Tuesday, December 30, 2008

Prescription For A Healthy Democracy

I have been mulling this for awhile now. Anyway I look at it, a democratic nation cannot sustain its central ideals of equality and citizen participation without every person in the land having access to affordable health care. Let me elaborate. It is not that the democratic principles and ideals are less important than health care- though one might argue that indeed life and limb are more important than the idea of free speech and equal rights. But that is a false dichotomy in that while health care is important to physical existence, democracy (when it works) meets a higher need to self-determine. Both are essential to the human condition in their own complementary ways.

The idea of democracy sets a vision of self-governance, fairness and justice that nations, which believe in dignity and rights for all, aspire to. A nation that pursues this democratic ideal, however, needs other accouterments to ensure that not only do all people within its boundaries have dignity and rights but that other factors, such as poverty, ill-health and illiteracy, do not keep them from participating in the democratic process. If a nation has fabulous health technology but only a certain proportion of the people residing within its borders can avail themselves of it without going into debt or otherwise bearing financial hardship, then what good is the existence of the most sophisticated democratic apparatus or even health apparatus? Most of those who cannot afford health care will either die early or be poorer and unhealthier and thus, less likely to exercise their right to vote. How do I know this? I know that when I am suffering from something as innocuous as a bad headache, I am not prone to thinking intellectually about the things that I could be doing. I only do those that I absolutely must do to keep going or rely on family for help. Most of us humans are like that. When we feel a threat to our health or that of our kin, we do go into something of a survival mode.

My point is that without universal health care, over time a nation skews its democratic process to favor those who can maintain better health. If in that nation health care is expensive and employment related, then these are generally the employed and the wealthy. So even though Lady Liberty might welcome the "tired, poor, homeless and the tempest-tost," she cannot guarantee them the basic right to good health which will ensure that they are as able as anyone else to participate in the democratic process throughout their lives which are no shorter or unhealthier than anyone elses.

Check out this powerful poster I found on the web. Makes the point nicely.

Addendum 31 Dec., 2009 - Lest people think this blog is only about the US, let me clarify that this applies also to other democratic experiments such as in India. There, while all citizens are supposed to have free public health provisions, one has but to look at the state of public-funded clinics and hospitals to know that corruption has way-laid the resources. The Indian democratic experiment while vibrant in some ways, weighs oppressively on the poor who do suffer from ill-health and early demise. All democratic nations NEED to provide universal health coverage for all people (not just in name either) in order to be a fully-functioning and true democracy.

Thursday, August 21, 2008

Animal Rights Organizations

While growing up (in India) I was part of a family that included dogs. However, I have never had a pet here in the States till recently. I always wanted one but I also always had excuses for why I couldn't have one right then. At last, recently, we were selected by a little cat at the Humane Society Shelter and we brought home Neobe. It has been a revelation in many ways. Not least of which has been an introduction to the health care system and issues facing non-humans in the United States.

I have always believed in and supported organizations that fight for animal rights such as PETA, HSUS, ASPCA and WWF. I thought that by supporting organizations like these, I was helping to make the life of pets and other animals better. I just never realized how they worked. While most of these organizations lobby for and advocate better treatment of animals, this doesn't translate into better care for the household pet in most cases. A recent example is that of the HSUS rescuing many dogs from a puppy mill in Tennessee. The HSUS is doing its best to provide all the animals care and to try and place them in homes and it has shut down the puppy mill. However, if you walk into any HSUS shelter across the nation, you will realize that they are mostly "kill" shelters. This means that animals that don't get adopted are euthanized within a set period of time. Contrast this with many local no-kill shelters that don't receive the kind of money and support and even recognition that the HSUS might receive but that still manage to care for all animals received. Two of these in the Denver area are the MaxFund and the Animal Rescue and Adoption Society. Another wonderful example is D.E.L.T.A. run by Leo Grillo out in California.

Here's another strange fact. Despite the proliferation of all these wonderful high-profile, animal-rights organizations, the United States continues to suffer from overcrowded shelters. I did not see a problem on this scale in other developed nations. Despite all these years of advocacy for pet sterilization, shelters swim in puppies and kittens come a certain time of year. And it is very much a hidden problem unlike the developing world where strays end up on streets to live miserable and brutishly short lives. Here we like to keep them out of sight and mind- in shelters where they can live cramped, anxious and short lives generally.

Despite the presence of this many wonderful animal-rights organizations, the United States also suffers the ignominy of being perhaps the only developed nation where you can take your cat to your vet and have her/him declawed. This is a practice labeled unethical and inhumane in most developed nations. Why aren't we fighting harder to prevent something known to be cruel every where else? How did the other nations ensure that this doesn't happen to innocent cats?

Another revelation is that you cannot find charitable veterinary organizations in communities. Veterinary offices charge a lot of money every time you visit their offices. This ensures that the poor and those with financial challenges (such as students, the unemployed, the elderly) are unable to afford pets or if they are still determined to have pets, then they are generally unable to provide the pets with good health care from a veterinarian without digging themselves deeper into the hole. This also means that if you find an animal in distress, you may hesitate to pick it up and walk into a vet's clinic if you know that every visit will cost you about $50 not including the medications or any treatment.

The cost might also explain why many people won't get sick pets treated. What, you are surprised that there are sick and untreated pets in many households? You can read about sick and untreated pets in most animal care organization reports and veterinary reports (Case in point: It is recognized that owners will often ignore and not treat cat illnesses, and so research into cat illnesses and treatments for them lags behind that for dogs).

Normal household pets need advocates too. Just because a pet is adopted doesn't mean our societal responsibility to it is at an end. This is nowhere more obvious than in this time of foreclosures in the United States when so many former pets are now abandoned or surrendered to shelters with no guarantees to life.

I had thought that the animal care situation in this country would look rosier after so many years of active work by so many wonderfully committed organizations. Yes, let's fight against veal crating and battery farming and puppy mills and seal clubbing and KFC. But let's also educate and make shelters a place of warmth and life and change our philosophies towards pets and their care. Let's not make having pets a luxury only few can afford. I still support these organizations but now I am also finding myself appreciating local and no-kill shelters that try to better the quality of life of so many domesticated and feral animals.

Click on the photos of kittens and puppy to see where they were found. The cat sleeping is Neobe. :)

Friday, August 15, 2008

Woeful Waste

For years now when I print a document I stand by the printer with paper in my hand and feed it in one sheet at a time. When the printer spits out a page, I flip it and re-insert it in order to make double sided documents. I was puzzled that American photocopiers had the ability to turn documents of all kinds into double-sided copies but American printers somehow never developed the technology to make double-sided prints.

I will happily admit that this is as much an indictment of my gullibility as of the manufacturers of printers in America who like to keep consumers in the dark. I was disabused of the seeming backwardness of printer technology when I got the opportunity to work at a university in the U.K. where all printers were capable of printing double-sided documents with no extra trouble. You just made the appropriate selection on the print set-up screen on your computer. It seems that the regulations for recycling etc., being more stringent across the pond, the very same manufacturers were indeed able to surmount this problem of printers that could print on both sides of a sheet of paper.

Even today, I am unable to find double-sided printing as a feature on common household American printers. If you search you can find some 'special' printers marketed for having this 'fabulous' money and paper saving feature!! Paying extra for such printers is something a few corporate companies may do. But most small businesses as well as academia and those of us regular folks at home often get by with the state-of-the-art for home printers which hasn't changed for the last decade or more. So folks like me have to stand by the printer and feed it one page at a time and take about 10 times as long to print a document as a double-sided printer would take.

Here's a guy, who missing his corporate double-sided printer figured out another way to overcome his lack of double sided printing. Again, you will note the convoluted steps one has to go through to do something that is good for all of us- i.e., use less paper and save some trees. What is it about being located in the world's number one economy and a place where a lot of new research and technology is developed that we can't get manufacturers to take us seriously as consumers? What would it take to get broad access to something as simple as a cheap double-sided printer?

