declines in fatal crash involvements.
The institute's chief of research adds: "No matter how we looked at the fatal crash data for this age group—whether by miles driven, licensed drivers, or population—the fatal crash involvement rates for drivers 70 and older declined, and did so at a faster pace than the rates for drivers 35-54 years old."
So what gives? "Reasons for the fatality declines aren't clear, but another new Institute study indicates that older adults increasingly self-limit driving as they age and develop physical and cognitive impairments," says the IIHS. In that study,
The oldest drivers were more likely to say they restricted their own driving. Drivers 80 and older were more than twice as likely as 65-69 year-olds to self-limit driving by doing such things as avoiding night driving, making fewer trips, traveling shorter distances, and avoiding interstates and driving in ice or snow. The percentage of drivers who said they limit their driving increased with each added degree of impairment. Drivers cited memory and medical impairments more often than vision or mobility ones.
In other words, as we age, self-knowledge and self-regulation compensate for our loss of abilities. As Farhad Manjoo reported four months ago in Slate,
Statistics on current road deaths show that people over the age of 65 are only 16 percent more likely to cause accidents than are people aged 25 to 64. Drivers under 25, meanwhile, are the most dangerous people on the road—they're 188 percent more likely to cause crashes than middle-aged adults.
Aging is a tragic but beautiful process: As we decay in some ways, we grow in others. We become less able to control the world but more able to control ourselves. As IIHS points out, our decline isn't just physical; it's mental, too. Yet we understand ourselves better than ever. Even as our vision deteriorates, we become more clear-eyed about our own limits. And even as our memory degrades, we develop a more important kind of knowledge: We know what we don't know.
Not everyone grows this way. To the extent that self-regulation has reduced fatal crash rates among aging drivers, the implication is that old people can be made more aware of their limits and can adjust accordingly. If you're aging, the lesson is to monitor and govern your driving. And if you're young, the lesson is to cultivate what old people have—self-knowledge and self-control—while your mind and body are still at full strength.
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First, we said IVF embryos weren't pregnancies. That's technically correct: Pregnancy begins when the embryo implants in the womb. Then we called early embryos "pre-embryos" so we could dismantle them to get stem cells. That was technically incorrect, but we did it because it made us feel better. Now we're adjusting the word conception. Henceforth, testing of IVF embryos to decide which will live or die is "preconception." Don't fret about the six eggs we fertilized, rejected, and flushed in selecting this baby. They were never really conceived. In fact, they weren't embryos. According to Serhal, each was just "an affected cluster of cells."
More here.
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Hey, cell-phone zombie! Wake up! The National Safety Council is trying to pull you over.
The council, a congressionally chartered nonprofit that helped lead the fight for seat-belt use, wants a nationwide ban on cell-phone use while driving. Not just a ban on holding your phone. A ban on using it.
It's about time. Three months ago, Human Nature looked up the research on cell-phone use at the wheel. It's brutal. Even with a hands-free device, talking on a phone can impair driving skills more than intoxication does. Brain scans show the phone conversation sucking the driver's mind from one world into another.
Just last week, a lawsuit in the "texting-engineer" train crash near Los Angeles alleged that the engineer's bosses knew about his texting habit but ignored it. This weekend, I was complaining that the company should have taken driving while texting as seriously as we take driving while drunk.
My complaint has been answered. On Monday, the NSC agreed. Council president Janet Froetscher cited the same flaw in hands-free cell-phone laws: "Even if both hands are on the wheel, your head is in the call, and not on your driving." And she drew the same comparison to alcohol: "When our friends have been drinking, we take the car keys away. It's time to take the cell phone away."
Can a total ban get through the legislative process, politically? It'll be hard, precisely because, as Froetscher notes, 270 million Americans use cell phones, and 80 percent of them use their phones while driving. But the council has succeeded before, and it will do so again, if it can persuade lawmakers and the public to see cell phones in cars the way we now see liquor. "We have been through this before with seatbelts, with drunk driving," says Froetscher. "We do research. When the research demonstrates that something is very dangerous and we can save lives, we educate the public about it."
