Two Reasons I Think Single-Payer HealthCare Needs to Happen

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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

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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)

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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

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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.

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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)

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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.

Sex and Sexuality: We Can Do Better

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Jon Krakauer’s Missoula: Rape and the Justice System in a College Town
The New England Prep School rape case
Peggy Orenstein’s latest book, Girls & Sex
Sex trafficking rates skyrocketing
The advertising phrase (and perhaps its most bedrock belief) “sex sells”

I could go on, but I think you’ll get the point. I’ve written here many times about rape culture and Sex Ed and I have very, very strong opinions, both as a sex assault survivor and as the mother of two daughters. But more than that, I am concerned for the way our entire culture treats the topic of sex because I think that from a very young age we are taught that sex is, first and foremost, a commodity, and secondly (sadly, a distant second for many, many people), an act of affection and/or love between individuals.

Long before most parents even consider broaching the subject of sex and sexuality with their children, they are bombarded by slick magazine ads, television shows, movies, and books that depict sex as a commodity, as something that we all ought to want and that we can buy our way into. There are many young people who are taught by older children or adults that their sexuality is something that can “buy” affection or special favors. Parents who prostitute their children are not only profiting financially, but they are teaching their children that sex has power and if you want money – or if you have it – you need only sell yourself. Many teenagers, both girls and boys, have a deep understanding of sexual favors – there are those who purchase social capital by giving blow jobs or hand jobs to others and those already in power who cement their status by receiving those favors.

Even if these kids do get “Sex Ed” in school, it is largely mechanical in scope, outlining anatomical features and talking about how pregnancy happens and how to avoid STDs. By the time they are adults, very few of them have an understanding of sex as something that is theirs to define – that they have every right to engage in it with an expectation of pleasure as opposed to some “reward.” Our American notion of “sex” is a very transactional one that is often one-sided. By the time we have the courage to really talk to our kids about sex (if we ever do), there is so much damage to undo that it feels overwhelming. And for children who learn early on, through abuse or sex trafficking, that sex is a tool, it is possible that their fundamental understanding of this act that is supposed to make their lives more whole has been forever damaged. How do you undo the notion that the person with more (power, control, money, status) has the right to obtain sex from the one with less when that is what you are shown in so many different ways over and over, nearly from the time you were born?

When girls are raised with the idea that their power lies in their ability to grant or withhold sex (the most egregious example of this I’ve heard of recently was Spike Lee’s latest movie Chi-Raq), it is damaging to their ability to see sex as something that is more intrinsically rewarding. When they are surrounded by images of women who are sexually provocative and who are praised for it (Kim Kardashian’s nude Instagram photos, anyone?), they are taught that sex is a tool, and that it ought to only look one way or it isn’t right.

When boys are raised with the notion that the more sex they have, the more masculine they are, it is equally damaging. Because, in our culture, they are born with more power at the outset, when they are presented with the idea that sex is a commodity, it isn’t much of a mental leap to imagine taking sex when they want it, simply because they can. When we set sex up to be about power, we can expect rape to follow along shortly. When business lunches are conducted in strip clubs and sex trafficking rates rise sharply during the Super Bowl, you can be sure that we have embraced sex as a commodity.

The question is, are we willing to live with the consequences of that or can we start talking to our young people about what else sex might be, instead?

It’s All Bringing Me Down

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I’m having a hard time remembering to focus on the positive. I spend way too much time following this ridiculous presidential race and it is taking a toll on my attitude. I am like a moth to a flame, flitting around looking for warmth and illumination and banging into the bulb a few times before I remember it’s not real. A day or so later, I do it all over again.

I watched the Democratic debate last Sunday and talked back to the TV screen. The girls rolled their eyes at me and admonished, “they can’t hear you.” I know, but somehow it makes me feel better to counter one candidate’s point with my own response, especially when they don’t call each other on their bullshit.

I am a firm Sanders supporter for a whole host of reasons, and I think he did well in Sunday’s debate, but I have to caution myself that there is no one candidate with whom I will agree on everything. I fell in to that trap with Obama and found myself very disappointed from time to time. I don’t know why I found it so surprising when he made a decision that ran so counter to my beliefs – cabinet appointments and trade agreements and energy policy. I have lived in this world long enough to know that I won’t agree with anyone about everything.

I am so overwhelmed with the negative, though. The news (repeated news) from the Drumpf rallies of physical violence against protestors, both by Secret Service agents and random attendees, is so disheartening. The angry, hateful language that is inspired by all of the GOP candidates and reported with glee by media outlets is a tsunami that washes over my head every day. I heard a teacher say on the radio the other day how hard it is to talk to students about compassion and empathy for each other when the biggest bullies they see are famous for being bullies. These men who are loud and brash and don’t give a damn about anyone but themselves, who are rich and powerful and disregard the rights or feelings of anyone else, whose names show up on TV and the internet all day long every day, they are the antithesis of empathy and compassion. I am used to seeing it in comments online, the trolling, the gas lighting, but to have it showcased from a stage with lights and flags and people clapping is disconcerting to say the least.

