That Pesky Minimum Wage Conversation

, , , ,
Photo from The Guardian
https://www.theguardian.com/us-news/2017/jul/07/democracy-vouchers-seattle-politics-low-income-homeless#img-2

It’s been a while since I posted anything even remotely political here – likely due to the daily onslaught of information a la the Drumpf shitshow. Generally, when I post something in response to the political goings-on, it is after much thought and reflection, because often these things are murky and I like to have a clear head when I write about my positions. With the fast and furious, continual chocolates-on-a-conveyer-belt (think I Love Lucy) nature of our current administration, it has been nearly impossible for me to clear my head long enough to say anything coherent. I know I’m not alone.

However, one issue that keeps coming up in my world is the $15/hour minimum wage conversation. It was passed in Washington state, is being pushed in other states, was recently passed in British Columbia, has been analyzed by several university studies, and is hotly debated even as a national standard. I’ve read the news coverage of the studies, observed debates online, listened to folks talk about it on NPR, and am having a really hard time not being cynical about all of this.

For me, what it comes down to is humanity. (Ok, most everything comes down to that for me.) The simple fact is, even though some places have passed minimum wage legislation, there is nobody that I know of who works a minimum wage job and is currently being paid $15/hour. All of these measures are “phased in” over a period of time. And to be clear, $15/hour is NOT A LIVING WAGE in most places. $15/hour for a 40-hour week means that you are making $600 a week before taxes. That means that you’re making less than $30,000 a year before taxes. Depending on how many people are in your household (would have to be five or more), that doesn’t even qualify you for Medicaid without extenuating circumstances because the federal poverty level for 2017 for a family of four is $28,200.

So, the places that are passing these minimum wage bills are generally the ones where the standard of living is higher (ie. Seattle), which makes sense, given that if you want to live in Seattle and you’re making $15/hour, your entire paycheck will go toward your rent. But since you don’t hit the federal poverty level, you don’t qualify for SNAP benefits, so I hope you like the taste of carpet, because that’s all you’ll be able to eat. Unless you work in a restaurant and you can nick some food there.

But, oops, remember, that these laws are being phased in. So if you’re working a minimum wage job in Seattle right now, you aren’t making $15/hour yet.

So. Yeah. Humanity.
One of the most vehement arguments against the $15/hour minimum wage I’ve seen in my liberal enclave of Seattle comes from small business owners like restaurateurs and hipster shop owners. They “can’t afford” to pay folks that much and stay in business.

Go out of business.
I mean it. That might sound harsh, but if you can’t afford to pay the people who work for you, the people in your own damn community, the people who are the face of your American dream, enough money so that they can live with a roof over their heads, know where their next meal is coming from (and it’s not the trash can), and get to work without a 90-minute bus ride, you don’t have a solid business plan and you should probably go back to the drawing board.

Businesses are not more important than people.
Just because you have a great idea for a small business that you think hipsters in Seattle will flock to doesn’t mean you deserve to be in business. It should be part of your business plan to analyze whether you can pay your workers enough to live on, and offer them paid leave and health insurance. If you can’t, find a place that’s cheaper to set up shop so you can or go back to your day job. I have a dream, too. Lots of them. But if I am going to build those dreams on the backs of people whose lives depend on Medicaid funding and SNAP benefits (in this administration? Oy), then I’m living with blinders on. Big, white privilege blinders.

The studies that say that the $15/hour minimum wage will “hurt the economy,” are putting businesses before humans. They are putting some nebulous, unpredictable “economy” before humans. Are we really a country that is so concerned with an idealized, unsustainable, continually growing pile of money that we are willing to let the people who work in entry-level and service jobs live on the streets? If we continue to argue that these kinds of policies will hurt businesses while we cut social services, that is exactly what we are saying. And in Seattle, it is what we’re living. There are recent studies showing that the majority of people living on the streets are those who were working in low-wage jobs, with families, who simply couldn’t afford to pay their rent – either because of some unforeseen medical catastrophe or by some slow attrition of their ability to pay their bills despite working at least one full time job.

I am not an economist (thank God!), and I appreciate that this is a complicated issue in some ways. But in the way that is most important, it is not complicated at all. If we care about our fellow human beings, we will find a way to make sure that they are taken care of. Period. We will lead with our morality and common humanity and figure out a way to make it work. That is how all dreams are made. Follow the dream and work out the details as you go.

It’s Complicated…

, , , , ,
By Kurt Baty – Own work, CC BY-SA 3.0

I know that, and yet, there is still something so appealing about believing that the world is black and white, that things are either good or bad, and so are people. It is both efficient in terms of time (I can decide whom or what to invest my energy in and when to walk away) and emotionally satisfying (no agonizing over the minutiae, just make a judgment and move on).

And it’s rarely true. In fact, I’m pretty sure the only things that are black and white are those two crayons in the box. (Don’t get me wrong: there are some things that, in my mind, are Absolutely Wrong and I will continue to acknowledge the nuances within, and still condemn the behavior.)

I am a social-justice-minded person. I have strong values and strong opinions and I love fighting for space for those without it, hearing new voices, expanding my view of the world. And sometimes, I read about something in the news and let the ethical warrior side of me take over. I re-post things and sign petitions and vow to boycott companies and sometimes, that feels like the exact right thing to do in terms of aligning my behavior with my values. But sometimes I get conflicted.

Like when scandals come up involving giant companies like Uber. While I went along with the suggestions to delete the app from my phone and vow to use other rideshare companies when the news came out about the CEO’s reprehensible behavior and choices that don’t support my values, I was still a little worried. Mostly because I thought about the drivers – the vast majority of whom I’ve ridden with that are pleasant and professional and friendly. The drivers who are working in this flexible gig-economy world because they have other jobs and obligations that don’t fit in with an 8-5 job. Maybe they’re going to school or parenting or taking care of their aging parents. Perhaps they don’t speak English well enough yet to get another type of job or this is the thing they’re doing while they train for a better job. Maybe they’re retired and on a fixed income and this is the way they put aside a little money in case of emergency. Doesn’t my boycotting the company they work for impact them more than it impacts the CEO, at least percentage-wise? He’s already a millionaire. Maybe losing some revenue will affect his company’s bottom line a bit and perhaps his ego will take a big blow, but for the driver who depends on every paycheck, I may be creating more hardship for them than their employer does.