The insurance industry agrees that a total cell-phone driving ban "makes sense based on the research." The council has also identified a proven mechanism for nationalizing such a ban: Congress can use its highway-construction legislation to financially reward states that pass no-cell laws. And 16 states have set a potentially useful precedent by banning cell-phone use among drivers with learner's permits, intermediate licenses, or both.
To me, the persuasive analogy is alcohol. Intuitively, cell phones in the car seem more justified and less objectionable than booze does, because booze is stupefying, whereas phones are engaging. But the more the phone engages you in its own world, the more it stupefies you in the one you're navigating. Nobody's saying you can't use your phone or your car. Just not at the same time.
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Would you like to take performance-enhancing drugs to boost your pro sports career? Are the drugs banned as a form of cheating? No problem. Just find a doctor willing to certify that you have a "deficit" of the performance factor in question.
That's what seems to be happening in Major League Baseball.
More here.
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Last month, we talked about the transition from George W. Bush to Barack Obama and what it might signify for biotech policy: a shift from a conservative interest in technological frontiers to a progressive interest in distributive justice. Less debate, for instance, about things like future artificial wombs, and more attention to things like incubators made from car parts. The point of car-parts incubators was that nobody cares about the latest million-dollar American baby born at 21 weeks when you live in a country where preemies die at 35 weeks. What most of the world needs is an affordable incubator that works for most preemies and can be reliably maintained.
Here's another target for the progressive ethic: eyeglasses. The man leading the charge is Joshua Silver, a physicist at Oxford. In Saturday's Washington Post, Mary Jordan explains the situation:
In the United States, Britain and other wealthy nations, 60 to 70 percent of people wear corrective glasses, Silver said. But in many developing countries, only about 5 percent have glasses because so many people, especially those in rural areas, have little or no access to eye-care professionals. Even if they could visit an eye doctor, the cost of glasses can be more than a month's wages. This means that many schoolchildren cannot see the blackboard, bus drivers can't see clearly and others can no longer fish, teach or do other jobs because of failing vision.
Silver's answer: Adjustable glasses.
[T]he more liquid pumped into a thin sac in the plastic lenses, the stronger the correction. Silver has attached plastic syringes filled with silicone oil on each bow of the glasses; the wearer adds or subtracts the clear liquid with a little dial on the pump until the focus is right. After that adjustment, the syringes are removed and the "adaptive glasses" are ready to go. Currently, Silver said, a pair costs about $19, but his hope is to cut that to a few dollars.
Silver has already distributed some 30,000 pairs, chiefly through the U.S. Department of Defense, which is giving away 20,000 (with U.S. public-relations inscriptions attached) in Africa and Eastern Europe. His next goal is to disseminate another million pairs in India. The ultimate target is 1 billion people who need glasses but don't have them.
Silver's glasses are ugly. They don't correct astigmatism or catch glaucoma. They're inferior to what the eye-care industry can sell you. But they're superior to what most people in need of vision correction can buy, which is nothing. I'm a congenital critic of utilitarianism (the idea of promoting the greatest welfare of the greatest number of people) when it threatens humanity. But when it serves us -- all of us -- I'm a big fan.
If you like Silver's vision, here's his Web site. Take a good look.
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Remember that train crash near L.A. in September, where the engineer was texting while driving? Twenty-five dead, 130 injured. In three hours of work before the crash, the engineer received 28 text messages and sent 29 more. He sent his last message 22 seconds before impact, just after passing a signal that would have alerted him to the disaster ahead.
Now some of the victims have filed suit. They're alleging that the engineer's bosses were warned about his texting habit. Here's the New York Times summary:
The plaintiffs' lawyers said at a news conference that a co-worker of Mr. Sanchez [the engineer] had told managers ... that Mr. Sanchez frequently used his cellphone while on duty, in defiance of company policy. ... The employee placed at least two calls to managers from July to September, [the plaintiffs' attorney] said. In addition, he said, the employee told him that on a routine inspection two months before the crash, a supervisor caught Mr. Sanchez violating the policy barring engineers' use of cellphones while on duty. Still, he said, the engineer was never punished.
