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September 25, 2005

Take some risks

Jonathan Kozol says: stick your neck out!

What I tell these young people is, the world is not as dangerous as the older generation would like you to believe. Anyone I know who has ever taken a risk and lost a job has ended up getting a better one two years later. The ones I pity are the ones who never stick out their neck for something they believe, never know the taste of moral struggle, and never have the thrill of victory.

September 22, 2005

Should the third year of law school be abolished?

Daniel Solove and Laura Appleman are debating that question at legal affairs.

What if the USDA really is full of stooges?

Can the state of Montana impose testing requirements for mad cow disease that exceed those required by the USDA?

Montana Gov. Brian Schweitzer has said that regulators at the USDA are "a bunch of stooges" who have been bought by the big meat packing companies, and has criticized federal mad cow testing requirements as too lax.

The governor has ordered additional tests of Canadian cattle imported into Montana, which will be paid for by a $3- to $5-per head fee charged to the packing companies. Officials at the USDA say that these requirements may be an illegal burden on interstate commerce. Gov. Schweitzer claims that they are a necessary and permissible health and safety regulation.

May the state of Montana do this? Do these regulations unconstitutionally burden interstate commerce? Are they preempted by any federal statute?

I haven't looked too closely at the controlling precedent, but as far as I know the answer to the constitutional question may turn on whether the burdens on commerce imposed by the increased testing requirements outweigh the health and safety benefits for the citizens of Montana. Kessel v. Consolidated Freightways Corp., 450 U.S. 662 (1981). If so, statements like this might come back to bite the governor:

Critics have said Schweitzer is embracing a protectionist policy, but the governor said he was concerned about Canadian cattle imports driving down the price of Montana cattle.

“Bottom line, I’m trying to keep family ranchers in business,” he said.


I realize the political temptation to pander to in-state ranchers is almost overwhelming. In this case, though, Schweitzer ought to stick to his protecting-citizens-from-mad-cow-disease rhetoric. That's all the excuse he really needs.

September 20, 2005

For shame! (updated)

NEW YORK -- A doctor's group critical of drug companies is protesting its exclusion from the American Academy of Family Physicians' (AAFP) annual Scientific Assembly—a major event for pharma marketers.
Come on, is exclusion really necessary? Well, maybe it is if the event is less a "scientific assembly" than it is an opportunity for pharmaceutical firms to ply doctors with gifts rather than persuade them with scientific evidence. (Via Matthew Holt.)

EDIT: GruntDoc links to Dr. RW, who links to the No Free Lunch website. Apparently the AAFP has changed its mind. Good for them.

The best part of this story?

No Free Lunch has accepted the AAFP’s invitation and plans to be present at the session which opens September 28 at the Moscone Center. Attendees are encouraged to visit The No Free Lunch booth, #1613, immediately adjacent to that of the California Table Grape Commission.

Open dialogue about the pharmaceutical industry's influence on physicians may not be, but it's reassuring to know that table grapes are definitely "within the character and purpose of the Scientific Assembly."

Here's the AAFP's press release.

September 19, 2005

Liberals? Conservatives? Pah! I'll take the agrarians.

Wendell Berry has a new essay this month in Orion magazine; here's the abridged web version.

I'll be the first to agree that Berry can sound like an old curmudgeon sometimes. His writing is never as sexy as even the most pedestrian essays at, for example, Tech Central Station. But I'd ask you to give Berry some of your time and attention, and see if afterward you don't agree with me that he gets it basically right.* Many of his essays are on the web somewhere; here's one, and here's another.

If for some strange reason you don't agree with me, all the better. Then we'll have a lot to discuss.
_____

* And Tech Central Station? Yeah, they basically get it wrong.

September 18, 2005

A short Sunday blog post

Anthony Rickey is reading (or at least claims to be reading) Neil Gaiman's Anansi Boys ("trickster god chic"). I'm curious to hear what he thinks of it, and I hope he'll tell us about it on his blog when he's finished.

