November 2009 Archives
It's about time the medical profession began taking seriously the costs as well as the debatable benefits of annual mammograms for women over 40 (among other routine screening procedures). If the controversial new set of guidelines constitutes rationing, it may be one form of rationing that's overdue; the challenge is for women who consider "clean" mammograms clean bills of health to recognize that their value is limited, partly by the ability of doctors to interpret them. I've been a little lax about obeying the annual mammogram mandate for some years, since reluctantly submitting to a biopsy because of an anomaly in a hard to read film. "It doesn't look evil," an oncologist assured me, and nothing that looked evil was revealed subsequently by two ultra sounds and an MRI. Against my instincts (and the judgment of one radiologist who advised a series of follow-up mammograms), I was eventually persuaded to undergo a needle biopsy -- an unpleasant procedure that entailed an overnight hospital stay (of which I have no memory, thanks to some wonderful drugs). "In Europe, they wouldn't operate; their protocols are different," the surgeon acknowledged, when I discussed my doubts about our protocols with him.
This sorry experience was, however, an education in medical decision making: the clinicians advising me (a radiologist, oncologist, and internist) were compassionate, generous with their time, focused on my welfare, and honest about what they didn't know. But an additional radiologist consulted for a second opinion insisted that he could enable a meaningful biopsy, and his insistence inevitably drove the process. My strong belief that he was mainly invested in proving an ability to locate cancers that others couldn't, was no match for the advice of other cautious, trustworthy doctors disinclined to dismiss the claims of a respected radiologist. But they weren't patients, exposed to the boundless egoism exhibited by him and his hospital superior: "Let's hope we're right," the department head said, taking my hand and feigning concern, after I agreed to the biopsy. "Let's hope you're wrong and I don't have cancer," I replied.
The biopsy was negative, but it didn't mean that I didn't have cancer: it meant that tissue extracted in what may have been a meaningless operation was benign -- which is not to say I wasn't relieved. But along with relief, I gained an understanding that yearly screenings and even biopsies can offer no guarantees of being cancer-free. So I wonder how many women will welcome the new recommendations for fewer mammograms, perhaps greeting them with a silent "I told you so," and how many will continue the yearly screening regimen, with its false positives and, perhaps, even falser sense of security.
(Photo: Scott Meis Photography/Flickr)
By questioning the presumed virtues of independent voters as a group, I was not suggesting that individual voters have paramount civic obligations to identify with either major party. Independents share Democratic perspectives on some issues and Republican perspectives on others (according to Pew,) so I'm not denigrating them for eschewing party membership. There are also logistic reasons not to enroll in a party: I'm officially un-enrolled partly in the hope of cutting down on junk mail and partly in response to the Massachusetts primary system. But individual voters do have obvious civic obligations to remain politically informed and engaged as well as principled -- not whimsical or simply self-interested - when they enter the voting booth. Of course, self-interest is a powerful motivator for partisan as well as non-partisan voters, which is why presidents like to hand out tokens of their affection, like $300 tax rebates or $250 in recovery assistance to social security beneficiaries (regardless of actual need). But the less voters know, the less attention they pay to politics and policy and the less they trust the basic processes of democracy (elections,) the more likely they seem to be guided by self-interests unmitigated by information and ideals. And, (again, according to Pew) "independents score far lower than either Democrats or Republicans" on "an index of political interest and engagement." They are also "consistently skeptical about the electoral process."
You can take pride in this skepticism, considering it a sign of sophistication (and when skepticism means a disinclination to believe what you want to believe, regardless of evidence, I applaud it). But you might also ask yourself why, if skepticism is on the increase, so is misinformation: facts have rarely seemed to matter less. You might regard skepticism about representative democracy with some wariness: As I suggested earlier, it can devolve into cynicism, crude situational ethics, and a tolerance for self-interested lies, none of which signals sophistication so much as surrender.
You can take pride in this skepticism, considering it a sign of sophistication (and when skepticism means a disinclination to believe what you want to believe, regardless of evidence, I applaud it). But you might also ask yourself why, if skepticism is on the increase, so is misinformation: facts have rarely seemed to matter less. You might regard skepticism about representative democracy with some wariness: As I suggested earlier, it can devolve into cynicism, crude situational ethics, and a tolerance for self-interested lies, none of which signals sophistication so much as surrender.