Tuesday, August 12, 2008

Progress Report On The Dongria Kondh Story

In a tragic fait accompli, the Indian Supreme Court has approved mining by Vedanta and Posco (a South Korean company) in the hills of Niyamgiri in Orissa. There were many strenuous campaigns against mining in this eco-system by the indigenous dwellers of Niyamgiri, forestry officials and farmers to name a few. The Norwegian government went so far as to divest itself of Vedanta stock in order not to be tainted by a project that has and would continue to adversely affect human rights and the environment. (You may read the whole story in a previous blog I wrote.)

The Supreme Court has mandated that a certain sum be spent on tribal development and welfare. But this sum is a pittance and not something desired by the tribals. And leaving the welfare of Indian citizens in the hands of some multi-national seems a very shoddy road-plan for human rights and economic development.

The rush to development claims new victims. The gap between those who are benefiting from the economic development and those who are not continues to grow. India continues to feel the pressure to be counted as one of the two emerging economic giants even as China has left it far behind in developing infrastructure and education. Indian corruption continues to siphon off funds directed towards the poorest and the most disadvantaged. Indian politicians need to consider new ways of achieving goals as the old ones never worked. We need to be smart and develop in such a way that we don't spend decades recovering from the damage done by the rush to develop. And we certainly shouldn't victimize the citizens of India in order to meet development goals. Otherwise, how can we claim the democratic high ground?

Wednesday, August 06, 2008

The Celebrity Circus

We had been lulled into complacency in a post-Hilton world. No longer did we have to have inane heiress famous for being famous thrust at us instead of world news and events. The serious business of the U.S. choosing its next president was beginning to heat up. And then Mr. McCain had to go and bring back Inanity to primetime. Grrroan. What was he thinking? Who is advising the septuagenarian? In an ad aimed at making people think of Obama's "celebrity" status, he uses footage of Britney Spears and Paris Hilton. Ms. Hilton, never one to miss an opportunity for self-promotion, has now made a faux campaign ad thanking McCain for his endorsement. One has to admit though, that the ad is funny.

But Mr. McCain, who has not been doing too badly- considering that Obama has the novelty factor and has attracted tons of younger blood to the election campaigns- does not have my thanks for bring Ms. Hilton back into the public eye. Mr. McCain could easily have focused on other aspects of the Obama campaign, which has been far from perfect. Mr. Obama has been frittering away the passionate support from the liberal and younger end of the spectrum instead of securing it and expanding into the other demographics. Soon after being endorsed the Democratic nominee, Mr. Obama has been moving to the center and those who had so hopefully supported him as the agent of change saw him backtrack and espouse ideas which seem antithetical to one who claims not to be adept at playing politics. Obama should have taken the high ground and stuck to his campaign finance promises. He should have not given in to pressure from big business and said that phone companies should not be penalized for supporting wrong-headed policies on wire-tapping, etc. etc. He should not try to be loved by everyone all the time. Clinton (the president) was good at that and even convincing.

There are other policy issues that Mr. McCain could challenge Mr. Obama on. To pick on him for his celebrity status just seems like a cheap shot. And one that has inflicted Paris on us again!

[Click on picture of Paris Hilton to view original ad at funnyordie.com.]

Thursday, July 24, 2008

A Tribal David V. A Multi-National Goliath

This is a story about a tribal group in India. The Dongria Kondh live in eastern India. There are fewer than 8000 of them left and they live in the forests in a hilly part of the state of Orissa. It is one of the more backward states in terms of education, income, economic growth, etc. And the tribals being more remotely located are considered even more backward in India because they have little or no education, few economic means, poor access to modern health care, etc, etc. However, the answer to tribal well-being is not, as most developing nations seem to think, assimilation. Many tribes are unique and practice a way of life that is very much in tune with their natural surroundings.

The Dongria Kondh live in the hills of Niyamgiri in a place called Golgola. They live in little villages and live on produce from the forests- fruits, medicines, animals- and a little bit of subsistence agriculture. They sell some of their foraged bounty in the towns to buy things they need like clothes or cooking utensils. But on the whole they keep to themselves. They belong to the world's oldest religion- animism. They pray to things in nature.

It turns out that the hills they call home are full of bauxite (which is the ore from which aluminum is made) and other minerals. The government of Orissa has awarded the contract for mining and processing the minerals and ore to a multinational out of UK called Vedanta. The Dongria Kondh know that if Vedanta begins to mine their hills, it will be the end of them and their lifestyle. This has prompted some of them to say that they will kill or be killed to protect their home. But knowing how the world works today, we know that a mere tribe, even if it is willing to lay down its life, doesn't have the kind of pull needed to sway a government and a multinational.

Fortunately for the Dongria Kondh, there are other players who also believe that mining in Niyamgiri is not a good idea. The Wildlife Institute of India is one such organization. They believe the mining operations will irreversibly damage the eco-system unique to the hills. A Supreme Court committee found that Vedanta violated the Forest Conservation Act when it built its refinery on the bottom of the hill and recommends that its environmental clearance be withdrawn. The Committee also noted that people were coerced and forcefully driven out of their homes to make way for the refinery. In addition, Norway's government (an investor in Vedanta) has divested itself of all Vedanta shares (about $14 million) after its Council on Ethics -a department which monitors state pension investments- warned that investing in the company would make Norway complicit in all current and future ecological damage and human rights violations.

The case is now winding its way through the Supreme Court and Vedanta is fighting hard to bolster its claims that it will bring technology, electricity, wealth, health, employment and education to this part of the world; that environmental damage will be minimal as Vedanta will only dig about 10 to 15 meters(!) down and then fill in holes when done; that people claiming environmental damage and human rights violation are all lying.

India needs resources to develop. But the major use of the aluminum produced by this factory is for food wrapping (bars of chocolate, potato chips...). Resource exploitation and utilization must be done with a long term view. Norway, a country which is arguably the world's most developed (in terms of how healthy and happy its citizens are), has come to realize this and has appointed a state philosopher to oversee its investments. The idea would be laughable elsewhere but is actually extremely smart. Of course, there are still problems (as I will talk about in another post), but thinking of ethics, environmental good, human rights, and other such value-laden principles, is not a peculiarly Norwegian luxury. Developing countries should at least be considering these very same principles in their quest to leave behind hunger, poverty, illiteracy, disease..., if they don't want to come to a point where the quest to develop rapidly has wiped out sub-populations, rich eco-systems, faith in government and a healthy life.

Meantime, the fate of the Dongria Kondh hangs on a Supreme Court decision.

[The picture is taken from the BBC. To see this and more pictures of the Dongria Kondh, please click on the photo.]

Wednesday, July 23, 2008

Racism Yeah! Sexism Nah!

Something about this campaign season has been striking. With the democrats yielding two "firsts" - the first woman who could have been president or the first not-only-white person to be president - the battle pitch was set. There were plenty of things to talk about but most issues never got center-stage quite as much as personal differences between the candidates.
Here is the bit that was striking and bothered me. Ad hominems against the Clinton camp were never seen as sexist except by a small group of women and were even nationally acceptable and deemed humorous. She is much reviled in the news media and so attacks on her about her cleavage and sexuality and dressing and person and voice and words... were not seen as attacks against womynkind but rather against a deserving, obnoxious target. On the other hand, stood America's first not-all-white contender to the throne. Anytime he was criticized, it was as if all black-Americans were attacked and Americans had to prove their credentials as race-inclusive. (We won't even cover how America's oldest candidate to the office fared.)

How is it that in this day and age an anti-Clinton group called Citizens United Not Timid could exist and its founder not be prosecuted for a hate-crime? What if someone had made an anti-Obama group called Not In God's Green EaRth? What if someone made an anti-McCain group called People Revolt in Collective Knumbers? (Ok, I know I won't make a good living as an acronym designer but you get my drift.) Would we react differently? I think we would react differently. Check out the poster above by the anti-Clinton group. It wants to teach people what Hillary Clinton "is." Check out its flag- if this is not an attack on all women, then what is?