September 16, 2005

Medical student depression: what to do about it

This week I posted links to two interesting pieces about medical school:

1. Medical students tired, underworked? (a NYT article about sleep deprivation among medical students)

2. Medical students: tired, bored, and depressed? (a New England Journal piece about the high rate of depression among medical students)

Let's take the depression piece first. There have been some good comments on physicians' blogs about the reasons why medical students get depressed. Sydney at Medpundit acknowledges that medical school is a "completely transformative process" and a time of profound change, and then she blasts the brutality of the clinical teaching:

The third year of medical school, when students enter the hospitals and see patients, also marks the moment that their teaching is handed over entirely to practicing physicians - and they are brutal. The brightest and best students are treated as know-nothing scum and burdens to be born by the rest of the medical team. There is never, never, any praise - only denigration. At least, that's the way I remember it, with few exceptions.

I don't know how many years it's been since Sydney graduated from medical school, but her venom here reminds me of several conversations I had with alumni of my medical school. They were still viscerally angry at the way they were treated as medical students, even though they'd graduated ten years earlier.

This anger certainly isn't universal. Several commenters on Dr. Kevin Pho's blog seem to have had a much more pleasant experience:


Med school was the best four years of my life. The comraderie was great. I became more efficient and it seemed easier (perhaps because it was always interesting) than actually getting into medical school. I also met my wife, ran a marathon, and had a lot of good times while going 120K in the hole.

My own experience in medical school was a little bit of both. I ran three marathons, but my times got worse with each race. (I attribute that to the chronic sleep deprivation of med school...) Medical school was a happy time because I was learning so much and doing so many interesting things. You can't help but be thrilled when you've learned enough to take a thorough and efficient history from a patient in the ED, or when you can start to decipher an EKG, or (even better) when you've learned to juggle both tasks in a busy ED at three in the morning (my attraction to emergency medicine may be obvious here). On the other hand, I can remember being treated like a "know-nothing scum" on some of my rotations. That's not fun. I remember feeling isolated because I almost never got to rotate through a service with my friends, and just when I felt I was starting to get to know people on one rotation, it was time to move to a different one, sometimes at a different hospital, and once again I wouldn't know anyone at all. I hated the feeling that I was constantly being evaluated, and not just on my patient care and my knowledge, but on my "enthusiasm." Sometimes it all felt like I was never allowed to just be myself.

I don't know if any of these anecdotes are helpful for identifying systemic reforms. Much of how you experience medical school depends on your individual situation. If you're lucky enough to meet some good mentors, or an inspirational former cardiologist from El Salvador, or your future spouse, then you'll like it a lot more. Perhaps any systemic reforms ought to be aimed at ensuring that these things happen more often.

Here's some off-the-cuff suggestions:


  1. Give medical students more control over their schedules. There's plenty of studies out there showing that hopelessness is correlated with feeling unable to control what happens to you. Medical school curricula that don't allow any electives until the fourth year, rotations that give students no control over their call schedules, and attendings that don't give students any responsibility for deciding when to go home each day all contribute to the sense that you're not driving your own bus. Also, if you have more control over your schedule, the chances that you'll rotate with your friends will increase, so your sense of isolation will decrease. It's probably much more effective to give students more control than it is to limit their work hours or give them more time off.

  2. Adopt a zero-tolerance policy for unprofessional behavior by attendings and residents. It's unprofessional to belittle a medical student (or anyone else) at any time, but especially in front of the patient or the medical team. Attendings who routinely do this often claim that they're just providing constructive criticism, but it's funny how their constructive criticism of people with authority over them is never the same as their criticism of underlings. These attendings know what's right, but they just choose not to do what's right. Everyone's going to be grumpy or angry from time to time, but there are professional and unprofessional ways of expressing anger. Apologies are always free. If medical school deans and department chairs are proactive and lead by example, the instances of unprofessional conduct towards underlings will decrease dramatically. It's got to start from the top.

  3. Each service should explicitly define the role of the medical student as much as possible. Many of the problems described in the NYT article above come from not being clear about what the medical student's role is. Vague slogans like "the medical student's role is to learn as much as possible and to assist the team" aren't inaccurate; they're just insufficient. Is the student's primary job to learn as much as possible? Then he or she shouldn't be expected to get burritos for the team at 11 pm. Let them do it if they want, or if it's fair, but don't forget to ask why they aren't reading about the patient they just admitted instead. Or maybe the student's role is to assist the team -- like it often is on a busy ob/gyn service. Be explicit about that. "Hey, we're so busy that the best way to teach you and still care for our patients is to designate you as the all-around gofer. Expect it, keep your antennae out, and you'll learn a lot." Maybe the only role for the student is to observe, like perhaps on a third-year neurosurgery rotation. In that case, explicitly allow the student to go home when there aren't any more cases scheduled.