Two weeks ago, I saw a message on a Facebook group I’m part of (a FB group that is all about supporting and empowering women), asking if anyone would be interested in joining a day-long women’s empowerment and employment event to provide a breakout session workshop. They were specifically looking for content that centered around wellness and well-being and self care. I was hooked.  After a few emails, I realized that the event was being put on for women who are Uber drivers in Seattle and I admit to having a twinge of discomfort. Digging a little deeper, I discovered that this event centered around helping these women, who are mostly part-time drivers, understand the gig economy a little better and enabling them to find other ways to get into it to support themselves. Uber’s partner for this event is a local organization called Tabor 100, an “association of entrepreneurs and business advocates who are committed to economic power, educational excellence and social equality for African-Americans and the community at large.”

Whoa.

I signed up. Other breakout sessions included one that helped women envision their own paths as entrepreneurs or career growth, one dedicated entirely to self-care, and another that helped women learn to manage and grow their wealth. They provided a beautiful continental breakfast, a full lunch, free headshots by professional photographers, and the opportunity to get your business certified with the Office of Minority and Women’s Business Enterprises. Oh, and childcare. Full. Day. Childcare. For free.

This day was truly about empowering women to be part of the sharing economy in a way that works for them, with a ton of information about the opportunities that are out there as well as tips and tricks to more fully engage in those opportunities. My workshop centered on using mindfulness to ground yourself in your values, create personal boundaries, and find joy everywhere you go.

I vowed to go in with an open mind and I came out with a full heart. This is the kind of company (at least the Seattle version of it) that I can say I’m proud to have been associated with, even for just one day. This was not some gimmick to show the world that Uber is a friendly company and win back shareholders. I don’t even know that it was widely publicized. This was an honest attempt to acknowledge the employees of this company, remind them how important they are, and help lift them up.

So, it’s complicated. I reinstalled my app because I hope to see some of these women on the road soon and get to know them a little better.

Please Don’t Unfriend Me

, , , ,

In the past several days, I have seen more requests for people to “unfriend” and “unlike” pages on social media than ever before.

I have spoken with people who acknowledge that their loved ones voted for a different Presidential candidate than they did and roll their eyes, saying that they don’t get it.

I have seen calls for parts of the country to split off from the rest because of the deep philosophical divisions that showed up on Tuesday night, and I have listened and watched as groups form with the intent to “fight.” I heard one person say last night that she doesn’t talk to people who voted differently than her because “we can’t.”

We can’t afford to not talk about this.


It’s hard.
It is often painful.
It sometimes feels as though we are speaking different languages.

And we have to try.

The future of our country depends on it.

The first thing we can do is stop pretending that debate is conversation. In a debate, there are sides. There are factions with deep-seated beliefs and the goal is to show up and talk the other person under the table. The entire setup is predicated on the idea that this is a zero-sum game. That one side is “right” and the other is “wrong.” Debates are about power, they aren’t about common ground, and what the American people need right now is to find our common ground.

Instead of one-upping each other, we need to listen.
Instead of either/or, we need to start thinking in terms of yes/and.

When Lola headed out to take the bus with a couple of friends to the movies yesterday, I nearly had a panic attack. At some point, it occurred to me that I was sending my 14-year old daughter out with another young woman (who happens to be black) on to public transit and out into the world without an adult. Before Tuesday, I wouldn’t have given it a second thought. But in the days following the election, my Facebook feed was filled with stories of women and girls being harassed in public, people of color and Muslims attacked for simply being who they are, and I was gripped by fear. I hated the fact that I had to give her instructions as to how to behave on the bus – eyes up at all times, assess the situation constantly, if your gut tells you something isn’t right, scan the area for the nearest trustworthy adult and have an exit strategy that puts you in a safe place. I tried to do it as calmly as I could without scaring her, but still letting her know that she needed to heed my warning.

I am keenly aware of the daily fear that accompanies being a woman in this country. I am also aware of what many of my friends who are people of color go through on a daily basis and I think I understand their fears. I have heard and acknowledge the fears of those who are immigrants, refugees, and people who do not identify as Christian. I also feel as though I understand the concerns of folks who are part of the LGBTQ community.

And…

Yesterday, I had a very interesting exchange on Facebook with someone who supported Donald Trump’s presidential bid. He wrote that he wanted us to all stop fighting and start working to make this country great for “our kids,” and I inquired whether he meant all kids – black and brown kids, immigrant kids, gay and transgendered kids, and Muslim kids. What ensued was more than 30 minutes of back and forth clarification, peeling layers to really understand what he meant by making our country great and if it was inclusive of all of us. What I learned was that he doesn’t care a whit about reversing Roe v. Wade or marriage equality. He isn’t interested in deporting anyone and he believes that the Bill of Rights was written to include every single one of us, regardless of what we look like or where we worship or who we love. His reasons for voting the way he did had nothing to do with racism, xenophobia, homophobia or sexism.

In my quest to understand, I had to refrain from lumping him into the box that is so handy and makes it easy to jump right back in to that zero-sum game of Wrong and Right. Goodness knows, I didn’t agree with Hillary Clinton on everything she said. In fact, I vehemently disagree with her on several issues, and I know that I wouldn’t want to be characterized as someone who is in full support of her positions on military spending or energy policy. Because of that, it is my responsibility to treat others the same way. I can’t make a blanket statement that every single person who voted for Trump is racist, misogynistic or sexist. They may well have voted for him despite that.

And…

The fears of folks Trump has alienated and denigrated are real.
They have every right to have their feelings validated and fight to keep their personal freedoms.

And…

The fears of folks who don’t live in urban areas where the economy is rebounding, where opportunities exist for job training and social programs are just as real. Those folks who have struggled to put food on the table for their kids, whose schools have been taken over by the state because they have failed to meet standards for years, who have been farmers and miners for generations and still want to be, but those jobs are going away or getting harder to do without the support of the government? Their feelings are just as real. Their fears are just as existential.
They have every right to fight for someone they hope can pay attention to their plight, too.

Just because I haven’t lived those fears doesn’t mean they aren’t real. They just don’t show up on my radar. Like the fears of women and immigrants and minorities don’t show up on the radar of folks who haven’t lived that reality.