The environment in which this election is taking place us gives us a clue to the zeitgeist. It was entirely acceptable to have a Clinton nutcracker but no doll of Obama was made or will be made. I wish the respect extended to Obama had been extended to Clinton as well. I am not asking for equal opportunity nastiness and tearing down. I don't want Obama or McCain to be attacked and name called but I would like to see some recognition and outrage when Clinton is attacked in a way that is psychically damaging to all women. I would like more people to express an outrage when a woman's campaign to aspire to the president's office is asked to shut itself down over and over again. If America was ready to accept a person across the color divide (at last) then surely, it must have already accepted someone who was representative of at least 50% of the populace in terms of her gender before now. Apparently not. And apparently not now.

Whether Obama was the candidate or not, Clinton would still have gotten treated poorly. We all love to pay respect to god and country. Let's start by paying our respects to mother, sister, wife and daughter.

Friday, May 30, 2008

Someone Called The Cops On Me!

I returned from dance practice yesterday evening to find my husband getting back from the gym. He told me that the cat had brought in a baby bunny. Before she could harm the baby, Frank separated her from it and left it on the porch, hoping it would hop back home. I went straight to the porch and found there a tiny baby bunny. It was about 2.5 inches long and weighed a couple of ounces. It was sitting right where Frank had left it a couple of hours ago (the cat was locked indoors).

I knew this little thing would not survive without feeding from its mother. So I picked up the wee thing and decided to walk around my community of town homes and see if I couldn't find it a safe bunny hole. I did try to set it down from time to time near where I saw some adult bunnies grazing but no luck. I continued my quest for a secure location with some chance of it finding a bunny mommy. What with coyotes and other predators (like my cat) little bunnies are not safe in the prairies.

A little while later I saw a cop car. The young cop pulled up near me and said, "Ma'am, someone called us to report you." Puzzled, I said, "Yes?" He continued, "A lady called us to report someone in yellow walking the lawns." I said, "And?" He just looked sheepish and embarrassed so I said, "Is it a crime to walk the lawns now?" He laughed and said, "No, I'm sorry." I showed him the bunny and told him that I was looking for a home for it. He said, "Good luck with that ma'am. I'm sorry about this but we have to respond to calls." By this point, I was starting to feel upset and hurt that someone would report me and that a cop would actually come up and talk to me. He was a nice person who tried to be as kind as he could be, but to be approached by the police is still unnerving. I said to him as he was beginning to pull away, "If that lady calls again, would you please tell her that what she did was not right." He said, "Yes ma'am, I shall be calling her back."

I tried to find a bunny hole as quickly as I could since I had begun to shake and feel upset and tearful. See the thing is, I attend Bharatnatyam dance lessons and I was dressed in a bright yellow salwar kameez for it.* I had not even realized that I might have looked different to anyone else as I had passed a few of my neighbors- some familiar and others new- and exchanged pleasantries with everyone on my bunny sojourn. Everyone had been kind and nice. I remember passing under one window where a lady was talking loudly on the phone and I heard the word yellow but I thought it a coincidence and moved away so as not to intrude on her conversation. I hadn't realized that she felt threatened by seeing me walking outside in a yellow outfit.

The time since last evening has given me a little bit of perspective. Talking to some dear friends as well as my husband has helped a little. This is happening in the same time frame as Dunkin Donuts pulling the ad with Rachael Ray wearing a b&w scarf because a right-wing hate-monger says Ray's scarf is somehow glamorizing and condoning middle-eastern terrorism. Puh-leeze!

Yesterday, I would have wanted to say that my brush with the police indicates racism or xenophobia here in America. But now I think that what we have here is plain old intolerance of yellow. Hard-core, foaming-at-the-mouth, the hidden underbelly of a seamy reality- the hatred of yellow. It is not ok to come right out and say you hate this bright and sunny color. But at the same time, when you see it, it makes you angry and you wonder at the inconsideration of the person who walks about happily rubbing your face in all this yellow-ness. I was going to add a picture here with me in the offending outfit but thought better of it. Instead, I have added a jazzier and jeweled version of the salwar kameez I wore yesterday, in seafoam and lavender. If this offends anyone, please write me and I will send you Parker Police's phone number. They should be getting used to receiving calls about the colors I wear and walk about.

[* Bharatnatyam is a form of classical Indian dancing and it is ancient. Kinda like yoga- in fact a lot of mudras are shared and of course, the language of both is Sanskrit. In fact, in India, female yoga practitioner's often wear the outfit I had worn for my dancing.
The bunny pictured is not the exact same one written about here. This one is another victim of my cat's translocation program. The bunny mentioned in this article was safely relocated to a bunny colony near my home.]

Wednesday, May 21, 2008

Misplaced Pride?

In my previous blog I wrote about the court-mandated changes in the U.S. currency that should be forthcoming unless the court case drags on or the ruling is overturned. One piece of the news however, was a bit puzzling and perhaps even disturbing. The National Federation of the Blind sided with the U.S. government in this case and said that no changes were needed in the currency. In an interview on NPR, the NFB spokesperson said that this issue is detracting from other more pressing and important issues for the blind. Such as, said he, the blind still have trouble being accepted in the work place and are often seen as not being as competent as a sighted person. He went on to imply that acknowledging that the blind need a change in currency is tantamount to accepting that without "special" arrangements the blind function sub-par. Here is an excerpt from the NFB's website about the ruling:

National Federation of the Blind President, Dr. Marc Maurer, said: “Today’s ruling by the United States Court of Appeals for the District of Columbia Circuit is profoundly misguided and may unintentionally do real harm to blind Americans. Hundreds of thousands of blind people use paper money every day without difficulty. We hope that this ruling will not have the unintended consequence of reinforcing society’s misconception that blind people are unable to function in the world as it currently is. Identifying items by touch (including currency) is convenient, but not essential to blind people being able to participate fully in society. For a court to say that if we cannot identify it by touch, we can't use it is a fiction and a dangerous one. Millions of items that cannot be identified by touch must be managed by the blind in business, industry, and education every day. We are successfully managing all of these endeavors, and the court's ruling challenges our ability to do so without any supporting evidence.

If America really wants to improve opportunities for education and employment of the blind, then it should focus on providing Braille instruction to the 90 percent of blind children who are not getting it, effective training for the 70 percent of blind adults who are unemployed, and books for the approximately 300,000 people who are about to be locked out of the only library for the blind.”

This is a convoluted argument. A person's worth is not judged by how good s/he is at telling change on the world's only currency designed to give this kind of difficulty to its users. The NFB should realize that the change in currency would be less a special accommodation than a step toward equal rights. And fighting for equal rights is not tantamount to an admission of a weakness. It is an acknowledgment of a system skewed against a sub-group within the population.

All the things that Maurer talks about in his second paragraph should still be important and the government should do those too. For Maurer to present it as an either-or scenario is ridiculous. Dr. Maurer's claim that the court ruling challenges the blind person's ability to function in a modern world is a gross misreading of the ruling. The noises coming from the NFB sound a lot like misplaced pride.

[The photograph is from the weblog of Doli Akter, a young blogger in Bangladesh. She wrote a photo essay about being blind in Bangladesh. The photograph shows a young man counting the money handed to him by the cycle riksha wala. If you click on the photo, you will be taken to her weblog.]

Tuesday, May 20, 2008

What You See is What You Get

Today the U.S. Court of Appeals for the District of Columbia Circuit upheld a decision by a lower court, made in 2006, which ruled that the U.S. discriminates against blind people by printing money that is indistinguishable by feel. The Treasury Department has been fighting this change for a long time by saying that it shouldn't have to be told how to design money and that the blind have adapted to the greenbacks by asking store clerks to help, using credit cards or by folding bills of different denomination differently...

Considering that the U.S. has an extensive set of guidelines through the Americans with Disabilities Act and through its wide adoption in most public places (such as restaurants and libraries), it is indeed an anachronism that the debate on making the currency more friendly is still happening. I remember having this conversation years ago with Americans as well as with Europeans.