Medicine can be an infinitely rewarding profession. The intrinsic desirability of the career shouldn't be an excuse for medical schools to get lazy and to neglect the basic principles of effective education. Medical school deans ought to worry when they see such high rates of medical student depression, and they ought to think seriously whether there's anything they can do about it. Even if most depression turns out to be caused by the student's first exposure to sickness and death, for example, the medical schools could ameliorate this problem by admitting more students with clinical backgrounds like EMTs and nurses who've seen sick patients before.

Ultimately, we owe it to our patients to make sure that we're the best physicians we can be. Depressed physicians can't function as well over the long term as non-depressed physicians. If the medical schools did their part, and if the medical students did theirs (by taking care of themselves and seeking help when they need it), our patients would reap the benefits.

EDIT: You can read more anecdotes at over my med body.

September 15, 2005

Vioxx and the jury system

Evan Schaeffer has posted his defense of the jury's decision in the first Vioxx trial:

That was the promise of Vioxx, but it wasn’t to be. And now, as a result, a very small minority of commentators are calling for tort immunity for drug companies and discussing reforms to the jury system that would benefit drug companies. I think these ideas are radical and unnecessary. The tort system and the jury system may not be perfect, but they are certainly better than any of the alternatives, especially those involving granting favors to drug companies that might lead to even greater health risks.

Medical students: tired, bored, and depressed?

On the heels of the NYT article I linked to yesterday comes this article in the New England Journal of Medicine:

White Coat, Mood Indigo — Depression in Medical School
...
Medical students are more prone to depression than their nonmedical peers. Researchers recently surveyed first- and second-year medical students at the University of California, San Francisco (UCSF), and found that about one fourth were depressed. Others have suggested that although the rate of depression among students entering medical school is similar to that among other people of similar ages, the prevalence increases disproportionately over the course of medical school.
...
Students may become depressed at any point in medical school, but Gartrell has found that the period of greatest distress occurs during the third and fourth years, when students rotate through the hospitals and clinics. "In the clinical years, there's just far greater commitment of time, plus as match pressure begins to emerge, it's an extremely stressful time for a lot of people," she said. Students are often separated from friends and classmates and must work with a constantly changing set of residents and attending physicians, which contributes to their sense of isolation. Gartrell said that many of the female students she sees are worried that the mounting demands of training and clinical practice will not allow them time to find a partner, marry, and have children. Haynes noted that the increase in sleep deprivation during rotations may also expose mood disorders.

Again, I'll have to defer comments 'til later. Gotta run to Crim Pro now.

September 14, 2005

Joe Biden steps up. Who's next?

By now, everyone except Mark Steyn recognizes that the Bush administration has gotten us into a pickle in Iraq. Bush deserves the criticism he's getting, but the Democrats also deserve criticism for failing to propose any serious alternative strategies for dealing with the national security nightmare that Iraq could (or already has) become.

Proposals like these in the Washington Post from Sen. Joe Biden are exactly what we need to see more of from both Democrats and Republicans. Regardless of whether Biden's concrete proposals make sense or not, at least he's going beyond simple Bush-bashing by offering some substantive alternatives to Bush's simple-minded "stay the course."

Medical students tired, underworked?

The New York Times has this article about medical students:

While sleep deprivation and long workdays are deemed rites of passage for medical students, there is growing concern among medical educators that students may be spending excessive hours in hospitals doing work of little educational value, to the detriment of their education and health.

I'll have to hold my comments for later -- must read for class now.

September 13, 2005

Libertarianism

If you think that right-wing religious fundamentalism is the most absurd political viewpoint in America today, you're wrong. It may be the most dangerous, or the most repellent, but it certainly isn't the most absurd.

The most absurd political viewpoint in America is libertarianism. Libertarianism is absurd on at least two levels. First, it's absurdly popular for such an extremist political philosophy. (That libertarianism's attack on the entirety of what we call "government" is an extreme position should be obvious.) Most other extremist viewpoints cling to the fringes of respectable society, where their followers manage to maintain a few websites and keep a few mailing lists, but libertarianism is ensconced at the most well-funded think tanks in Washington, and is always threatening to capture the imaginations of this or that senator, governor, or President.