We can continue to try and convince each other that the things that show up on our personal radars are more important than the things that show up on someone else’s if we want to. We may gather bigger numbers next time and “win” elections. But we won’t have addressed the underlying issues that are driving the divide and we will continue the wild swing of this pendulum that throws our country into chaos every few years. The only way to slow it down is to learn about each other, to set aside what we think we know and listen to what others live with. Unfriending each other or voting to split states off from the Union might make us feel safer, but it only deepens the divide. And it won’t make the other side go away. It certainly won’t make them change their minds. It is the equivalent of a parent kicking their teenage daughter out of the house because she is pregnant. It doesn’t make her any less pregnant, it just leaves her with fewer supports and it means you don’t have to look at her anymore when you come downstairs for breakfast. We have to face this with compassion and a genuine desire to find commonality or we will continue to break apart even more.  I truly believe that the people of this country have more in common with each other than we know. It is in our own best interest to find those goals we all share and begin talking to one another because it appears that there are some folks in power who are more interested in being Right than they are in being part of something real and honest and human.

Immediate Takeaways from Last Night’s Election

,

I sit here full to the brim. My heart is heavy, my stomach quivering, mouth dry and thoughts racing. I remind myself to breathe deeply a few times a minute and struggle to define what is happening. I am both drawn to social media and reminded to pay attention to how it makes me feel. I am grateful for the conversations I have had with Eve and Lola last night and this morning; appreciative of the opportunity to temper anger and fear with reflection and self-awareness. So far, here is what I believe to be true:

 

  • Americans who voted for vastly different outcomes than I did have just as much right to cast their votes as anyone else. Regardless of whether someone’s vote was cast in anger or fear or hatred, the fact remains that we live in a democracy. Everyone’s vote counts.
  • I can’t know what motivated anyone else’s vote unless they tell me, and trusting the media to tell me isn’t a valid option. They’re the ones who were so wrong about how this election would go, remember? That means they have little insight into the way many people’s minds work. The media is just as divided as this country’s electorate is and is mostly populated by a group of college-educated, white folks. That is hardly an accurate representation of the country.
  • There are no more racist, misogynist, elitist, ableist people in America today than there were yesterday. And, more importantly, we can’t know what motivated people’s votes (see bullet point above), so saying that this election was a mandate for racism, sexism, or elitism is altogether incendiary and not useful. We don’t know that, frankly.
  • The people of this country have allowed themselves to be divided by fear, income inequality, geography, and hatred. Fear is a powerful motivator, but unless we really strive to listen to each other with the intent to understand, we will get nowhere. I have watched (and I am guilty of this, too) people purport to have ‘discussions’ about the election that were simply about convincing the other person that they are wrong. When discussions become about right/wrong, winning/losing, they cease to be about understanding. It is human nature to dig in and defend our position. It feels too scary to stop and wonder whether anything is truly black and white and whether we could have something to learn from someone who thinks differently than we do. Until we learn to acknowledge and set aside our fears, we cannot hope to build bridges and come together around common goals. We won’t even be able to identify common goals.
  • We often fail to recognize the ripple effects of our actions. Folks who voted as a reaction to something may soon come to regret that choice if the stock market crashes, they lose their health insurance, or Roe v. Wade is repealed. We are all connected and every single action we take has consequences that we can’t predict. Reacting out of fear or anger or hatred often doesn’t give us the time to think about what those actions might set in motion. Folks who are waking up today and reacting to the news out of anger or hatred – vowing to fight against those who elected our new president or threatening to leave the country – have every right to feel those emotions, but acting on them will only drive us farther apart as a people. We are all connected.
  • The dichotomy that exists in America is amazing. The popular vote was split nearly 50/50. In the face of elections where conservative Republicans will control the White House, Congress, and the Senate, the number of women of color in the Senate quadrupled last night. Gun control measures are expected to pass in four states, and there were at least ten anti-corruption measures that passed across the country last night. My state just elected the first Iranian-American, disabled Lieutenant Governor. We are a complex nation of people who have more in common than we know, and if we can come together and begin to remember that the value of human beings is immense, and more important than money, we can begin to heal.
I don’t mean to sound naive. I live in a position of privilege that means I am not imminently worried about my citizenship, my health insurance, my civil rights, or my ability to remain in my home. That position affords me both power and responsibility. I will continue to remember that it is my duty to be engaged, to listen and try to understand, and to support the things I believe in most vehemently, all the while acknowledging the right of others to believe differently. That is what this country has always purported to be about.

Welcome to the Most Fearful Nation

, , ,

Slowly but surely, inexorably, every step this country takes pushes us farther into a corner. It didn’t start with 9/11, but it certainly accelerated our descent into fear, and we are now reaping what we have sown. A populace who succumbs to the shouted words of its leaders to “protect yourselves,” “be alert,” “report suspicious activity,” and complies, putting police officers in schools, adding security protocols layer by layer, selling military-grade weapons to local police departments – this populace has come to this: snipers on rooftops shooting at peaceful demonstrations, punching each other at political rallies, spending millions of dollars attempting to block individuals from using public restrooms.

How can we be surprised? When we have all listened to the rhetoric that warns us about the Other?
How can we feign shock when we have been conditioned to look for what separates us and be on guard?
When our politicians increasingly skip over the step of diplomacy and build coalitions to “bomb the shit out of [insert country/terrorist group here],” can we not see how much of our collective American psyche is built on fear?

The thing about fear is that it is necessarily reactive. We like to think it is proactive, that we are simply PROTECTING OURSELVES, but the act of protection means that there is something we are afraid of. And in protecting ourselves, we build walls, we isolate ourselves and retreat into tight spaces where often the only recourse is to fight our way out. We have bought into the idea that in order to be safe, we must be feared ourselves, and so we arm ourselves with weapons and hateful words to be used against others.

And this fear takes on a life of its own – it prompts someone to report a suspicious character simply because of the way he or she is dressed or to be kicked off of an airplane for being middle eastern and doing math.

It takes us to the point where we are so fearful of sharing a public restroom with someone who doesn’t look like us, act like us, think like us, that we try to enact laws to keep transgendered people from peeing in the stall next to us.

Every time an unarmed person of color is shot by a police officer, we live the result of that fear.
Every time a non-binary-gender-conforming person is killed or beaten, we live the result of that fear.
Every time we choose violence over dialogue and assume that the only way to protect ourselves is by shooting first, we reinforce that fear and paint ourselves farther into that corner.