Growing up in India, I never thought about the fact that each note was distinctly colored and of a different size. I never made the mistake of handing out a Rs. 20 bill when I meant to give Rs. 5. The bills ascend in size with denomination. We have done away with the old Rs. 1 and Rs. 2 bills- they are now coins. The Rs. 5 bill is the smallest paper denomination now. The colorful notes make for a pretty riot of color in your wallet.

Moving to the U.S., I found the greenback (and its more recent reincarnation, the somewhat-pinkback) to be all alike. I found myself pulling out the wrong note quite often compared to never before. There have been times when someone has pointed out to me that I had the wrong denomination. I am sure there have been other times when the wrong denomination has slipped out or in unnoticed. The greenback has been designed very conveniently to fit the billfold wallet. You don't have notes of different sizes floating in it. They all stack in nicely. I wondered how convenient it was to have this lovely uniform greenback if you were blind.

One of my dearest friends is blind and has been from a very young age. She is an associate professor of political science at an east coast university. She is completely self-sufficient and owns her own home. I brought up the issue of the currency on one of our many chats. And yes, she has tried to adapt given that she cannot change the currency. But of course, it is an inconvenience as I saw myself when I accompanied her to the store sometimes. Someone has to tell her what a particular note is and then she tries to fold it a certain way and put it in a pocket. I suspect, she loses money sometimes as folded bills also feel like wadded up paper and receipts. But perhaps I am wrong.
Meantime, the Europeans have moved on. Since the introduction of the Euro, this discussion is a non-starter as the Euro not only has distinct colors, it is also sized differently with lower denominations being smaller.

Changing the dollar to make it more distinct for distinct denominations is an idea whose time came a while ago. The U.S. is playing catch up now. Why should a simple change like this not be made when the benefits to a whole section of the population are easily recognizable? Having distinct bills is good for everyone as it reduces denominational errors but it is imperative that this change go through for those of us who shouldn't have to rely on someone else for something so simple as telling change.

[Click on pictures to be taken to website where they were found. The picture of the Rupees is taken by Steve Mullen. Thanks!]

Saturday, May 03, 2008

How Can A Person Be Illegal?

May 1st passes by mostly unnoticed in this country. May Day is The Labor Day. I know, that seems confusing to many in the United States who understand Labor Day to fall in September and think of it as the biggest sale day of the year. The other Labor Day is acknowledged in many parts of the world as celebrating the social and economic achievement of the workers/ labor movement. Some in the US are cognizant of the importance of this day.

In Seattle, this May 1st, the members of the LGBT community (of whom my sister is one) protested the conditions faced in the US by the many workers from other nations, such as, facing unreasonable searches, separation from family, deportation and generally degrading treatment. It takes a group of people fighting for their rights to recognize the anguish of another marginalized group. Till yesterday, I called the many Mexicans and other workers in this country who did not have legal visa status "illegal immigrants." Today I am so ashamed that I have been using this term without thought.

Even though in the past I have written about immigration issues (deaths in custody, benefits of migration & intimidation by ICE), in everyday language, I have been using the term "illegal immigrants" to refer to the many guest workers who fell out of status or those who crossed the border in search of a better life. It is a term much in use by the media, the authorities, politicians and people you meet (like at the gym or the grocery store). So, I never gave it another thought.

But what does it mean for a person to be "illegal"? No person is born illegal. If a person does something that all of us can consider to be illegal- such as murder someone, or steal from someone or hit someone- then they would be a criminal. But despite having committed an illegal act, the person would not have become illegal. It is a strange concept to have people who are illegal. As if they need to be wiped off in order to restore legality. Terms like this dehumanize people and allow us to treat them as if they are criminal or worse. Even if it is the economic situation created by the developed world in the immigrant's nation, that has lead to a centrifugal movement. Even if it is the economic situation in the developed world, which depends on cheap and unsupported labor, that has drawn the itinerant worker across the border.

Immigrants are blamed for a lot and credited with little. We can all probably think of some Americans (and for that matter, Europeans and Australians) today who behave like ignorant bigots mindless of their own ancestors' struggle for basic rights and to better their family fortunes by moving across borders. They say that their ancestors came to this country legally and worked hard for the prosperity they have. However they forget that the story of America's settlement hasn't been pretty in the past. For instance, did you know that from 1882 to WWII, the Chinese Exclusion Act passed by the American congress, withheld citizenship to the Chinese person along with "convicts, lunatics and idiots"? Prior to 1880, the Chinese were allowed in, in droves, to work the most back-breaking jobs at low pay.

Unfortunately, we are not much further along in 2008. The way we treat migrant workers is shameful. These are people driven by the same desire to better themselves that most of us can relate to. Let's look within ourselves to find better solutions for economic problems than demonizing those less fortunate.

[Please click on the bottom photograph to see more pictures from the past and the present at the host website of Ellis Island. This particular picture is from 1892 and shows European immigrants. The top two signs were part of a vile email I received whose purpose was to drum up anti-immigrant hysteria.]

Thursday, May 01, 2008

Give Us This Day Our Daily Bread

A news article from a few years ago reported that on average, American families eat out 18 times in a month. The statistic stunned me. I was thinking oh my, are most Americans rich enough to be able to eat out that often? Another article questioned whether eating out was more expensive than cooking at home. Conventional wisdom from another age and place would suggest that eating out has to be more expensive than cooking at home. Conventional wisdom may not be so wise anymore in this age of fast-food proliferation.

In the United States, people have gotten used to spending only around 10% of our personal disposable income on food. (Even the poorest families pay only a third of their income towards food expenses.) Americans do not have the highest per capita income and yet, when compared with other nations in terms of proportion of per capita expenditure on food, Americans spend the least!* This combined with spending about a third of their income on shelter, leaves the average American family with more than half their spending power still intact. This extra income, after taking care of life's two big essentials, has been important in the spending patterns and developments in consumerism we witness today.

This model of capitalism and consumption doesn't crave quality. It craves a Walmart and McDonald's type mentality which depend on mass production at cheap cost. What's more, this brand of capitalism has now been exported to some of the fastest growing economies of the world. I believe that the way we have been living and feeding ourselves has been neither healthy nor fulfilling.

How is it that you can buy a quarter-pounder at Micky D's for 99¢ when it takes 700 lbs of grain to grow 1 lb of beef? (And let's leave aside McD's outlay on advertising for the 99¢ burger.) Not only do we not question how and where cheap food comes from but we behave like real gluttons eating all that growth-hormone laced, stressed-cow meat. Meat consumption is at the highest point it has ever been in human evolution. We eat not to survive anymore but because cheap food has been easily available. But cheap food is not healthy food. I am not saying that by costing more, food is guaranteed to be of better quality. But good quality food cannot be obtained as cheaply as food has been available in the hypermarkets of America (or for that matter, the world now).

The global rise in food prices is not the worst thing that could happen to us. It is the worst thing that could happen to the world's poor and those who spend most of their income on food. Food is essential to life and good food is essential to good health. If food became a central item in our bills again, perhaps we would learn to appreciate what we put in our bodies and perhaps we could also drum up some compassion for others in dire straits here and across the world. We would learn to live on less and spend less on non-essentials. We would learn that ethanol made from food-grade corn is a poor panacea for our pollution problems. We would learn to use the car less and use public transportation or bicycles more so that we have more money for essentials. We would teach our kids the importance of saving electricity to lower our bills so we could spend them on healthy family outings. Can you see why I think that by paying too little for our food we also value it little?

*In 1994, Americans spent 7.4% of their income on food to be eaten at home whereas, the Canadians spent 10.3% and the British 11.2%. In countries like India, almost 50% of the income went toward food eaten at home.
[click on picture to be taken to site where it was found without attributions.]

Saturday, April 26, 2008

Hypocritic Oath

In December 2004, I interviewed with Merck for a position. I was flown out for an interview to their research division in New Jersey. I spent the whole day meeting various individuals. I had finished my doctorate earlier that year and I thought I would be a good fit in a pharmaceutical research department doing medical research and publishing.

I got asked how important publishing was to me. I said I enjoyed research and publishing was another step in the process of disseminating findings to the larger academic and lay community- so yes, it was important. Great, said they. Unlike academia, I was told, the process of getting research funded was not a big issue at Merck. As long as I worked up an idea well and could show justification for it, the money could always be found- I wouldn't have to go through the kind of onerous process that grant-writing in academia usually involves.