Remember, these are just allegations. They'll have to be tested at trial, if it comes to that. But if they're borne out, let's not make the same mistake Sanchez's superiors allegedly made. Let's take driving while texting—or while phoning—as seriously as we take driving while drunk. After all, as this column mentioned three months ago, research shows that even with a hands-free device, talking on a phone can impair driving skills more than intoxication does.
Alcohol has been around for millennia. Cell phones have not. We evolved to function in the natural world, one setting at a time. Nature has never tested a species's ability to function in two worlds at once. We're now taking that test, and we're flunking it. So here's a message to the 45 states that let people drive while holding a phone, and to the 50 states that let allow driving while talking on a hands-free phone: Sober up.
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Are mental disorders as important as physical injuries? Many advocates say that they are and that we should treat them accordingly. Most of the fight is over insurance coverage of mental health. But part of the action is in the U.S. military. There, the question has been whether to award the Purple Heart for post-traumatic stress disorder. This week, the Defense Department announced its decision: No.
Eight months ago, when we first checked in on this debate, I was skeptical for two reasons. One was that PTSD would turn out to be widely overdiagnosed. In general, mental wounds are harder to define and identify than physical wounds are. There are obvious cases, but there are also fuzzy ones. Where do we draw the line? How do we keep the Purple Heart from being cheapened?
The second reason was that the Purple Heart, unlike basic health insurance, isn't a policy instrument. It's an honor. Officially, it denotes "meritorious action." And honor isn't the first step in a cultural transformation, no matter how worthy that transformation may be. It's the last.
I've been reading DoD's explanation of its decision and looking back at what I wrote eight months ago. And I'm beginning to think the decision may be wrong.
The reason has to do with gay marriage. The "honor" argument against the Purple Heart for PTSD is a lot like the argument against same-sex marriage. Marriage isn't a right or benefit, conservatives argue. It's a special commitment, a moral institution. Gays may deserve equal employment opportunity, just as mental-health patients deserve basic health insurance coverage. But marriage, like the Purple Heart, is a higher standard. It's an honor that should be awarded last, or maybe never.
Andrew Sullivan nailed this argument 20 years ago: Conservatives are largely right about what marriage is. They're just wrong that this understanding precludes extending it to homosexuals. In fact, they have it backward: Marriage would anchor gays, like straights, against "the chaos of sex and relationships to which we are all prone. It provides a mechanism for emotional stability, economic security, and the healthy rearing of the next generation." The key is to preserve the definition of marriage as commitment: to let go of the heterosexual requirement while fortifying the distinction between marriage and shacking up. My favorite proposal, to prove the point, is same-sex covenant marriage.
Something like that should be the solution to the Purple Heart debate. Opponents of the Purple Heart for PTSD say mental disorders can't qualify because the warrior doesn't "shed blood." That's foolish fundamentalism: Lots of people are wounded without literally shedding blood. DoD also says the wound must be "intentionally caused by the enemy." But the Purple Heart is already awarded for wounds that weren't precisely intended by the enemy. The enemy just throws his grenade at your platoon. Exactly which of you gets incapacitated and how—shrapnel, shock, whatever—isn't his concern.
On the other hand, DoD rightly points out that there have to be "objective" medical ways to distinguish clear-cut PTSD from fuzzy or fake versions. Otherwise, Purple Heart awards will become cheap or arbitrary. Along these lines, the department articulates three clear, reasonable, and tight criteria. First, the wound must be "the result of enemy action where the intended effect of a specific enemy action is to kill or injure the servicemember." Second, it must be "an injury to any part of the body." Third, it must be "caused by the enemy from an outside force or agent."
Can PTSD satisfy these criteria? In principle, I think so. The first criterion is relatively easy to address: You must face the same physical risks as any other Purple Heart recipient. The second is more difficult: Objective physical measures of PTSD must be established. This could be done, for example, with brain scans. We aren't there yet, so consider this a research project for the PTSD movement. The third criterion is a nexus of the first two: You would have to assemble some kind of case file showing that the signs of PTSD in the brain scans or other physical measures postdate the combat incident.