The United States has become a country whose primary focus is on protecting itself, whose primary motivation – by default – is fear. It will only get worse from here unless we make a conscious effort to elect officials who come from a place of community, openness, shared humanity. The only thing we will get from fear is more fear.

Two Reasons I Think Single-Payer HealthCare Needs to Happen

, , , , ,

Warning: Rant coming in 3, 2, 1

There have been times in my life when I have been so f%*king DONE with our country’s convoluted system of healthcare that I wasn’t sure whether to cry, throw myself on the floor and pound my fists until they’re black and blue or scream bloody murder from the highest peak I can find.

I know lots of folks who can relate.

Seriously. Socialized medicine, folks. I mean it.

I know it won’t make everything easy-peasy, simple and clean, but it can’t make things worse.

When I went to college, I was determined to become a pediatrician. That’s all I had wanted to be since I was in elementary school and I could see it happening. I took organic chemistry, cell physiology, medical ethics classes. I struggled with some more than others, but I loved them all. My senior year, I studied for and took the ridiculously long MCAT and spent hundreds of dollars applying to medical schools and then decided to take a year off to work in the field before deciding whether to go ahead and go.

I ended up working for several years as a surgical assistant for a small group of doctors and I learned about the other side: the business of medicine. I hung out with the business manager and discovered how to tweak our diagnosis codes and pore through the (then) printed catalogs of allowed procedures to bill things so they would get paid for. When patients came in for emergency surgery, after the OR was scrubbed of blood and every last instrument was cleaned and put in the sterilizer, we convened for a quick meeting to determine just how to position the procedure to whichever insurance company might be involved so that we could have a higher chance of being paid. This not only determined which codes we used to bill, but it often meant that the doctor had to dictate his notes in a particular way so that, in case the insurance adjuster (not a physician or a nurse in most cases) asked for them, they would fully support the billing we submitted.

During those years, I discovered that if what I truly wanted to do was build relationships with patients that impacted their lives and their health, going to medical school was not the way to do it. As the surgical assistant, I spent more time with the patients than anyone – pre and post-op – and heard about the other things going on in their lives as I changed bandages and removed stitches. The doctors, while they may have liked to have more time to spend with patients, spent the majority of their time maximizing insurance payments by dictating notes, seeing a ridiculous number of patients per day, scheduling back-to-back surgeries to maximize OR usage, and occasionally getting on the phone with an insurance company who was refusing to pay for more than two scalpels or two hours of anesthesia to defend their choices.

Needless to say, I chose not to go to medical school.  And in the next several years, I spent time fighting with insurance companies for a physical therapy business, a dermatologist, and the state mental health division, not to mention myself and my family. I learned just how insurance companies make rules that increase their profits and narrow choices for their customers. I discovered that the high-level relationships that are made between drug companies and major hospital groups and insurers almost never benefit the health or wellness of a customer unless it happens to be in alignment with the bottom line of the companies involved.

A few weeks ago I called a doctor’s office for a family member to get diagnosis and procedure codes for an anticipated surgery. I then called the insurance company armed with information to ask whether these codes were considered covered procedures. After nearly an hour on the phone I came away with a vague answer that included information about the deductible and the potential coverage depending on a number of variables over which we have no control.  If the doctor is “in network” (he is), his services are covered at X%. If the hospital is “in network” (they are), their nursing and OR services are covered at X%, as long as it is a day-surgery. Overnight stays are covered at X-Y%. If the anesthesiologist is “in network” (we have no control over that and no way of knowing until the day of the surgery who that person might be), their services are covered at X%, but if that doctor is “out of network,” services are not covered at all. Not only that, but on “out of network” providers, the amount the patient pays is not applied to the deductible or the out-of-pocket maximums for the year (presumably because we had the audacity to go rogue – even though we have no choice in the matter). There are further decisions about OR supplies (one would think that those would be considered part of the surgery facility charge, but, no, it seems they are billed separately), so if the surgeon chooses a more expensive bandage or stitches, it is likely those won’t be covered at all.  I could go on, but you get the gist.

This morning, I phoned our dentist’s office to discuss a particularly high bill we received and after another hour of talking with them and the insurance company, I was told that Lola’s emergency dental procedure last summer while we were on vacation was not only not covered (out of network), but none of the $500 we paid for it were applied to our deductible (out of network). I calmly asked the representative,

“So, this was literally an emergency. As in, the plane touched down, we stopped at the pharmacy to get pain killers for our daughter, and as soon as we hit the hotel we asked the concierge to recommend a dentist who could see her ASAP (Saturday morning in Hawaii). First of all, does your insurance company have in-network providers in Hawaii? And if so, am I expected to call all of the islands to find one who happens to practice on the weekend and is willing to see my daughter? Is that a thing I should have done?”

“No. It’s not a thing,” he says.

“Explain that to me, please.”

“Was it a medical emergency? Because if it was, you should have run it through your medical claim instead of dental, and then it might have been covered even if it were out of network. But it wasn’t, and it’s too late now. It was processed as out of network and that’s how it’s going to stay. And, no, we don’t have any in-network providers in Hawaii.”

So, ultimately, it’s my fault that I didn’t sell it as a medical emergency? Or is it the dentists’ office fault? The dentist who got up on a Saturday morning and spent three and a half hours with Lola patiently tending to her and then calling us that night to make sure she was ok.

And why wasn’t my out of pocket amount applied to the deductible? Because we went rogue. Because we didn’t follow the rules. Because, if it had been, the insurance company (Premera Blue Cross, btw) would have been on the hook for all the rest of the follow up procedures that have taken place as a result of this situation in the last nine months. But they aren’t, because it all started with us needing dental care somewhere else in a hurry.  When I pointed this out to the representative this was his response:

“Well, you just really want to have your dental emergencies when you’re at home. That’s the best way to do it.”

Duly noted.

Socialized medicine, folks. Single payer. The same rules for everyone.

Health care (even dental care). It’s a basic need.

Diving In, Part 3: New Vaccines and Random Questions

, , ,

Part 1 is here
Part 2 is here


I would like to go on record as saying that I don’t think vaccines are a bad thing, in and of themselves. I do think that they have served an important function in our understanding and the prevention of many diseases. However, I don’t think there is such a thing as a panacea, as much as we would like there to be, and over the past few decades, the medical-industrial complex has become so interwoven with the public health system that I’m not certain it is serving the people it claims to serve any longer.