But how important, I was asked, was it to me that I get credit for the research I carried out. I must have looked a little non-plussed as it is not a question one prepares for. I said well, in collaborative research, all contributors should be acknowledged. Someone must have realized that I was quite clueless where all this was heading and laid it out for me in two ways.

1. I was told that most Merck studies were carried out in-house but then suitable medical doctors were found to be added on as main authors. They may have helped in, say, recruiting their patients or maybe contributed in some other indirect way or maybe were an acknowledged area expert in that topic who did not contribute in anyway. It was a quid-pro-quo. The doctor (usually an academic) got their name on a publication, always a good thing, and the Merck employees got the satisfaction of knowing it was their study as well as plenty of financial remuneration- certainly more than any academic job could provide.

2. I was told that one way to tell who the real author of a study is to phone all the authors from the top, one by one. Only one of them, perhaps listed toward the end, could give you details of the study design, the statistical analysis and the results. That was the real lead of the study and that person would be a bona fide Merck employee (in other words, that person would be on the books as an employee of Merck). The first author (the medical doctor) may have contributed to the editing of the final paper but doesn't have any role in running the study or writing up the results; and they certainly were not listed on Merck's payroll.

I was told that while the research itself was top-notch, due to the nature of the industry and the research environment, it was expedient to find more credible authors as the venues for publication were the world's top medical journals. A few weeks after the interview, I got a job offer. It paid better than my two other options- a post-doctoral fellowship and a tenure-track position at a state university. While a part of me knew that it would be a career-path that would mean fewer worries about finances, another part of me doubted whether I could actually be happy in a position where I would have to be "flexible" to justify the ethicality of what I was doing.
I ended up deciding against it and having other options was probably a key factor in that decision. There have been recent "revelatory" pieces in the news which have "outed" Merck as having written studies for doctors. The pharmaceutical industry is a huge money-making machine with scarce concern for the consumers of the medicines being churned out. Bad drugs put on the market; studies showing ill-effects cut short or scraped under the carpet; doctors invited to "educational" cruises...and now this. Why are we even surprised at this chicanery after all that has already transpired in the last few years?

[Click on picture for credits.]

Friday, April 25, 2008

The Real Victim of Propaganda

On the 18th of April, 2008, a couple of Dutch soldiers were killed and a couple more were injured by a roadside bomb in Afghanistan. One of the soldiers killed was Lt. Dennis van Uhm who was the son of Gen. Peter van Uhm, who took over command of the Dutch forces the day before. The Taliban claimed to have specifically targeted the young soldier with a mine according to their spokesperson. The Dutch government dismissed the claims the same day saying that they doubted the Taliban even knew before hand who the young soldier was. Link to story.

China claims Tibet as part of one-China and says that the "splittist" Dalai clique had been behind the recent violent demonstrations by Tibetans resulting in many mainland Chinese losing their lives and property. It says that it found evidence to show that the Dalai Lama instigated the protests. The Dalai Lama denies that he played any part in inciting the riots and condemned China's heavy-handed crackdown. According to Tibetan sources, more than a hundred Tibetans lost their lives but according to the Chinese this figure is about 20 or fewer. Link to story.

Muslim scientists and clerics, at a 2008 conference in Qatar, have called for the adoption of "Mecca time" to replace the GMT. The conference was titled Mecca, the Center of the Earth, Theory and Practice and is representative of a growing trend in some muslim societies where it is claimed that all scientific knowledge is already in the Quran and it only needs unearthing (pun intended) by the scholars and clerics. A certain geologist at the conference held that unlike other longitudes, Mecca was in perfect alignment with the magnetic north. Link to story.

All the stories presented above have elements which test our credulity. One comes across many instances of such stories in the news or information put out by various organizations, groups or nations (I have selected the above 3 due to their recency and exemplary nature). Some of the claims made in these stories seem outrageous to those of us exposed to multiple viewpoints through multiple media sources (some of which may be biased, making "multiple" the crucial word in that sentence). We wonder whether the person, group or government claiming something, which seems extraordinary, really expect us to believe what seems questionable to begin with. Why does their evidence seem so one-sided? Why do they never entertain any other view-point? Why is their claim never subject to outside examination? Why is their claim seldom, if ever, falsifiable? And ultimately, do they really believe what they say, even when it sounds like an outright lie?

The claims in these stories would fit nicely under the sobriquet of propaganda. They are especially formulated statements to present a world-view that furthers a particular agenda of the entity that presents them. But you think, "Sheesh, this is pathetic! I would never believe this drivel..." In fact, I have thought this for years. But, we are missing the real aim of those who create and disseminate these statements. The purpose of propaganda is not to convince those outside of a regime, religion, system or group. If anyone outside buys into propaganda that is a bonus for the creators of the propaganda. Propaganda is, in fact, aimed at in-group members who are provided these strident and unbalanced views, as if there were none other, in order to bolster their conviction in and support of the system they may be exposed to.

In the examples above, the Taliban claim is meant to portray the Taliban (see picture for some members) as being more coordinated and powerful than the forces of the west fighting them. It may not be believed by most in the west but, for those in Afghanistan whose allegiance is being vied for by the administration of Afghanistan, this statement may serve as further evidence that the Taliban is indeed a force to be reckoned and one that might actually be more than a match for the forces of the west.

A friend who was in China recently attested to the stridency of the Chinese media in whipping up the masses against the Dalai Lama. The Nobel Peace Prize winner is portrayed as being a devious person who is against Chinese peace and prosperity. The media makes no mention of the Dalai's call for non-violence or his requests for Tibetan autonomy rather than independence, leaving the Chinese people to draw the conclusion that the Dalai Lama wants to break up China violently. As to China's claim that very few Tibetans lost their lives, it is a claim that can only be met with dubiousness given all the other evidence of Chinese activists who disappear or are thrown in jail. It is unthinkable that the nation of the Tienanmen debacle would let the demonstrators in Tibet escape even as it accused them of killing Han Chinese and destroying their property. But sadly, many of the Han Chinese who claim Tibetans as their countrymen, do believe it.

For the Mecca story, oh where to begin! Anyone with the most rudimentary geometry lessons should be able to tell that one line passing through a certain point cannot be more "perfectly aligned" with that point than all the other lines passing through it. The Mecca longitude is no more perfect than any other longitude passing through the magnetic north of the planet earth. Yes, the GMT is a relic of the colonial past but it is a standard that is adopted by most of the world at the present time. (India is on an offset time zone but that is another story which predates colonialism and doesn't dispute science or geometry.)

This Mecca news item brings to mind an incident. Last summer when I was taking a train between Belgium and the Netherlands, I sat across from a person who turned out to be a muslim of (most likely) north African descent. He was a manager at McDonalds. He was dutch. The conversation at some point turned to belief systems and he believed in Allah and Mohammad and how Allah created earth and mankind etc. etc. I asked him why this planet under this sun was chosen by Allah of all the millions of other sun/stars in the universe? He said, "What other sun?" I thought he was joking but it eventually dawned on me that he really could not comprehend the existence of other suns and planets; a star was just a twinkle in the sky.

I told him that scientists have seen other suns and planetary bodies through telescopes and science conjectures a lot about celestial bodies (and I didn't mean angels). He flatly refused to believe in what I was saying. I had no way to show him anything then so I got his email address to send him the evidence. I have still not done it because I don't know where to begin and why anyone whose world view had been so constricted by agenda-driven information (such as that propagated by imams the world over) should believe some random websites about the existence of stars and planets out there in space. And even if they did believe me, I am sure it could also be attributed to Allah the magnificent and munificent. There is no science other than the science already revealed in the Quran it would seem.

Propaganda isn't half as hurtful to you and me as it is to those whom it is truly aimed at.

[Click on picture to see credits.]

Tuesday, April 22, 2008

Another Bloody Olympics...