Second, libertarianism is intrinsically absurd. Not because it advocates for a minimalist state (this view has a lot to recommend it), but because it simultaneously argues that, with a minimalist state in place, we would experience an efflorescence of technological innovation, our economic productivity would skyrocket, and our current suburban ways of life would not only remain intact but would be enhanced with more disposable income and more consumer choice.

Folks, I've gotta say it flat out: that's ridiculous.

Even the most devout religious fundamentalists can't top the libertarians' starry-eyed faith in the unregulated "free market" (a mythological construct of the same order of magnitude as Zeus or Santa Claus) to function in the absence of (and even to replace) the web of laws, regulations, rules, taxes, and benefits that comprise the modern state. Ever since I was three years old, I've wanted to be able to fly like Superman, but unlike the libertarians' yearning for the completely "free" market, I've never spoken, argued, or acted on the faith that flying with the aid of a cape was really possible.

The war in Iraq and hurricane Katrina have inspired some writers to lay into libertarianism. I've linked to two exemplary essays below the fold.

Neither of these are completely coherent, but they both give libertarianism the sharp rebuke that it so richly deserves. Ironically, both pieces were published in Europe, not the United States. Jedediah Purdy explains to his German audience why the U.S. looked like a third-world country after Hurricane Katrina:

The pictures seem to confirm Europe’s worst suspicions about the United States. In the desperation and vulnerability they portray, they are images of a failed state, of a Third World concealed just beneath American wealth, and of an armed and violent people primed for guerrilla warfare against their neighbors.

That terrible impression is not the most illuminating. The basic failure is in American political culture’s tolerance of deep and crippling inequality. The more immediate failure is that the country is now governed by people who do not take seriously either the purposes or the tasks of government.
...
...A major strain of American political culture has never admitted that the state has a part in ordering society. This strain is a type of romantic libertarianism: those who hold it believe that private relationships and private virtues--the family, the marketplace, and churches and voluntary associations--are not just important to society, but sufficient to maintain it. They regard the state as a source of intrusion and inefficiency at best, tyranny at worst.
...
The basis of this libertarian indifference is denial that in a complex society, private security and private virtue ultimately depend on the state’s monopoly over violence. Private life, even at its most generous and imaginative and free, is conducted against the backdrop of state power: the power that enforces private contracts, distributes private property, and will jail or even kill the intruder who tries to force his way into a private home. Without that security, people become dangerous to one another--not because most people are predatory, but because some are, and in a world without law, paranoia and preemptive violence grow: man is not a wolf to man, but he can learn to be; the law and the state avert that lesson.
...
After the disaster of New Orleans--the natural disaster of Hurricane Katrina and the social disaster of the failed response--there is no more room for the illusion that the virtues of charity and voluntarism are enough to keep people safe and well. This is to confuse their goodness with their effectiveness. They are virtues precisely because they express recognition that people are vulnerable and fragile, that we need one another to stay safe and alive. But the point of government is very different: it is to make people less acutely fragile, vulnerable in fewer ways. There is no risk--rather, no hope--that we can ever overcome our vulnerability; but the scenes from New Orleans are reminders of why reducing it has been the great purpose of modern government. They are also grim reminders of how imperfectly the world’s richest and most powerful country has pursued that end.

Terry Eagleton's main targets are the neoconservatives who orchestrated the war in Iraq, but his analysis of why they failed so badly implicates the fantasy of "absolute freedom" -- expressed in foreign affairs by the neocons and in domestic matters by the libertarians:

...Absolute freedom eats itself up. Yet its violence, today as in Hegel’s time, continues to infiltrate the daily life of capitalist societies. Absolute freedom means negative freedom: a freedom from all restraint, which can see limits only as barriers to humanity, not as constitutive of it. The world is imperilled not by hard-nosed cynics who insist that nothing is possible, but by wide-eyed, ‘can-do’ idealists for whom anything is possible. Most of these are known as Americans. When the ancient Greeks encountered this kind of blasphemous overreaching, they called it ‘hubris’ and looked fearfully to the skies. And it is from the skies that it has had its tragic come-uppance.

Socialism is not about reaching for the stars, but reminding us of our frailty and mortality, and so of our need for one another. In contrast, absolute freedom regards the world as just so much pliable stuff to be manipulated in whatever way takes its fancy. This is why postmodernism, or some aspects of it, is one of its latest inheritors. For all its consumerist greed, this uncompromising freedom is a virulently anti-materialist force; for matter is what resists you, and absolute freedom is as impatient with such resistance as the US is with the resistance in Iraq. The world becomes just raw material to cuff into shape. Michael Jackson’s nose is its icon. It is only when such raw materials begin to include whole people and nations that it becomes a form of deadly terror.