One example of this phenomenon lies with the development of HPV vaccines. I wrote about this in 2013 here, detailing my issues with the vaccine Gardasil. Since that time, more countries have either banned or started investigating this particular vaccine because of the high number of adverse side effects, and yet in the US, our public health officials continue to advocate for its use within an even wider population. It is now recommended that boys have this vaccine and that all children have it starting at a younger age (an age at which NO trials have been done to determine safety or efficacy). If we were truly interested in long-term public health and not making money for pharmaceutical companies, we would proceed cautiously with this vaccine which has been shown to have some correlation with teenage-onset menopause and severe neurological issues.


Another example of the rush to develop vaccines that (I believe) are unnecessary is the chickenpox, or Varicella zoster, vaccine. Ours is one of the few countries that routinely and widely vaccinates our children for this disease that has not been shown to be deadly in the vast majority of cases. This article found at the National Center for Biotechnology Information illustrates the reason why, after much scrutiny of the matter, the United Kingdom does not push chickenpox vaccines on its children as a matter of routine. The conclusion of the physicians there was that there are two main areas of concern regarding this vaccine:

1. “…introduction of a routine childhood vaccination drives up the age at which those who are and remain non‐immune get the illness and chickenpox tends to be more severe the older you are,”


and


2. “…what will happen to the epidemiology of shingles if chickenpox vaccination is introduced in the United Kingdom?”


The answer to these questions from pediatricians I have taken my children to are as follows:


1. If your kids don’t get the disease naturally now, because all the rest of the kids are vaccinated for it, they will more likely get it when they’re older, when it is much worse, so they might as well follow the crowd and get the vaccine. What they neglect to mention is that the efficacy of the vaccine has been shown to be between 3 and 5 years, which means indefinite booster shots for the rest of their lives. And if they don’t – say they forget for a year or two when they first move out (like in college, when they’re exposed to tons of different infectious diseases), they’ll likely get a horrible case of it. They also neglect to mention that, had we not developed this vaccine and given it so widely (as opposed to just kids who are immunocompromised or otherwise indicated to have it), we wouldn’t have the issue of kids not getting it naturally. 


2. There’s a shingles vaccine. Don’t worry. Great, so now, on top of the multiple chickenpox vaccines my kids will be getting for the rest of their lives, they have to get shingles vaccines? 


If you’re a pharmaceutical company, you’ve created a solution to a problem that didn’t really exist. But with the CDC on your side, you are guaranteed to have a captive audience for your vaccines for years to come. And in my state, physicians are given financial incentives (higher ranking with Medicaid and state insurance programs as well as payment) if they have a significant percentage of their patients who vaccinate fully. Thus the pressure I get every time I take my kids to the doctor for a check up.



It seems that, in the UK, they have decided to be more conservative with their recommendation and follow the research instead of the money. Interestingly, it turns out that in households with children who acquire chickenpox naturally, there is a smaller incidence of shingles. What that means is that there is likely a protective factor against shingles for adults living with children who have naturally acquired immunity to chickenpox. 
So, why the development of the chickenpox vaccine? Previous to the development of this vaccine, fewer than 100 people per year (out of 4,000,000 who contracted the disease) had complications that led to death. One hundred people sounds like a lot, but that is 0.0025% (or 0.000025) of the people with the disease. And the rest of those people had not only naturally acquired immunity, but some protection against shingles as adults. The normal lifetime risk of getting shingles is 10-30%, but the UK researchers noted that, with a chickenpox vaccine program, the incidence of shingles rises 30-50% until everyone is vaccinated, which could take decades. 

In my opinion, this particular vaccine has become a boon for pharmaceutical companies despite the fact that it protects very few people from the serious side effects of childhood chickenpox and instead, opens up an entire generation of young adults to risk for adult chickenpox infection and future shingles. If you add in the risk associated with multiple vaccines (some reported side effects of the Varicella vaccine include shock, seizures, encephalitis, thrombocytopenia and Guillian Barre syndrome), you’re looking at a lifetime of risking your health again and again versus the risks associated with acquiring chickenpox naturally and suffering it’s side effects.

Back when vaccines were first developed, they were designed to combat highly infectious, deadly diseases, and they were mostly developed by pure scientists who had little financial stake in the outcome. These days, pharmaceutical companies who are concerned with their stakeholders’ satisfaction commission their own scientists to create vaccines that may or may not be immediately necessary (the “fast tracking” of Gardasil is one egregious example of a corporate push to market that was altogether unnecessary) and gradually increase the population and number of boosters that are given, continually growing their market share. Until we can be assured that the entities who are recommending the vaccine schedule have no conflict of interest and have done truly independent studies on safety, efficacy, and necessity of each and every one of the vaccines on our current US schedule, it is unfortunately up to the consumer to advocate for themselves, their families, and follow the money. 






Diving In, Part Two (Or, Why the Vaccine Debate Isn’t Cut and Dried)

, , ,

In case you missed, it, Part 1 of my writing on vaccines in the US can be found here.



I suppose that, like most other very controversial subjects, it shouldn’t surprise me that the vaccine debate tends to get framed as an all or nothing, black and white, choosing sides issue. Whenever we are driven by fear, human beings tend to lose the ability to think rationally and begin to believe that there is a Right and a Wrong answer, and the question of whether or not to vaccinate can certainly be a fearful one.
I do continue to be mystified, however, by people who should know better – public health officials and medical practitioners, for starters – that position vaccines as an all-or-nothing proposition, and here is why:
Vaccines are not all created equal. Accusing me of being “anti-vaccine” because I am concerned about the safety and/or efficacy of some vaccines or the current US vaccination schedule is akin to saying I am “anti-car” because I wouldn’t consider driving a Volkswagen but I might choose a Toyota.