... and another exercise in jingoism. Here's a link to an op-ed piece in the NYT about how the games have deteriorated in spirit. The graphics below arrived in my mail-box and I thought I would add it here for maximum dispersion. I don't have the names of the creator to credit. Feel free to copy and email.





Saturday, April 05, 2008

Washing Hands and Creating Killers

When I was working at the Med School in Birmingham, UK, all the clinicians and researchers I ever spoke with were aware of the anti-biotic resistance that is now prevalent around the world because of a misuse and overuse of antibiotics. Indeed, NHS trusts have received recommendations to try and reduce unnecessary prescriptions of anti-biotics for short illnesses of unknown origin. Most such illnesses are self-limiting anyway as the doctors will point out, when asked. They are all aware of the epidemic of prescription-led multi-drug-resistant strains that have sprouted. And yet, when I walked into the ladies room, everyday I was faced with the soap we were to use- Triclosan. At a medical school where medical research is being carried out and medical policy being created, how can another soldier in the war to create resistant bacteria be deployed so wantonly?

My puzzlement may be a sign of my frustration. I still have conversations with my neighbors and friends (here in the United States) that judge a doctor's efficacy and "caring-ness" by how quickly anti-biotics are dispensed. But instead of fighting back with education and information, these doctors do not "first do no harm". They cave in. I know that it is not so hard to talk to lay people about this issue because I do it all the time. And while my background and education give me some credibility, it is far less than that wielded by a family physician. In the absence of their physicians backing up what they have heard or read on the outside, these people (my friends and neighbors, for instance) go right on believing that anti-biotics in general are harmless and helpful- and I end up having these conversations again and again, appearing like the quintessential pushy person, or giving up.

How many people have you seen carrying those little anti-bacterial washes for their hands? They are even advertised on TV (well they used to be till recently, though I must admit, I haven't seen one recently). They are sold everywhere, not just at pharmacists'. We treat medicine quite cavalierly without recognizing its true benefits and costs of use. And let's not delude ourselves- even the anti-bacterial hand wash is medicine. I am reminded of an experiment narrated to me by Jurriaan who went to medical school in the Netherlands. Students are asked to rub a finger in a petri dish, then wash their hands with soap and rub the same finger in another petri dish. Which dish do you think had a denser bacterial population after a day?

In India, you can buy prescription drugs (such as anti-biotics) at pharmacies without prescriptions. People store them in their first-aid kits for years and use them as needed (the need is self-determined). In the US, many doctors will hand out prescriptions if you complain of a flu-like cold or throat pain, etc. And if you are (un)lucky enough to end up with one who doesn't follow this practice you can try brow-beating them with your conviction of a need for anti-biotics or threaten to go to a doctor who will comply. In some cases, you may actually have to go to a different doctor, but this doesn't happen very often. In the UK, it depends on your luck generally but doctors are less prone to being brow-beaten because in the NHS, your choices are more limited than in a private health care system. But as we saw, the anti-bacterial hand wash are somehow not even being considered as another culprit in the development of drug-resistance bacterial strains in the UK. How self-defeating!

The fact is we humans, just like most other animals, are prone to getting sick from time to time. Most illnesses are self-limiting in that even untreated they will eventually resolve themselves while leaving you a little worse for the wear. It is not easy to tell, especially early in an illness, what causes it- the two major outside causes being a viral or a bacterial infection. This is especially true of the kinds of occasional flus, colds, stomach upsets, inflammation, etc., that we seem to catch at work, play,... life.

Anti-biotics and anti-bacterial hand washes kill bacteria- the latter is weaker and widely-used, and thus, even more dangerous as it leaves stronger bacteria alive to reproduce. Anti-biotics do nothing to viruses. A progressive viral illness can eventually leave your immunity weakened enough so that you will then be open to some other opportunistic bacterial infection (this is what happens with AIDS). But starting all treatment for any illness with anti-biotics makes as much sense as starting the treatment for AIDS with anti-biotics. All it will do is deplete the existing bacterial reserves in your body which protect you in many ways and also serve a vital function (such as in digestion). In most healthy people (and animals) the occasional viral or bacterial infection will resolve itself. This is good for your immune system as well as for your body in general since it does not have to recuperate from anti-biotic use. That diarrhea, the mal-absorption, weakness, dehydration & the occasional pregnancy after anti-biotic use despite being on a pill... can usually be attributed to the medicine.

Now admittedly, some (viral or bacterial) infections can be quite severe and in the immuno-compromised (such as sick or older people and young children) there is a place for responsible anti-biotic therapy where the benefits outweigh the costs; but, make no mistakes, there are still costs. To ignore these, as we have done, is to ask for trouble.

But this still does not justify the use of anti-bacterial hand washes. Anti-bacterial washes and sprays only create a greater problem for immuno-compromised individuals as well as the general populace by wiping out benign bacteria and allowing virulent strains to become more common. You are helping no one and harming many individuals by using these products. It is irresponsible public health policy that allows these products to be widely available to the public.

It was the second petri dish that had more bacteria, in case you were wondering.

[This post is dedicated to my friend Teresa.]
[The first picture shows MRSA and the second Salmonella. Both were found without attributions on different websites. The MRSA picture was found on http://courses.washington.edu/z490/br/microbes.html & the Salmonella picture was found on
http://samslist.blogspot.com/2007/11/salmonella-typhi.html.]

Thursday, April 03, 2008

A Torch that Inflames a Stepped-On People Reveals a Hero in its Shadows

The Olympic torch is expected to arrive in India around the end of April. India is home to a huge Tibetan expatriate population along with their spiritual leaders, the Dalai Lama as well as the Karmapa (both contenders). Many Tibetans have been born in India and have never been to Tibet. India, which is tentative in its dealing with China, has tried to walk a fine line between offering refuge to those in need and at the same time curtailing them from voicing dissent with China openly. More on India's tightrope walk in another post.

Many were hoping that one of the reigning stars of Bollywood, Amir Khan- a man who is less conventional than most of the other top actors, would take a stand against the violent crackdown in Tibet by refusing to carry the torch as formerly agreed upon. Well, so far, Khan has said that he will be carrying the torch with a prayer for the Tibetans in his heart. Perhaps, he will still see fit to make a stronger gesture of support than this. Or maybe not.

Meantime another hero has emerged. He is the Captain of the Indian football team- Baichung "The Scorpion" Bhutia. Bhutia hails from the state of Sikkim*. Bhutia is a Buddhist and his refusal to carry the oppressive torch (yes, it is an Olympic torch but it also shines the light brightly on China's actions) is not only symbolic but a much needed shot in the arm for the Tibetan struggle even as the Indian government has prevented any marches or demonstrations against China. The Indians even detained about 100 Tibetans to prevent them from marching to the Chinese border. Bhutia was quick to point out that he was not asked by any group or person to pull out. "I sympathise with the Tibetan cause. This is my way of standing by the people of Tibet and their struggle. I abhor violence in any form. I feel what is happening in Tibet is not right and in my small way I should show my solidarity." Go Baichung!!

[* China used to claim Sikkim but agreed to recognize it as a part of India in return for India recognizing Tibet as a part of China (how long this recognition on China's part lasts will determine how long India will continue to suppress overt anti-China demonstrations within its boundaries). What is surprising is that the Indian government even feels that it needs China's recognition. After all the Sikkimese chose to be part of the Indian union in a referendum in 1975 by a vote of 97.5% in favor! Last I heard, no such referendum had been held in Tibet. India's stance seems to show how keen it is to avoid a direct confrontation with China. In the last such confrontation, fomented by the Chinese, India took a drubbing.]

Saturday, March 22, 2008

Too Posh To Push? Not if You Care for Your Mite

The c-section rate in the USA is now 25% and climbing. This means that at least every fourth birth is being carried out in a hospital by a doctor who is cutting open a woman's womb to bring the baby out. And yet, it cannot be asserted by any specialist that a quarter of all births are complicated and require such a dire & invasive procedure to give birth.