Most of the time, this ravaging beast called absolute freedom is kept safely caged. It is hemmed in by laws, procedures, obligations, regulations, the rights of others. Yet the dream of being the only individual in the world (for this is what such freedom would finally involve) never quite fades, given the narcissism of the human species. From time to time, then, this madness, which lurks at the very core of conventional middle-class society, breaks out anew. It is like a lunatic who gives the slip to his keeper and goes on the rampage. This is how Burke saw the Jacobins, who ended up disappearing down the black hole of their own sublime negativity.


Michael Jackson's nose is the icon of American postmodernist absolute freedom. Heh.

Via political theory daily review.

September 12, 2005

Obama: Democrats share the blame

The Chicago Tribune reports on its interview with Sen. Barack Obama:

"It is way too simplistic just to say this administration doesn't care about black people," Obama said in a Tribune interview. "I think it is entirely accurate to say that this administration's policies don't take into account the plight of poor people in poor communities and this is a tragic reflection of that indifference, but I also have to say that it's an indifference that is not entirely partisan.

"We as Democrats have not been very interested in poverty or issues relating to the inner city as much as we should have.

I hope the current crop of "republican-lite" Democrats in Washington is paying attention.

September 10, 2005

A little scavenger hunt

Mark Schmitt at The Decembrist describes the pitifully inadequate resumes of the people Bush chose to lead FEMA, and wonders if we might find more examples of crass cronyism at other federal agencies:


This leads me to suggest an exercise, perfectly suited for the distributed talents of the blogosphere: Where's the next disaster? Are there other agencies where the top staff is so totally unqualified to the job at hand? Let's have some digging into those agency websites. Most probably won't offer the potential for human tragedy that FEMA holds, but let's start with places like the Occupational Safety and Health Administration (that director seems marginally qualified) that we know the administration doesn't care about. Foxes guarding the henhouse also qualify.

I would be surprised if we didn't find some other juicy examples out there. Surely Bush has a lot more campaign cronies than can he can stuff FEMA with. Where'd he put the rest? FDA? Treasury? As for foxes guarding the henhouse, my guess amounts to three letters: E. P. A.

Can anyone answer this question?

Heidi asks:

Where do I send the letter that gets these people investigated and thrown in the clink?

Go Blue

logo-mich.gif

Ok, so I do have a streak of disdain for college football in me. There's just something about enormous herds of fans all wearing the same clothes and drinking a lot of beer that turns me off.

(Why these same things don't seem repulsive in the context of a Colorado Avalanche game is still a mystery to me.)

Ordinarily I couldn't give two shakes about the Michigan football team. Win or lose, I don't care. But this week is slightly different. This week, the Wolverines are playing Notre Dame in the Big House.

I care about this game, but not because Notre Dame is a big Michigan rival. The rivalry between Michigan and Ohio State is even bigger, and I don't give a rat's ass about that -- two enormous midwestern Big Ten schools squaring off against each other on the football field is right up there with the Scott Peterson trial on my list of overhyped "events" that I'd rather ignore. No, the reason I care about the Notre Dame game is that I just can't stand Notre Dame.

When I was a kid, I remember that there were only a few football teams that were always on TV each week. The local teams like the Colorado Buffaloes and the Air Force Falcons were almost always televised, as was the nation's number-one team in the AP poll that week. All of that made sense to me, but I remember being a bit confused about why we in Colorado Springs would always get the Notre Dame game. I mean, they're a school in northern Indiana, for crying out loud. Why should they get national TV coverage when they were ranked number 17? I asked my parents about this, and they told me that maybe it was because so many people across the country identified with Notre Dame -- anyone with Irish ancestors, or anyone who was Catholic.

That's not fair, I thought. Why should the Irish and the Catholics get special treatment? Besides, what kind of a mascot was a "Fighting Irish" anyway? When I was eleven, it was obvious to me that that Notre Dame had one of the lamest mascots out there. Buffaloes were better, but so were Bears, so why couldn't we get the Baylor games or even the UC Berkeley games? I didn't know what a "Crimson Tide" was (still don't), but that sounded a hell of a lot better to me than "Fighting Irish." Ditto for "Huskies," "Seminoles," or even (gulp) "Cornhuskers."