  • There are a vast array of vaccines available, some of which were created decades ago and some that are fairly recent. 
  • Some vaccines on the market are multivalent (that is, they are designed to inoculate against more than one disease-causing organism) and others are monovalent (for one organism only).
  • Some vaccines were created to work against bacterial disease and others were designed for viruses.
  • Some vaccines contain adjuvants (chemicals that are supposed to increase the body’s immune response to create stronger immunity) such as aluminum and others do not.
  • Some vaccines are designed to be injected once in a person’s lifetime and others require multiple boosters in order to maintain a high level of immunity.
  • Some vaccines contain inert ingredients derived from animal parts, others from human fetal tissue, and things like MSG (monosodium glutamate).
  • Some vaccines have been tested many times over a long period of years on individuals of all ages, genders and races, and others have been “fast-tracked” which means that there was a determination that there was some public health risk that necessitated them getting to market faster, so there hasn’t been the same rigorous level of testing. 
I could go on, but hopefully it is imminently clear that the vaccines Americans are encouraged to give their children (and have themselves) are very different from one another. Much like buying a car, it is important to do research on each individual vaccine in order to determine a risk/benefit ratio and decide what is comfortable for you. For example, when my daughters’ doctor recommended the chickenpox vaccine for them, I researched it as thoroughly as I could and ultimately chose not to have them get those shots because I felt as though the risks outweighed the benefits. Similarly, they have not had the HPV vaccine and I don’t foresee either of them getting it anytime soon. (If you’re curious about why, you can read this post particular to the Gardasil vaccine. Since I wrote it, there has been a great deal more information published by other people who are critical of both Gardasil and Cervarix that shouldn’t be difficult to locate online.)

Please don’t think that I am under the impression that doing research on the safety  and efficacy of individual vaccines is a simple endeavor. I am fully aware that it is not, and I know how lucky I am to have both the time and the educational background to locate, digest, and mostly understand the data. Many, many people are unable to do what I have done, and the system is unfortunately not set up to support any kind of patient education regarding vaccines or any other pharmaceutical, for that matter. Many vaccines are available through drugstores and grocery stores in America, which makes it a challenge to have an in-depth conversation with the provider regarding risks and possible complications. Even if you go to a physician for vaccines, many of them aren’t as well-informed about the individual attributes of each vaccine as they could be, and a great deal of them are unwilling to have a candid conversation about the ingredients of individual vaccines. In a perfect world, the person who is recommending that you inject your child with something would have looked at the studies done on that drug to determine whether or not it is a good idea, but the amount of information is incredibly huge. The doctors I’ve met are content relying on the word of the CDC that vaccines are safe, but because these drugs are created and sold by massive
corporations who may or may not be interested in the greater good of public
health, but who are nevertheless incentivized to create a product that they can
bring to market quickly that will produce enormous profits for their
shareholders. In turn, these corporations use that money to lobby lawmakers who
wield a great deal of power over government agencies responsible for
determining whether these vaccines are safe and effective and when they get to
go to market, as well as recommending where in the vaccine schedule they ought
to be placed. There is a very clear conflict of interest for many physicians
and scientists working on vaccines who are being paid by large pharmaceutical
companies to create new vaccines. And, in many states, regular family physicians are paid by the state to give patients vaccines, so the more children they inoculate, the more they are rewarded. 

Ultimately, this issue is much more nuanced than many of us would like to believe, and because it is so complicated, we often fail to have productive conversations about it. In my heart of hearts, I believe that we are all striving for a country with healthy children, but if we are going to get there, it will, at some point, mean that we sit down together without fear or anger or labels and get everything out on the table with that singular goal in mind. 











 

Diving in, Part 1

, , ,

For more than a year, I’ve been holding my tongue on the subject of vaccines for a whole range of reasons. The conversation seems to wax and wane, but now that it is front-and-center once again, I feel as though I am ready to put some of my thoughts and experiences out there.

I will do this in parts because the issues are incredibly complicated and I think they deserve a thorough examination, but because of an experience I had a year ago, I will start with the following letter.  I was invited, by MomsRising to be part of a gathering with Dr. Vivek Murthy, US Surgeon General, to talk about the MMR vaccine. It was positioned as a smallish group of folks that would dig in to the questions and issues surrounding the measles outbreaks that had recently occurred and I spent over a week doing research, asking other moms what they wanted to know, and crafting intelligent questions. When I got to the event, I learned that they had invited hundreds of other people to phone in and listen and instead of a conversation, it was to be a presentation by Dr. Murthy with a few select questions asked at the end (questions vetted by the presenters with no opportunity for follow up clarification or dialogue). Needless to say, I was disappointed and I later discovered that Dr. Murthy was on a tour of cities at the low end of vaccination rates and this was more PR than conversation.

When I asked Kristin, the head of MomsRising, about the format following the event and indicated that I had several unanswered questions, she seemed surprised and offered to forward all of my questions to Dr. Murthy so that I could get answers. I emailed her this letter with the subject line she suggested and have, to date, received no response.

The letter itself is lengthy, I admit, but despite that, I feel as though it barely scratches the surface of the complex issues surrounding vaccines. In Part 2, I will explain my overall thoughts on vaccines and I implore you to either ignore these posts or read them thoroughly and thoughtfully and respond with curiosity versus vitriol.