A lot of factors have been suggested as being responsible for the growth in c-sections in this country. Some of these are: the older age at which women are giving birth; our busy lives and the need to control where and when the baby is born; the medicalization of a natural phenomenon for various reasons such as the convenience of the doctor, insurance providers and their desire to make money; women's fear of pain, fear of vaginal tearing, fear of incontinence; women who think childbirth will leave them loose & stretched & therefore unable to experience good sex again; the acceptance of c-sections as normal birth, the fact that many celebrities with access to the best health care are choosing it...

And where America leads the world follows- albeit slowly in some cases. C-section rates have increased the world over but some nations have also been taking steps to capture this rate and to look at birthing more carefully. Not the US however. It continues to forge ahead and blaze a trail inconsequential of the long-term affects of such a radical procedure on human society.

Do women know that giving birth naturally through the vaginal canal actually endows the infant with exposure to the good bacteria the mother has? For instance, in a German study comparing c-section and natural birth babies, it was found that the former were more prone to diarrhea in their first year as well as being much more sensitive to certain foods such as cow's milk at 1 year of age. All the babies were exclusively breastfed for at least the first four months in case one is wondering if that somehow endowed differential immunity on the babies. The reason for this difference, the German researchers think, is the exposure to the mother's good gut bacteria while the child is passing through the birth canal which helps populate the babies system and strengthen its immunity. The c-section baby on the other hand not only does not get exposed to the good flora, it actually gets exposed to the hospital germs first. (By the way, breast milk also passes maternal good bacteria to the baby, so those who give birth via c-section and then don't breastfeed their babies are delivering a double-whammy to the poor mite.) Some researchers even believe that baby girls are colonized by their mother's vaginal flora which stays with them for life and protects them from infections.

How can we continue down this path where we may be putting the health of the species at risk by stripping it of some of the advantages bestowed upon it by a natural delivery? We need to take control of our health and our birth. All those reasons listed above as contributing to the rise in c-section rates should be addressed individually. Women should be armed with knowledge.

There are special cases where medical intervention in the form of a c-section birth is warranted to save the life of the baby or the mother or both (such as a breech position where the baby might be in distress). But the reasons listed above in paragraph two are not one of them. Women can give birth naturally at an older age and without more trouble than younger women. We should not try to determine where and when the child is born. Don't be lead by the convenience of others into giving birth through a c-section. Vaginal tearing is not an inevitable consequence of natural deliveries, neither are loose and stretched muscles or incontinence- learn and practice pelvic floor exercises. C-sections are not a normal mode of birthing. They have their place but if you can experience a natural birth while at the same time giving your baby some immunity, do it!

April Says: Hey -

Wholeheartedly agree with the sentiment expressed here. I personally have decided that it isn't until women take back what they have allowed to be stolen from them - a safe, and sacred, birth experience for themselves and their children - will the growing cesarean rate stand a chance of dropping.

I agree that some of the problem is the availability of knowledge - but much more of it, in my opinion, is our willful lack of forethought. I would argue that there is a tremendous amount of information out there for those that are looking, but most apparently choose not to look. Moreover, I think in this realm, as in many others, medical or otherwise, we have abdicated our own responsibility for decision making. And we face the consequences.

I say this not in an attempt to blame the many victims, but to instead suggest that we need a call to action.

Just some corrections and additions: I think one problem we encounter is trying to identify the appropriate selection rate for c-sections. Some places in France routinely had the rates below %6, I think, and without any decrease in maternal or infant mortality or morbidity. Specifically with regard to potential complications - well, birth is just about as safe as life gets. Breech, for example, only became a problem when physicians began to meddle in the natural process. Breech is not inherently dangerous - it is just a variant of normal. Unfortunately, just as few OBs know what a normal, unmedicated, unmedicalized birth looks like, few have seen natural breech births.

Also, a woman's vaginal tissue is, to some degree, made to tear, and to heal. Much worse than a tear is a surgical cut, which tends to take a lot longer to heal. Sadly, gone the way of the direct entry midwife has seemingly gone a lot of the knowledge about how to prevent tearing during deliveries - many, unfortunately, happen because of the protocol that forces a woman into an often humiliating position on her back, where she cannot push her baby out with tearing.

I am glad we are giving this issue time - thank you! I hope we can do more of it in the future.

Radhika replies:

Ok, I see your point about variants of normal birth (breech being one of them). I guess by normal I meant the straightforward births where one pushes and out pops a baby with no permutations or complications. I suppose the point I was trying to make there (and admittedly not very well) was that c-sections as a medical intervention are not without merit in severe cases as life-savers. But they have no place being another variant of the "normal" birth.

I also hear what you are saying about tearing of vaginal tissue. But are you sure that all vaginas tear up during birth? I didn't see my friend's vagina tear or bleed during birth. Can you write more about the tearing and healing?

Lastly, I'm not sure that we can blame the 25%-&-rising rate of c-section on willful lack of forethought alone. I really think the reigning paradigm has incredible inertia and in this case it is gaining velocity. And the reigning paradigm here is one based on medical intervention. Choosing to look for the information you mention requires additional deliberative action. Many will pass by the birth chapter without having access to this information because the majority of information they receive comes from their doctor and mainstream childbirth/pregnancy books and others who have gone through similar birth experiences. With the base rate (of those giving birth medically) being high and growing, the probability that this information will just be out there when they happen to look is shrinking. This is why someone like Ricki Lake stepping up and airing the issue at this point in time is a good thing. At the moment many women, if they ever come across someone like us airing our opinions on the issue, dismiss the ideas as clique-ish and new-agey.

Btw, had you heard about the healthy exposure to birth canal flora before? Especially the one about the little girls getting mothers' vaginal flora and keeping it for life? I hadn't. Way cool, huh?!

To which April responds:

A breech baby can just "pop" out, too. No complications, just a different way of entering the world. There are good reasons why the baby's head usually comes out first - not sure if we want to get into them here, but, again, many much of the data suggest that problems with breech delivery are often caused by who's assisting, not with the inherent nature of breech babies. But, I do think we agree - something that should be an option of last resort, to legitimately save the life of a mother or baby or both, is being abused.

All women do not tear during childbirth - sorry if I implied that. My point was that lots of women do experience some tearing, and it should not be considered abnormal. Superficial tears often heal quickly, without any complications for the woman, sexual or otherwise. Our attempts to avoid tearing, by episiotomies, for example, cause a lot more problems for women, in part because flesh that is cut with a sharp knife doesn't heal nearly as well as flesh that has torn. How the physician stitches the woman back up is yet another problem.

Sure, sure, momentum is a factor; I didn't mean to discount that. It's just that I *do* expect women to take the additional deliberative action for the sake of their own health and the well being of the baby. And, again, I am trying to not blame the victims here, but, frankly, one should at least prepare to not be a victim. I haven't seen the Business of Birth, but have heard a lot of interviews with the producer. I would love to know what fraction of birthing women enter hospitals and receive pitocin, for example. My very poor scientific study of those who are filmed for the Discovery Health shows suggest that at least half, and probably more, get it. That alone increases your probability of getting a c-section.

Wow - I feel like to some extent a revolution is necessary :) Defying the current paradigm, finding an alternative path - does that define a revolution? Sadly I think the likelihood of it happening in a culture where a huge fraction of people don't even perceive delivery by c-section as a "problem" is pretty small.

Radhika says:

I am loving this conversation. To me it is so clear that the "additional deliberative action" would be so lost on most women. Choosing baby cribs, painting a special nursery room, getting all "essential" baby implements (like stroller, pacifier, baby monitor, bottles, breast pump...), buying some "classics" like What to expect when you are expecting, taking lamaze classes, etc. etc. would be the deliberative action they are thinking of and so they would respond to you- yes, of course, I am excited and happy and making lots of effort for the baby.

Imo, this is not about deliberative action so much as what is the environment like for these women. How is it that they are not even hearing about or realizing that you can give birth healthily without any overt medical intervention? Why is it that all non-hospital births are portrayed as "emergency" and "ambulatory" in our popular culture (watch any primetime TV show)? Why is there a perception of criminal negligence or uncaring parent when one doesn't leave one's care in the hands of an Ob-Gyn? Obviously, at some point in the past this wasn't so. So how come there aren't vestiges of that more innocent and, in many ways, healthier child birthing past left in our present day culture.