Will service members and veterans with PTSD actually meet these standards? Some won't, and even the most qualified cases will be hard to prove. But they should be, because the Purple Heart is sacred. It's just that there's nothing inherently more sacred about being wounded in your backside than in your brain.
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How carelessly is Israel killing civilians in Gaza? Let's ask the hospitals and the United Nations.
In Dense Gaza, Civilians Suffer
Among the total dead—between 320 and 390, according to the United Nations—Palestinian medical officials say that 38 were children and 25 were women. The United Nations agency that helps Palestinian refugees said 25 percent of those killed had been civilians. (New York Times, Dec. 31, paragraph 6)
Sounds bad. Or how about this:
Israel Deepens Gaza Incursion as Toll Mounts
Palestinian medical officials estimated that the death toll during the war reached 550 on Monday. The United Nations estimated that about a quarter of those killed were civilians. (Times, Jan. 5, paragraph 8)
It's amazing how high the ratio of civilian to combat injuries can be. For example:
Gaza Hospital Fills Up, Mainly With Civilians
In recent days, most of those arriving at Shifa appeared to be civilians. On Sunday, there was no trace here of the dozens of Hamas fighters that the Israeli military said its ground forces had hit in the past few hours in exchanges of fire. The exact reason was not clear. Many ambulance drivers refused to go near the fighting. It also seemed possible that Hamas and Israeli fighters were still battling at some less lethal distance. It was difficult to know whether fighters were spread out at other hospitals. (Times, Jan. 4, paragraph 16)
And now, today:
U.N. Suspends Food Aid Into Gaza
The United Nations suspended its food aid deliveries into Gaza on Thursday after one of its contract drivers was killed during an Israeli attack ... (Times, Jan. 8, paragraph 1)
Those nasty, reckless Israelis. All they seem to hit is one civilian or rescue worker after another. In fact, you have to read all the way down to the very bottom of today's 30-paragraph story to find this:
But Palestinian residents and Israeli officials say that Hamas is tending its own wounded in separate medical centers, not in public hospitals, and that it is difficult to know the number of dead Hamas fighters, many of whom were not wearing uniforms.
Oops! No wonder the Times couldn't find those Hamas fighters at Shifa. The fighters aren't at the hospitals. So we don't really know how many of them have been wounded—or killed, since they aren't in uniform, even if we had access to all the bodies. So we don't know what percentage of the dead or wounded are civilians. All we know is that the percentage is lower than you'd guess from counting patients at the hospitals.
Every life is precious. The bloodshed in Gaza is awful, and I hope it ends today. But the ratio of civilian to combat injuries and casualties being reported out of the war zone is inflated, and we simply don't know by how much. It makes one side look more careless than it actually is. And the other side, by concealing its dead and wounded, is controlling the inflation.
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Can you get paid for donating an organ?
In practice, you can. All over the world, people are being paid for their kidneys. But what about the United States? Under U.S. law, can you demand compensation for such a gift?
Richard Batista of Long Island, N.Y., thinks he can. He's suing his ex-wife for $1.5 million, citing, among other things, the kidney he gave her eight years ago. He says she rewarded his life-saving generosity by having an affair, divorcing him, and keeping their children away from him.
Newsday implies the case will go nowhere:
Medical ethicists agreed that the case is a nonstarter. Arthur Caplan of the University of Pennsylvania's Center for Bioethics said the likelihood of Batista getting either his kidney or cash was "somewhere between impossible and completely impossible." Robert Veatch, a medical ethicist at Georgetown University's Kennedy Institute of Ethics, noted that "it's illegal for an organ to be exchanged for anything of value."
I'm not so sure. Batista can't take his kidney back, but that's not what he's after. He wants his ex-wife to let him visit their kids, on pain of compensating him for what he gave her. And what he gave her, according to his attorney, wasn't just an organ but a livelihood. According to Newsday, the attorney says the $1.5 million demand "reflects damages, including how much money she made as a result of being able to continue working and not having to go on dialysis." So the dollar figure isn't based on the price of an organ (which would be considerably cheaper, based on the going rate of kidneys abroad); it's based on the income one spouse accrued thanks to the other's sacrifice. And sacrifices between spouses are treated differently, under the law, from sacrifices between strangers or friends. There's a tradition and expectation of common benefit. You and your spouse become one flesh—in this case, literally.