Some childhood prejudices stay with you. I still think there's no good reason to give Notre Dame a national TV contract unless and until they finish the previous season ranked in the top five. I still think their mascot is lame. Especially compared with one of the fiercest mammals, pound-for-pound, in the entire world -- the wolverine. So this week, I'm rooting for Michigan's football team to kick the stuffing out of Notre Dame.

Go Blue!

September 09, 2005

Hiding from bandits, and from the cops

As the disaster of Hurricane Katrina recedes into the past, most of the vivid stories we've been hearing from the survivors will slowly be distilled in our minds into just a few parables. We'll forget the exact details of what may have happened, but we'll remember the lessons of the events. That's why it's so important to listen closely to all the stories now, before "Katrina" and "New Orleans" have solidified into a shorthand for simple maxims that may or may not be helpful.

For example, the lessons we'll draw from the violence of some of the refugees depends upon what we're hearing about that violence right now. Apparently, much of the national media have described a situation where most law-abiding victims of the flood were at constant risk from their fellow refugees who couldn't resist shooting, raping, and stealing as they waited for rescue. This may just be one side of the story.

A reader sends me this story from two visitors to New Orleans who were among the thousands of refugees stranded in the city after the flood. They endured far more threatening behavior from officials worried about looters and bandits than from actual looters and bandits.

Unfortunately, our sinking feeling
(along with the sinking city) was accurate. Just as dusk set in, a
sheriff showed up, jumped out of his patrol vehicle, aimed his gun at
our faces and screamed, "Get off the fucking freeway." A helicopter
arrived and used the wind from its blades to blow away our flimsy
structures. As we retreated, the sheriff loaded up his truck with our
food and water.

Once again, at gunpoint, we were
forced off the freeway. All the law enforcement agencies appeared
threatened when we congregated into groups of 20 or more. In every
congregation of "victims," they saw "mob" or "riot." We felt safety in
numbers. Our "we must stay together" attitude was impossible because
the agencies would force us into small atomized groups.

In the pandemonium of having our camp
raided and destroyed, we scattered once again. Reduced to a small group
of eight people, in the dark, we sought refuge in an abandoned school
bus, under the freeway on Clio Street. We were hiding from possible
criminal elements, but equally and definitely, we were hiding from the
police and sheriffs with their martial law, curfew and shoot-to-kill
policies.


I don't know what we'll learn from this disaster about the likelihood of poor black people to resort to criminal violence when a natural disaster cripples the local police force, but I hope we won't go jumping to any premature conclusions.

September 08, 2005

It's about time someone asked this question

When did "incentivize" become an acceptable synonym for "motivate"?

September 07, 2005

So this guy stops me on the street...

I'm walking to the grocery store today, and this guy who looked to be in his mid-20s approaches.

"Excuse me, but do you happen to know where there's a Baptist church around here?"

"Um, I'm not sure. I'm really no expert."

"What about just an area with a lot of churches? If I go this way [nods towards the south] are there any churches down there?"
"No, just a big lumberyard."
"Ok, well, thanks anyway."

Now if I were Neil Gaiman, I'd have rushed home and started writing a short story about how this guy was really an emissary from the Devil. He'd just gotten off at the Greyhound station in Ann Arbor, where he'd never been before, but he knew he was supposed to find this old Baptist preacher that his boss had had some run-in with years before in the bad part of Pittsburgh.

Instead, I came home and read this New Yorker article about Anthony Kennedy's predilections for citing foreign law. Obviously, I'm no Neil Gaiman.

September 06, 2005

We're all on ideological autopilot

With the exception of the near unanimous calls from both the left and the right for Michael Brown to be fired, the hurricane doesn't seem to have changed anyone's mind at all. Liberals view the disaster through their own ideological lenses and come to predictably liberal conclusions (see Exhibit A). Conservatives reach predictably conservative conclusions about the same disaster (exhibit B).

If Katrina has reminded us of anything, it's that ideologies are immune to worldly events. In fact, ideologies are powerful precisely because they allow us to respond to an almost limitless variety of outside events with just a few basic ideas. They save us from what would otherwise be an overwhelming need to think.