(Photo: Logan Mock Bunting/Getty Images)
"Partisanship and ideology" are the enemies of "true representation in Washington," according to Lou Dobbs, who apparently sees himself as the last objective man standing. David Brooks laments that independents (increasing in number) are underrepresented politically and in the media, which offers relatively few commentators who "come from an independent perspective" (he doesn't cite Dobbs as one of them). Media outlets addressing liberals or conservatives simply "deliver streams of prejudice-affirming stories," Brooks notes, implying that independents are the last objective people standing.
A calm, rightward leaning centrist like David Brooks has relatively little in common with the demagogic, birther sympathizing Lou Dobbs, but they do share a popular tendency to romanticize independents. Celebrating his own imagined independence from ideology, Dobbs promises that his next act will entail "constructive problem solving," characterized by the "rigorous empirical thought and forthright analysis" that partisanship has allegedly banished from the public square. What do independents want from such eminently reasonable policymaking? According to Brooks they want "a frame of stability and order, within which they can lead their lives," as if people infected by ideologies (in other words, ideals) crave chaos.
But if independents value systematic order and stability, they have an odd way of forging it: their behavior contributes to disorder and instability. Independents are, predictably, the most labile of voters (with no apparent irony, Brooks describes them as "astonishingly volatile"). Unmoored by party allegiances, "their political thinking is likely to be chaotic," political scientist Nancy Rosenblum observes.
In a persuasive defense of partisanship that debunks the "faux luster" of independents:
"Research reveals that they are the least interested in politics, the most politically ignorant, the lightest voters. Independent voters know less about politics and policy, appointments and their consequences... (they) are detached and weightless...Independents neither assume responsibility for the institutions that organize elections and government nor do they owe allegiance, or even justification, to other like-minded citizens."
So while it may be tempting to celebrate independents as pragmatic centrists, at a time when parties are associated with extremism, it's worth remembering that political pragmatism, un-guided by political ideology, is a dubious virtue, as Rosenblum suggests. Independents "score far lower than either Democrats or Republicans" on an "index of political interest and engagement," according to the Pew Research Center. They are "consistently skeptical of the electoral process and the responsiveness of officials."
Skepticism can inform voters, of course, and arm them against political hucksters; but it can also devolve into cynicism, and cynicism enables gullibility. Hannah Arendt argued when people are "ready to believe the worst" and also believe that "every statement is a lie anyway ... one could make (them) believe the most fantastic statements one day, and trust that if the next day they were given irrefutable proof of their falsehood, they would take refuge in cynicism."
I'm not suggesting that independent voters resemble the political mobs that Arendt analyzed. I am hypothesizing that what we celebrate as the virtues of independents are not so far removed from the vices attendant upon disengagement, discontent, and a view of electoral politics as a self-serving game. Independents who mistrust the political process and unprincipled partisans who exploit it may have more in common than they know.
"The principle that women should not intentionally and routinely engage in combat is fundamental, and enjoys wide support among our people," the U.S. Senate declared in 1980. In 1981, in Rostker v Goldberg, the Supreme Court relied on prohibitions of women in combat when it declined to strike down provisions of the Military Selective Service Act authorizing the mandatory registration of men, and not women. "The fact that Congress and the Executive have decided that women should not serve in combat fully justifies Congress in not authorizing their registration, since the purpose of registration is to develop a pool of potential combat troops," the Court reasoned. The plaintiffs in Rostker had not challenged the ban on women in combat: The case had been initiated in 1971, when women were generally considered unfit for combat, or service as firefighters and police officers; the ERA, approved by Congress in 1972, would fall prey, in part, to concerns about a gender neutral draft and combat rules. Conventional wisdom held (as one general noted in his congressional testimony,) that "women should not be placed in a forward fighting position.
Tell that to police officer Kimberly Munley, recovering from gunshot wounds received when she confronted alleged Fort Hood shooter, Nidal Malik Hasan. Tell it to the women effectively engaged in combat in Iraq and Afghanistan. Tell it to 53% of people who professed support for sending women into combat in a New York Times/CBS poll. Most of all, tell it to Congress, which has yet to repeal, or seriously considering repealing, the legal exclusion of women from combat. Sometimes the law is a sword for social change, and sometimes it shields the status quo. Sometimes it's a battering ram and sometimes it's the wall.