I'm sure some of you clever lawyers can figure out how to position this claim as an extension of those divorce cases where the wife gets compensated for devoting herself to her husband's executive career. "It's not the organ itself we're asking you to value. It's the financial benefit the defendant gained thanks to the risk, the pain, and the extensive, invasive medical procedures this good man, this loving husband, endured. Yes, it was a gift of love—but no less a gift of love than the other sacrifices so many spouses make for each other's careers. Let it be acknowledged in the same way."
I'm tearing up already. Will it work? I wouldn't bet a kidney on it. But it's worth a try.
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What is it with the Catholic Church and female anatomy?
The total opposition to abortion I can understand. The men in Rome believe that personhood begins at conception.
The opposition to artificial contraception strikes me as completely wrongheaded but not necessarily a guy thing. They believe that sex must be open to life and that life must arise through sex.
The misunderstanding of morning-after pills in their latest instruction to Catholics? Well, that's a bit ignorant. But even the average woman isn't familiar with the research on LH surges, luteal dysfunction, and endometrial damage.
On all these issues, I'm willing to give the men in Rome the benefit of the doubt. But then I read this report from the Vatican newspaper, via Agence France Presse:
The contraceptive pill is polluting the environment and is in part responsible for male infertility, a report in the Vatican newspaper L'Osservatore Romano said Saturday. The pill "has for some years had devastating effects on the environment by releasing tonnes of hormones into nature" through female urine, said Pedro Jose Maria Simon Castellvi, president of the International Federation of Catholic Medical Associations. ... "We have sufficient evidence to state that a non-negligible cause of male infertility in the West is the environmental pollution caused by the pill," he said, without elaborating further.
That's right: The new cause of male infertility is female urine. Specifically, the urine of women who are committing the sin of contraception.
Scientifically, the theory looks a bit wet. AFP continues:
The article was promptly dismissed by several organisations. "Once metabolised, the hormones contained in oral contraceptives no longer have any of the characteristic effects of feminine hormones," said Gianbenedetto Melis, vice-president of a contraceptive research association, quoted by the ANSA news agency. The hormones contained in the pill such as oestrogen "are present everywhere ... in plastic, in disinfectants, in meat that we eat," added Flavia Franconi, of the Society of Italian Pharmacology.
Perhaps it's a sign of the modern age that moralists feel obliged to associate their principles with health effects. Abortion isn't just murder; it causes breast cancer and psychological damage to women. Contraception isn't just a violation of God's will; it's an environmental toxin. But none of these health claims has turned out to be valid. And in this case, the claim is so perfectly consistent with the history of misogyny—blaming men's fertility problems on women's sins and fluids—that it risks not just scientific but moral discredit.
On the other hand, if it turns out to be true, I'll be really pissed.
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For ages, we've been telling children that ghosts aren't real. But the Department of Defense has just put out a request for proposals to create what are, in effect, virtual ghosts. Another truism of parenting is about to become untrue.
More here.
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I'm just back from vacation and trying to catch up on the war in Gaza. More on that later. But first, something I didn't have a chance to get to before the break: the Vatican's latest pronouncement on fertility technology. Apparently the men in Rome are having trouble understanding some nuances of the female reproductive system.
The pronouncement comes in the form of Dignitas Personae, an instruction from the Congregation for the Doctrine of the Faith, which articulates official Catholic positions. This document covers several interesting topics, which I hope to get to in the days ahead. But the one that calls for rebuttal right away is the section on "[n]ew forms of interception and contragestation." It says:
Alongside methods of preventing pregnancy which are, properly speaking, contraceptive, that is, which prevent conception following from a sexual act, there are other technical means which act after fertilization, when the embryo is already constituted, either before or after implantation in the uterine wall. Such methods are interceptive if they interfere with the embryo before implantation and contragestative if they cause the elimination of the embryo once implanted.