When I meet women now, I am as likely as not to ask if they gave birth naturally. I used to assume that more often than not I'd get a yes. Turns out, I get a yes almost every single time. But then we talk about how exactly they gave birth and it turns out natural can mean without pain killers, it can mean lying down in a hospital setting, in can mean with painkillers but through the vagina, it can even mean c-sections without complications! It seems our understanding of natural birth has diminished to the point that it means nothing to the everyday woman. Am I making this sound worse than it is? Am I being alarmist? I am going to finish Born in the U.S.A.(Marsden Wagner) and let you know.

Upon reading all this Molly Eness said:

I would recommend "Misconceptions" by Naomi Wolfe as another perspective on this topic. ( I think I am one of the women who you asked if I gave birth naturally.) I have a sister-in-law and a young cousin who are expecting their first child now and have been thinking about this topic a lot lately. While I completely agree that a natural childbirth is preferable, I also think that the pressure to have no intervention and the fear "chickening out" when the time comes are detrimental.

To which Radhika responded:

Molly, That is a really cool comment and one sure to generate even more debate. As someone who has gone through the experience, your perspective is valuable. I want to birth naturally (as and when I get pregnant). I totally get what you are saying. I'm afraid however, that the pressure is generally from the opposite direction. The jaws that drop and the askance looks are more common when I state I'd like to try a natural, unassisted (well assisted by friends, families and maybe midwife but not necessarily doctor) birth. I have not felt any pressure from the opposite side because I am not part of any natural birth group nor are these viewpoints commonly aired. Of course, I will not deny myself medical treatment should there be a genuine reason for it but I would hate to be on my back if I felt more like squatting, y'know. I suppose, in a way, I like the Swedish example where because of the low birth rate all births are legally required to be within the hospital but where the hospitals have birthing centers which cater to the desires for the various types of birth experience people would like. While the Swedish have mandated hospital presence because they cannot afford to lose a single child in childbirth, they have still not gone ahead and taken the control away from the mother (and father). In spirit, this is the attitude that should prevail about birth.

I'll check the book out. Thanks!

Click on "Pregnant Woman" to see details and credits.

Monday, February 25, 2008

Unfairly Influencing the Mandate

I have had more than my share of emails from MoveOn recently- one even titled "Obama-mentum." Cute! MoveOn is currently running a petition campaign titled "Will the Democratic Party Live upto its Name?" Here's what MoveOn writes: You've probaly heard about the "superdelegates" who could end up deciding the Democratic nominee. The superdelegates are under lots of pressure right now to come out for one candidate or the other. We urgently need to encourage them to let the voters decide between Clinton and Obama-and then support the will of the people. Can you sign this petition to the superdelegates right away?

How disingenuous of MoveOn! Telling the superdelegates to "don't do like I do- do like I say." MoveOn did not wait to see whom the voters would choose between Clinton and Obama and then support that candidate. No, they put to work their entire machinery and resources in supporting the candidacy of Obama and asked the voters to choose him. And they see nothing strange about asking others not to interfere in the "democratic process." They must think the voter is a putz to be manipulated by them.

I can't even vote in these elections as I am not a citizen and yet, it galls me that an organization I thought well of has turned out to be just another influence-peddler. In a special editorial for the New York Times today, Geraldine Ferraro writes of the role played by superdelegates. As she correctly points out, most democrats have not made their voices heard during the primary season. Even with an invigorated primary season this year, less than 30% of democrats have likely cast their votes in favor of one or the other candidate, which would mean that going strictly by primary vote counts, the nation could end up with a democratic nominee supported by around 15% of democrats at most! Not a sweeping mandate by any yardstick. Anyway, don't listen to me, but do give Ferraro a few minutes of your time- she is certainly more knowledgeable and eloquent than I on this issue.

And most importantly, Don't do as MoveOn tells you to do. Research your candidates, think through their policy stances and vote your conscience.

The political cartoon is from the strip State of the Union by Carl Moore. This particular strip is from the 2nd of Feb., 2008.

Monday, February 11, 2008

A New Challenge to the Separation of Church and State

Archbishop of Canterbury, Rowan Williams, stated in an interview last week, with BBC Radio, that he believes adopting certain aspects of sharia law would lead to better social cohesion of the muslim community within the UK. He believes that currently muslims are faced with "the stark alternatives of cultural loyalty or state loyalty". Let me translate that gobbledy-gook into plain English. He feels that many observant muslims are faced with the dilemma of obeying either their religious imperatives, as laid out by the quran (and the sharia interpreters), or the law of the land. He believes that muslims are being oppressed by having to submit to the common English law without recourse to their own sharia courts.

There are so many concerns which need to be separated and individually addressed here. Let me start first with muslim reaction in the UK. It is one of puzzlement. After recent talks of integrating the muslim community further into the mainstream of UK life and fighting feelings of alienation amongst the younger generation, one does not know what to make of the Archbishop's statements. Some raise practical questions: How would disagreements between sharia and secular law be resolved? Given the various sects, whose sharia would gain primacy? Others ask more penetrating questions: Wouldn't adoption of the sharia law actually achieve the exact opposite effect- that of further delineating the muslim individual rather than leading to further cohesion? Sharia is not renowned for its enlightened stance on most issues even if many in the world would willingly submit to it. What about the status of women? If sharia were formalized, would this not sow the seeds of discontent among other religious communities (like the hindus, christians, buddhists...) who could then ask to follow their own religious edicts instead of the national law?

Another aspect of this issue has to deal with the fact that by introducing muslim courts one would reintroduce an aspect of life most people may have been fleeing from, in the first place, by emigrating to a secular country. Rowan Williams wears the blinders of a religious man who cannot conceive of lives that do not revolve around religious conviction alone. There are plenty of younger people who are forced into arranged marriages and "honor" rituals in the UK, who have some recourse currently in the secular law of the land. Sharia courts would be a huge disservice to them. Indeed, he goes so far as to think that the introduction of sharia courts would somehow reduce these "cultural practices" by allowing for their legal monitoring. Huh? So sharia courts would bring to the fore that which was previously a hidden "cultural practice" but how would legal monitoring serve any purpose if sharia law considered said cultural practice correct?

Another set of questions raised by the Archbishop's comments relate to his motivation. Why would he be championing muslim rights to a separate sharia court? If one were to read or hear the full-text of his conversation with BBC's Christopher Landau, one will also hear other comments such as:
"What we don't want either, is I think, a stand-off, where the law squares up to people's religious consciences". [sic]
"An approach to law which simply said that there's one law for everybody and that's all there is to be said, and anything else that commands our loyalties or allegiance is completely irrelevant in the processes of the court - I think that's a bit of a danger".
"That principle that there is only one law for everybody is an important pillar of our social identity as a western democracy. But I think it is a misunderstanding to suppose that means people don't have other affiliations, other loyalties which shape and dictate how they behave in society and that the law needs to take some account of that".
He goes on to make more confused noises while presenting examples such as whether a catholic adoption agency would be forced to consider gay parents under equality laws. His words swing between seemingly selfless championing of religious rights to incoherent ramblings about the trampling of the religious conscience by western secular democracy. One begins to wonder whether his true motivations aren't to strengthen judeo-christian religion and ultimately the church of England's position and re-establish it as the font of legal and moral authority in the land.

The danger of undoing the separation of church (mosque, temple, synagogue...) and state is very real in many democracies. There have been attacks on secular institutions and laws before. This attack from within is unexpected and therefore, the more dangerous. Williams states that most people are torn between their religious affiliations and the law and that their religious needs (which he euphemistically calls cultural practices) should get precedence. His suggestions would certainly strengthen the religious orders but I am afraid his fiction about a more cohesive society would remain just that. Let the Archbishop note that sharia law is accepted in many parts of the world and human rights have certainly not improved in areas under sharia law comparative to areas under secular law.

Quotes were taken from news stories on the BBC.