(Photo: The U.S. Army/Flickr)
Hannah Arendt characterized the "right to marry whoever one wishes" as elementary, locating it among the "inalienable human rights to 'life, liberty and pursuit of happiness proclaimed in the Declaration of Independence.'" She was concerned with miscegenation laws, which in her view "constitut(ed) a much more flagrant breach of the letter and spirit of the Constitution than segregation of schools." She even considered political rights, including the right to vote, "secondary" to "the right to home and marriage."This defense of marriage rights appears in "Reflections on Little Rock," Arendt's controversial critique of federal efforts to desegregate public schools, written over 50 years ago. She was wrong to oppose forcible school desegregation, but she was wrong for good reasons that remain relevant today, to battles over speech and association, as well as gay marriage (which, as Andrew Sullivan observes, seems destined to be legalized, eventually).
Arendt's opposition to federal enforcement of equal education rights was partly pragmatic, partly a reflection of her strong distaste for thrusting children into the front lines of a vicious, often violent political battle, and partly a demand to limit government intervention in private life and liberties (which also underlay her regard for marriage rights). Arendt was sympathetic to the private associational rights of parents who wished to control their children's education. In this instance, her defense of associational rights was inapt: if mandatory desegregation violated the rights of white parents to send their children to all-white schools, mandatory segregation had long trampled the analogous rights of African-American parents; in any case, laws governing public education ought not be written by private biases.
But while Arendt was wrong to place public schools outside the public realm, while she was insufficiently attentive to the relationship between educational and political equality, she was quite right to defend the freedom to discriminate in private and social realms. "[D]iscrimination is as indispensable a social right as equality is a political right," she stressed. "What equality is to the body politic - its innermost principle - discrimination is to society...without discrimination of some sort, society would simply cease to exist and very important possibilities of free association and group formation would disappear."
Today, those "very important possibilities" are indeed in danger of disappearing, thanks, in large part, to illiberal attacks by liberals on the private right to discriminate. Prohibitions on allegedly offensive or abusive speech and exclusionary private associations are common on college campuses (as I repeatedly lament), where generations of students are being taught that verbal insults are actionable virtual assaults, where an imagined right not to be insulted often trumps rights the fundamental right to speak, and where private associations are expected to comply with public rules prohibiting discriminatory membership requirements.
If campus crusades against speech and associational freedom eventually flourish off-campus, as today's students age into tomorrow's bureaucrats, the U.S. could eventually resemble Britain, where official illiberalism is rampant. The far right British National Party, for example, is being forced by the government to revise its constitution and membership criteria that discriminate on the basis of race, sex or religion. Membership is message, which means that the message of the BNP--and other groups--may be subject to government approval. Meanwhile, the repressive campaign to eradicate racism--not simply from education or employment but from everyone's hearts and minds--has resulted in reports of 40,000 incidents of racism a year involving children, according to a recent story in the Daily Telegraph (relying on an account by a local civil liberties group). "Primary schoolchildren and toddlers in nurseries are being punished for making racist insults...even if they do not understand the terms they use...At the same time, diversity 'missionaries' sent into schools to teach pupils about bigotry are said to be increasing the divide between white and black children by forcing them to see everything in terms of race."
Diversity zealots like this eviscerate everyday freedoms without advancing equality. It may seem counter-intuitive, but the fight for equal marriage requires a commitment to preserving the fundamental rights of bigots--racists, sexists, and homophobes--to think and express discriminatory thoughts and to act on them in private and social life. "Social standards are not legal standards," Hannah Arendt pointed out, "and if legislature follows social prejudice, society has become tyrannical."
This was an argument against mandating equality in private life (when social mores demand it) and prohibiting it in public (when social mores condemn it). "The moment social discrimination is legally abolished the freedom of society is violated...The moment social discrimination is legally enforced it becomes persecution...." The day that opponents of equal marriage are required to attend gay weddings or socialize with gay couples or prohibited from expressing disdain for them will be the day they suffer the sort of persecution now visited upon gay people denied the right to marry.
(Photo: ProComKelly/Flickr)
Can someone explain to me why it is a criminal offense to have sex with animals but entirely legal to kill and eat them? Surely laws against bestiality don't reflect concern about the rights of animals, (who would probably opt for sex over death.) I don't mean to denigrate meat eating (I'm a carnivore;) I do mean to point out the absurdities of imprisoning people for "buggery."