This is an astute and useful set of distinctions. Unfortunately, the CDF immediately proceeds to violate them. Here's its next paragraph:
In order to promote wider use of interceptive methods [a footnote here specifies "morning-after pills"], it is sometimes stated that the way in which they function is not sufficiently understood. It is true that there is not always complete knowledge of the way that different pharmaceuticals operate, but scientific studies indicate that the effect of inhibiting implantation is certainly present, even if this does not mean that such interceptives cause an abortion every time they are used. ...
Really? Is the effect of inhibiting implantation "certainly present"? Let's review the mechanics of morning-after pills, specifically levonorgestrel, marketed as Plan B. The problem with the CDF's statement is that this "interceptive" is chemically identical to the best-known contraceptive: the pill. And the risk that this drug
will prevent implantation of an embryo is purely theoretical. There is no documented case of such a tragedy, since we have no way to verify conception inside a woman's body prior to implantation without causing the embryo's death. Even theoretically, the risk is vanishingly small, since the primary effect of oral contraception is to prevent ovulation, and the secondary effect is to prevent fertilization. To classify oral contraception as abortifacient, one would have to posit a scenario in which the drug fails to block ovulation, then fails to block fertilization, and yet somehow, having proved impotent at every other task, manages to prevent implantation.
So, the assertion of an anti-implantation effect is theoretically unsound. But what do the data show? Two years ago, the world's leading expert on levonorgestrel, James Trussell, co-authored an analysis of the available research in the Journal of the American Medical Association. The analysis confirmed that that anti-ovulation effects wipe out any data suggesting a possible anti-implantation effect. It concluded:
Published evidence clearly indicates that Plan B can interfere with sperm migration by altering the cervical and uterine environment, and that preovulatory use of Plan B usually suppresses the LH surge either completely or partially, which in turn either prevents ovulation or leads to the release of ova that are resistant to fertilization. Epidemiological evidence rules strongly against interruption of fallopian tube function by Plan B. Evidence that would support direct involvement of endometrial damage or luteal dysfunction in Plan B's contraceptive mechanism is either weak or lacking altogether. Both epidemiologic and clinical studies of Plan B's efficacy in relation to the timing of ovulation are inconsistent with the hypothesis that Plan B acts to prevent implantation.
In fact:
Progestational drugs, including levonorgestrel, are used therapeutically in assisted reproduction because they increase the rate of successful implantation and pregnancy. That observation a priori reduces the likelihood that Plan B interferes with implantation; it even raises the counterintuitive but undocumented possibility that Plan B used after ovulation might actually prevent the loss of at least some of the 40% of fertilized ova that ordinarily fail spontaneously to implant or to survive after implantation.
So, in summary:
[T]he ability of Plan B to interfere with implantation remains speculative, since virtually no evidence supports that mechanism and some evidence contradicts it. ... [T]he best available evidence indicates that Plan B's ability to prevent pregnancy can be fully accounted for by mechanisms that do not involve interference with postfertilization events.
So much for the question of effect. But what about the other part of the moral equation: intent? The Vatican document, still referring to morning-after pills, says that "anyone who seeks to prevent the implantation of an embryo which may possibly have been conceived and who therefore either requests or prescribes such a pharmaceutical, generally intends abortion."
But a woman who requests a morning-after pill doesn't necessarily seek to prevent an embryo's implantation. In fact, as we just showed, it would be irrational of her to seek that effect, since no evidence supports it. In fact, given the evidence, it would make just as much sense for her to request the pill in order to prevent embryonic loss. And anyone who has ever taken a morning-after pill knows that at that moment, your actual intent is to avert pregnancy at the earliest possible stage of the process, which happens to be ovulation.
Bottom line: The perceptive analytical framework established by Dignitas Personae, combined with the best scientific evidence and analysis, clearly implies that morning-after pills are contraceptives, not interceptives. Therefore, from the standpoint of respecting embryonic life, you may take them in good conscience.