Don't get me wrong; I'm not disparaging ideologies. We'd be paralyzed without them. But don't expect disasters like Katrina, or the war in Iraq, to change anybody's mind.

September 05, 2005

Glorfindel's review of undergrad fashion trends

Here we are at the University of Michigan, where seemingly limitless numbers of undergraduates have recently returned to campus and are ready to embark upon another year of reading, writing, and binge drinking.

From this vantage point, we are well-placed to observe and comment on this year's fashion trends among the adults-under-25 set. We can see if the passage of time has led to any fresh innovations in the way young adults dress, and we can see which, if any, elements of last year's faddish clothing have followed the unfortunate trajectory of the mid 80s' hottest style: nylon parachute pants.

You may, for example, harbor some idle curiousity about the fate of the most universal rule for young women's fashion since the beginning of the George W. Bush administration. I'm referring, of course, to mandatory midriff exposure, the sine qua non of every hip American woman under the age of 45. Love handles? Let 'em see 'em, in all their stretch-marked glory. Belly-button piercings? They're not worth the $150 you spent if we can't see them in Sociology 305: Topics in Popular Culture. Only 13 years old? You exemplify the fast-paced American lifestyle; I wouldn't be surprised to see you driving a brand new Audi when you turn sixteen!

So let's look around the Michigan campus and try to see whether any time has passed (in the fashion sense) since last year. Let's walk up Hill Street on a Football Weekend, past the frat parties and the sorority houses spilling beer and drunk undergrads across their sidewalks. Let's have a latte in the Starbucks on South U. and watch the college students order one sugar-free raspberry non-fat decaf latte after the other, turning down the volumes on their iPods so they can hear the clerk announce when their drinks are ready.

Let's do all this with an eye for the exposed midriffs that were mandatory last school year. Are they still the hippest thing out there?

Sure seems like it.

How about Butt Shorts? Them, too. Still hip.

Velour pants? Yep.

Gotta love our commitment to innovation and our passionate embrace of individualism!

September 03, 2005

FDA rejects over-the-counter Plan B

By now everyone's heard that Susan Wood has resigned from the FDA in protest over the agency's decision to indefinitely delay the approval of the OTC emergency contraceptive known as Plan B (levonorgestrel, the "morning-after pill").

Ordinarily I wouldn't have given this much thought, since I try to avoid the abortion issue whenever I can. It was only because the forceful denunciation of the FDA's decision (pdf) in the New England Journal of Medicine was so fun to read that I'm posting about this now. Not since Terri Schiavo have we had such a good demonstration of the political power wielded by social conservatives, even when they're totally out to lunch on the substantive arguments of the issue.

The arguments supporting FDA approval of this emergency contraceptive drug for over the counter availability are solid. The scientists on the agency's advisory committee voted overwhelmingly in favor of it. There's been a lot of hand-waving by the FDA about safety in younger women, and about the agency's authority to approve a drug for both prescription and OTC use by people in different age groups. The major arguments against Plan B, however, come down to two. First, that Plan B causes abortion, and second, that unrestricted access to Plan B by people younger than 17 would harm them in some way.

The first argument is weak on several levels. Most studies that I can find suggest that levonorgestrel prevents pregnancy by interfering with ovulation, not by preventing the implantation of a fertilized ovum (see, e.g. Croxatto et. al., Contraception 70 (2004), pp. 442-50; general discussion here). But even if, as groups like Concerned Women for America point out, we don't know the exact mechanism of action, it's hard to sympathize with their stance on this issue. To block access to a safe method of preventing unwanted pregancies because the drug might occasionally prevent implantation of a fertilized egg demonstrates the absurdity of the extreme anti-abortion position. An unwanted pregnancy can be profoundly harmful to an adolescent girl, to say nothing of the potential harm to the child. That the strict anti-abortionists would prefer these harms over the harm to an occasional fertilized egg that's prevented from implanting in the uterus is patently absurd. This kind of policymaking deserves the label "extremist."

The second argument, that access to Plan B without a prescription would harm women under 17, is equally weak. Wendy Wright of Concerned Women for America argues that OTC availability would increase rates of sexually transmitted disease, but I don't know how much credibility she should be given after she says things like this:

What's more, experts have found that men will frequently buy it, and some slip it to unsuspecting women. An age restriction would not hinder men who would buy the drug and give it to underage girls.