—————————————————————

Dear Kristin,
Thank you and the other folks at MomsRising for all you do
to rally, educate, and advocate for parents and children across the country.
The work you do is so important, based on what actual moms say they want and
need, and has thus far been amazingly effective. I appreciate your efforts to
get the Surgeon General in the room to address the concerns and questions of
parents regarding measles and the measles vaccine. I am keen to build on the
momentum and develop Tuesday’s event into a robust conversation that goes much
deeper.
I understand that the logistics of the event prevented it
from becoming an actual dialogue, but I think it’s important to recognize that
much of the substance of the issue has yet to be discussed. Because there was
no opportunity for folks to follow up on answers Dr. Murthy gave in real time,
or to clarify any of his answers by having an actual exchange with him or the
other two physicians on the call, I believe that there is much more work to
do.  Indeed, as demonstrated by the
poll taken during the conversation, 56% of the listeners report being either
“somewhat” or “very” concerned about the safety of the MMR vaccine. To me, that
speaks volumes.  I am writing to you
in the hopes that you will forward these questions on to Dr. Murthy or find a
way to engage him in another, more conversational meeting where these issues
are discussed. 
I am writing to you as a mom of two neurotypical kids who
have had most of their vaccines to date. I am also writing to you as a woman
with a bachelor’s degree in biology with a minor in chemistry who worked for
years in direct patient care as a medical/surgical assistant and then moved on
to work in Quality Assurance for the Washington State Mental Health Division.
While I agree that this letter is long, it is the result of several
conversations with other mothers who have concerns beyond what was discussed
the other day. I hope that you will take the time to read it and reach out to me
with any questions you have.
The vast majority of our questions have to do with the
safety of the MMR vaccine and, from your quick poll, I see that we are not
alone among the people who attended this event on Tuesday. Our main issues
around efficacy of the MMR are two:
  1.     Using global statistics to demonstrate the
    effectiveness of the MMR is an unfair comparison. To say that “there have been
    over 15 million lives saved by the MMR vaccine since 2000 alone,” as Dr. Murthy
    did in his closing statement ignores the reality that many of those lives would
    have been lost because the children are living in third world countries without
    proper nutrition or sanitation. It is incendiary and doesn’t adequately portray
    the situation here in the United States to use global numbers to talk about
    domestic issues.
  2.       I can locate no long-term studies that have been
    done to determine whether people of my generation (born in the late 1960s and
    early 1970s) who received their full recommended MMR vaccinations actually
    still have blood titer levels that show that they are immune to measles. In
    response to one person’s question, “Does immunity wane as people get older?”
    Dr. Murthy answered, “There doesn’t seem to be any evidence that suggests
    that.” I’m concerned that this conclusion has been reached without any actual
    scientific studies and it may, in fact, “seem” that immunity doesn’t wane
    because of the drastic drop in the incidence of measles in the US. It would
    seem to be a fairly simple examination to undertake a study of adults across
    gender, ethnic, and socioeconomic populations and determine whether or not they
    are still immune to measles thanks to the MMR vaccine. The term “herd immunity”
    or “collective immunity” gets used an awful lot with regard to vaccines, but I
    don’t know that it has ever been tested with regard to vaccinations. There is
    evidence that this phenomenon holds true in animal populations and with
    naturally-acquired disease, but I would like to see a study that shows that it
    is valid for vaccine-acquired immunity. We can’t base public policy on a
    theory.

The following are questions regarding the safety of the MMR vaccine.
  1.            On Tuesday, Dr. Murthy assured MomsRising
    supporters for the second time that they ought not to be concerned about the
    MMR vaccine shedding live virus. “Don’t worry about exposing others,” he said.
    “Carry on about your lives.” However, parents of children who are immunocompromised,
    either naturally or due to medications like chemotherapy drugs, are often told
    by their physicians NOT to get their other children vaccinated with any live
    virus, including the MMR. In addition, the vaccine insert produced by the
    manufacturer, Merck, is written as follows: “Excretion of small amounts of the
    live rubella virus from the nose or throat has occurred in     the majority of susceptible individuals 7 to 28 days after vaccination.” (emphasis mine). Additionally,
    this article     http://www.cnbc.com/2015/03/03/globe-newswire-public-health-officials-know-recently-vaccinated-individuals-spread-disease.html
    in a mainstream media outlet talks about the fact that experts know that
    recently vaccinated individuals can spread disease. And yet, parents who choose
    to delay or forego certain vaccines for their children are routinely vilified
    and blamed for disease outbreaks. I believe that this is one very compelling
    reason why so many parents are confused about these issues. Whom do we believe?
  2.       When vaccines are tested for safety, they are
    tested in isolation; that is, one at a time. But more often than not, they are
    administered to children in tandem with other vaccines. Why are there vaccines
    on the US schedule that are given in the same day but not tested together to
    assess their effects? Much like baking soda and vinegar are inert alone but
    explosive in combination, it is scientifically possible that when two different
    vaccines are put together, they will act differently in the body of a child
    than they did when tested alone. We can say that we think they are probably
    safe together, but without rigorous testing, it is irresponsible to give them
    to children with developing immune systems without being much more certain.
  3.       Also, when vaccines are tested for safety, they
    are not tested against truly inert placebos such as saline solution. Often they
    are tested against another cocktail of preservatives and adjuvants that are
    only lacking the vaccine itself. We are not just concerned about the vaccine
    components, we need to know what effect substances like aluminum adjuvants and
    MSG and pig gelatin have on the human body when they are injected. We also need
    to know what effects they have when they are injected in large amounts, as in
    the case of multiple vaccines given on one day. I wouldn’t eat a “safe” dinner
    off of a toxic plate, and I don’t want to inject my children with a “safe”
    attenuated virus that is held within a toxic set of preservatives. We deserve
    to know that     each and every component
    of the vaccines we are being given is safe.
  4.       All three of the doctors spoke of the Institute
    of Medicine as an independent body that reviews all of the safety and efficacy
    studies on vaccines (among other things). I am curious to know whether the IOM
    crafts and undertakes their own studies or simply reviews the studies done by
    other organizations that may have a vested interest in the outcome. The design
    of a scientific study is as much responsible for the data set that emerges from
    it as anything else, and if truly independent studies are not being designed,
    we cannot hope to get accurate information.
  5.       Dr. Murthy encouraged parents to talk to their
    healthcare providers if they have questions about whether or not their children
    should have a particular vaccine. I agree entirely, but I have to say that we
    don’t live in a perfect world where all families have healthcare providers that
    have the time to have detailed conversations during a well-baby check, have the
    intimate knowledge of what a vaccine package insert says, or even get their
    vaccines in a doctor’s office.     
    Families can go into Walmart and get vaccines for flu, chickenpox, HPV,
    pneumococcal pneumonia, hepatitis, meningitis and MMR, in addition to others. I
    am concerned that many of those folks do that because it’s cheaper and easier
    than making a doctor appointment, and I wonder how robust the patient education
    is or whether there are opportunities to ask complex questions, or if most
    parents even know what or how to ask. His answer is predicated on the
    assumption that most parents have a trusting relationship with their child’s
    doctor and I fear that that is inaccurate. I think it is also possible to
    discount the intimidation factor most people have when faced by a person in a
    white coat.      
  6.            Dr. Cohn and Dr. Murthy both talked about the
    requirements for providers and vaccine manufacturers to report adverse events
    to the VAERS. Further, Dr. Cohn explained that patients and families can also
    report to this body any adverse effects they experience due to a vaccine. This
    prompted many questions. First, how many parents are told that this is an
    option and offered information on how to go about reporting to VAERS? Second,
    is there an estimate of how many parents don’t report side effects because they
    either can’t tell whether they are related or because it will cause them to
    have to make another doctor appointment for their child, which is both costly
    and time-consuming? Third, in the case of a family who receives their
    vaccinations from a place like Walmart, how likely are they to report any
    issues and to whom? If they don’t know about VAERS and they weren’t going to a
    doctor for their shots in the first place, they aren’t likely to seek one out
    to report negative side effects unless they are severe. Lastly, Dr. Cohn said
    that the CDC, and the Department of Health and Human Services follows up on
    every report made to VAERS and I am curious to know what the threshold is for
    deciding that action is required in the form of further study. How many of the
    same or similar reports have to be made in order for them to determine that
    this is an issue and how much time elapses between the reporting of an adverse
    event and the review?      Finally, I am curious about something Dr. Murthy
    said in regard to autism and MMR. He said that, “because autism symptoms show
    up around the same time that kids are getting the MMR, there are some people
    who think the two are related, but they are not. This is why we need to really
    look at the populations, we need large numbers to do rigorous independent
    study. We need to look at broad data sets to see and what the data says is that
    there is no connection.” I am interested in whether there has ever been a study
    done on the relative health of vaccinated children versus unvaccinated
    children. We know that there are entire pockets of unvaccinated children in the
    United States and it would seem relatively simple to compare them to children
    who have been vaccinated on schedule. This seems like a straightforward study
    that would provide some interesting information about a range of potential
    issues that we haven’t considered might be correlated with vaccines.