It is naive to assume any over-the-counter scheme for the morning-after pill would be effective. A 17-year-old could buy it for a 13-year-old girl. Or worse yet, a pedophile could purchase this drug for his victims.

This wingnuttery sounds like what we'd expect from someone who was profoundly afraid of people under seventeen having sex, and/or who deeply misunderstands the connection between the availability of a drug and the likelihood of criminal behavior.

We should be concerned about underage people getting sexually transmitted diseases, and we should be concerned about pedophilia, but the connection between these things and Plan B is just too speculative. What's not speculative is that Plan B prevents unwanted pregnancy, and that unwanted pregnancy harms people, often in a very profound way.

The FDA can't do its job properly if it's being pushed and pulled by politicians who ought to be debating social policy in other arenas. If Congress doesn't want Plan B approved, they ought to legislate to that effect. Leaning on an agency that's charged with ensuring drug safety will only diminish the agency's credibility, and in the post-Vioxx era, it doesn't have a lot of excess credibility to play around with.

September 02, 2005

A Law School Post

citizenship papers

This semester I'm enrolled in a seminar called "Liberalism and its Critics." Well, guess what I found on the reading list for this course? Wendell Berry!

It's time to celebrate.

September 01, 2005

New Orleans: Inevitable?

The story of New Orleans is a long one, and it's full of bad decisions.

The original decision in the early 1700s to levee the river in order to build a "permanent" settlement on the floodplain is just about the worst. But once that bad decision was made, we could have done more to postpone the inevitable return of New Orleans to the sea. Perhaps we could have even postponed it long enough to organize an orderly evacuation of the whole city to higher ground. As it is, we didn't do our best. Hurricane Katrina took aim at the inadequate levees, and the people of New Orleans got only a day's notice to evacuate. The poor, sick, and elderly, who couldn't evacuate themselves quickly enough, paid the price.

When a city like New Orleans, built in a floodplain below sea level that's in the path of hurricanes, gets flooded under fifteen feet of water, its a little inapposite to go assigning responsibility for the disaster on this guy or that guy. Nature just kind of did its thing, and no mere human being can stand up and take the credit. Some newspaper editorial pages like the NYT have already started criticizing President Bush for the stuttering federal response to this catastrophe, but I think it's a bit premature. This is mostly a natural disaster for which Mother Nature is responsible (not a political or foreign-policy disaster like Iraq, for which Bush is responsible).

Nevertheless, although the flooding of New Orleans was inevitable, we ought to distinguish between several different kinds of inevitability. For example, it's inevitable that the Sun is eventually going to burn up all its fuel and slowly bloat into a red giant, engulfing the Earth. It's not likely that anyone will be able to do anything about that.

This disaster wasn't inevitable in the same way. People could have done much more to postpone the New Orleans flood, or to mitigate its effects. If we had acted differently, there'd be a lot fewer dead and displaced people -- mostly poor, sick, and elderly people that couldn't evacuate themselves -- along the Gulf Coast than there are now. This disaster was the result of human mistakes. It was inevitable simply because we can't ever expect humans not to make these mistakes. We aren't perfect and we never will be, but the point is that if we had acted just a little less imperfectly, New Orleans wouldn't be flooded right now.

Consider, for example, that we knew the marshy wetlands of the Mississippi River Delta were crucial for protecting the city from a storm surge, but we allowed them to be degraded and destroyed anyway. We also knew that the levees protecting New Orleans from floodwaters needed to be improved to protect against powerful hurricanes, yet we refused to spend the money to improve them. Senator Mary Landrieu of Lousiana sounds prophetic in this June 6, 2005 article on the budget cuts for the New Orleans district of the Army Corps of Engineers:

"I think it's extremely shortsighted, Landrieu said. When the Corps of Engineers' budget is cut, Louisiana bleeds. These projects are literally life-and-death projects to the people of south Louisiana and they are (of) vital economic interest to the entire nation."
Yes, the levee projects were literally life-and-death (mostly death) and everyone pumping gas at $3 or more a gallon recognizes their economic interest in the health of the Gulf Coast now. (Thanks to Swing State Project for the links.)

Regardless of whether the Congress, the President, or the local leadership in Louisiana is most to blame for postponing the construction of more adequate levees, the point is that someone, somewhere, screwed up. The fact that flooding was inevitable doesn't mean that sudden, catastrophic flooding that kills potentially more than a thousand people and leaves many more homeless was also inevitable.