Thank you for indulging our questions. I find it fascinating
that the amount of media attention given to this most recent measles outbreak
has spurred legislation in several states and, yet, 65% of the people you
polled on Tuesday indicated they are not concerned about the outbreak. That
said, I think this offers us a great opportunity to engage in some intelligent
exchanges about measles and the MMR. I appreciate your effort to get answers
for your supporters.  If you decide
not to forward this on to Dr. Murthy, please let me know and I will try to find
another way to have the concerns addressed. 
Sincerely,

Kari O’Driscoll

Talking To Kids About Sex (With Visual Aids)

, , , , , , , , , , ,

This is a response to Elizabeth’s comment on the previous post about sex as a commodity, and I will preface it by saying I wish I had a definitive answer. She asked how I would educate my sons about sex and rape culture if I had sons, and I think it is a particularly salient question. I thought about it in the context of my brothers and my dad, but my teenage years were a different time. Not that there wasn’t a hearty dose of misogyny and male entitlement, but it wasn’t talked about at all, and rarely was it ever challenged.

After puzzling on it for a bit, I went to a source I trust: Lola. As a 13-year old girl who is proficient in social media, steeped in girls’ empowerment, and has a strong, vocal opinion on social justice, I was interested in her ideas about how to talk to teenage boys about rape culture.  She started out by encouraging parents to watch this YouTube video about consent with their kids. All of them, boys and girls, starting at a pretty young age. It’s a pretty powerful analogy and points out just how absurd our ideas about sexual consent are.

I love this video because it doesn’t avoid the idea that a person’s consent status can change at any point. Yes, it is possible for someone to say “yes” and then change their mind, two or five or twenty-five minutes later. And no matter when it happens, it’s valid. I’ve talked to my kids about the concept of the Least Common Denominator (don’t let your eyes glaze over – this has nothing to do with math). That means that the person who is the least comfortable gets to make the rules. The lowest threshold for sexual intimacy is the trump card. So if I really want to have full sexual intercourse but my partner just really wants to make out on the couch, we stop there. Period.

The second point Lola said was important to share with teenage boys is that, even though they may not have personally done anything to make a girl feel uncomfortable, rape culture means that in many situations, we just are.  Even I, in my mid-40s and fairly fit, am always nervous when I get into an elevator with just one other person who is male. Always. That is rape culture. Rape culture is me not feeling comfortable getting into an Uber or a Lyft by myself with a male driver. Chances are, he is a nice guy who will pick me up and take me to the destination I requested without any detours, but rape culture means that I am acutely aware at all times that I lack power – and therefore physical autonomy – until I get out of the car.  And rape culture also means that I often suffer through comments on my physical appearance and speculation about what I might be going out to do (often with lewd body language) and don’t speak up because it might anger the driver and then I’m screwed. Lola said she would want boys to know that these kind of experiences happen daily to girls and women, even if they themselves aren’t perpetuating it. She wondered if they might be willing to imagine what it would be like to be constantly on guard, wondering if the next guy who spoke to you would try to do more than speak.

We ended up having a conversation about street harassment and she cracked me up when she said, “They should know that girls and women don’t get dressed in the morning so that they can go out and get comments on their appearance from total strangers. Ever. That’s not a thing.” Even if guys think it’s totally innocent or a compliment to tell someone how they look, it ultimately makes women and girls feel unsafe simply walking down the street.  This video is a powerful one because it is a small sampling of what many women experience on a daily basis as they go about their business. And the irony is, no matter how she was dressed, if she had been accompanied by a man her age or older, none of that would have happened.  Nobody would have commented on her appearance – some out of fear of the other man, and some out of respect for him. But none of them out of respect for her. And that is rape culture.

The fact is, as I wrote in my last post, in our culture sex is often about power, and those who are born with more power are the ones who often make the rules about sex. Frankly, the most impactful thing I’ve been able to do when I’m having a conversation about sex with my girls is to listen. I like to think that I’m fairly plugged in to pop culture, but I know that there is a lot that goes on that I don’t see. And I’ve discovered that if I listen without judgment, my kids actually first love to shock me with the tales of goings-on in their world, and then feel like they can dig a little deeper and think about how all of it makes them feel.  I have also discovered that talking about sex and sexuality in lots of different ways – commenting when we’re watching a TV show together or when I hear a story on NPR with them in the car, showing them a video like the ones in this post and watching for their reactions, or slipping this letter under someone’s bedroom door – gives us opportunities to continually explore and challenge the ideas we have about sex.

Elizabeth is right. Talking to our kids about sex is incredibly hard. Sometimes they get annoyed and don’t want to talk (or listen). Sometimes I’m not the best at explaining something or helping them understand where I’m coming from. Sometimes I’m not good at listening without judgment. But the most important thing I ever did for my girls was to let them know that I’m willing to keep trying. That they can come talk to me about hard things whenever they want to and that I will bring tough subjects up from time to time and ask them to indulge me. Because if we as parents don’t work to counter the basic themes about sex that our kids get from school and the mass media, nobody will.