At this point, November seems like a very, very long way away. And as I listened to an interview with the head of MSNBC yesterday, defending their decision to fire Melissa Harris-Perry and substitute election coverage for her show’s time slot, I shuddered with a premonition that I hate to even give voice to: that news outlets will get so addicted to ratings that come from covering hateful, yelling politicians that even after the election they will continue to spotlight the negative. Say it isn’t so. It feels as though it has been heading that way for a long time, even before the election really heated up, and I wonder what it might take to interrupt the cycle. I can only hope that MHP finds another forum for her show, one that is committed to entertaining diverse, productive discussions and interesting discourse rather than reality-show-themed shouting and rhetoric.

I am heartened by the voices of those who talk of peace and democracy, and I suppose that is why I am such a fan of Bernie. While he could be seen to be the personification of patriarchy – white, male, older than 50 – his words and actions belie that description. He is, to my mind, more concerned with listening than with speaking. He is not convinced that he has all of the solutions, and his record shows a careful consideration of details and implications, and a distinct lack of interest in intervening heavily in the affairs of other countries to disrupt or “solve” issues that are particular to them. I am reminded that there may be issues about which we disagree, but I think that it is his approach, his entire ethic that excites me and not necessarily the nitty-gritty details.  I am holding out hope that his message will continue to make it through the noise and that those who are willing to pay attention will end up being the ones who make the difference in the end. And, I have come to the conclusion that I have to spend a lot less time listening to the chaos of the mass media if I am to stay optimistic.

There, I’ve Finally Said It. No More Guns.

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I just don’t understand the appeal of having a gun. I didn’t really grow up with them, although my mom’s first boyfriend after she divorced my dad and her second husband both loved them. They each took us kids out shooting in the rural areas of Oregon, aiming at tin cans on a log. I don’t remember much about it, to be honest, whether I was afraid of the kick of the pistol or if the sound bothered my ears. I have no idea whether I got a rush seeing the can jump off of the log when it was hit or even if I ever hit one. I don’t recall any conversations about where the guns were kept or if they were locked. I do remember my stepdad’s sunny office at the back of our house sporting a box of bullets in the windowsill, but I don’t recall being afraid of them, even though I was sometimes afraid of him.

We didn’t grow up hunting. Dad never really talked about it, but I know he had a gun for a while. I don’t think I ever saw it or touched it or even thought about it. Nobody in my family ever talked about needing one for protection, even when it was just us kids and Mom living alone.

So maybe I’m missing something. Maybe I don’t have some piece of the puzzle that I would need in order to really feel strongly about “my 2nd Amendment right.” But, frankly, I am more than willing to forego it altogether as long as the shooting stops. As long as I never have to see another story about a toddler accidentally shooting himself or his mother. As long as I don’t have to hear about teenagers playing Russian Roulette on a dare and someone ends up dead. As long as I don’t have to hear that there is another guy loose in some town somewhere shooting people for no apparent reason. I’ll give it up. And I’ll ask you to give yours up, too.

Because here’s what I see. In our current circumstances in this country, when there are more people living in poverty than there maybe ever have been, when there is extreme racial and gender inequality, against a backdrop of loud ranting on social media and radio and television shows from people who freely persecute and alienate other people, we can’t afford the 2nd Amendment. We can’t keep our guns if we aren’t willing to treat each other like human beings.  It’s too expensive. The cost is too high.

I have no scientific evidence to back this up, but I have a strong belief that simply owning a gun lowers the threshold for violence. That, all things considered, if you have two people with similar personalities and tendencies, one with a gun and one without, and they each get into a fight with someone – the kind of fight that really pushes your buttons, makes you see red – the person with the gun will be more likely to escalate to violence than the person without one. I believe that someone who owns a gun is more likely to use it to settle a score, to make their feelings known, to end the battle once and for all, than the person who doesn’t have a gun handy is to throw a punch, use a knife, or find some other weapon. I believe that there is something impersonal about using a gun that allows us to feel detached from the act of violence in a significant way, such that we don’t have to consider what it might mean for us. If we have to stop and think about getting into a fistfight with someone we are arguing with, we have to wonder how badly we’ll get hurt in the scuffle. But if we have a gun and the other person doesn’t, it’s an easier decision. The effort it takes to pull a trigger just isn’t the same as the effort it takes to physically assault someone.

And before you point out that I just made an excellent case for everyone to own a gun, just stop. Because the above scenario is only for arguments and road rage and innocent victims killed by an enraged Uber driver in Kalamazoo.

The idea that we would all be safer if we all owned guns is belied by the statistics on accidental shootings. According to the Washington Post, in 2015, an average of one person per week was shot in the US by a toddler using an unsecured weapon. In the first six weeks of 2016, nearly 350 people have been shot in accidental shootings. That is more than five people per day, shot accidentally. Nobody can protect themselves from an accidental shooting by using a gun. I don’t care how much of a ninja you are.

And, for the record, I also reject the argument that what we have here is a mental illness issue. To be honest with you (and, again, I am no expert, I’m not a certified mental health professional, so this is ‘just’ my deeply held conviction), I don’t think that ANYONE who sets out to shoot a bunch of random people in a school or movie theater or from an overpass is someone I would call NOT mentally ill. I think that in order to want to inflict serious bodily harm on a group of people you don’t even know, by definition, means that you have a mental illness. Unfortunately, we don’t tend to know that until after it’s too late and people are dead.

We could piecemeal this situation with background checks and laws against certain people owning guns – violent criminals, those with a restraining order, people undergoing treatment for mental illnesses – but we won’t cover the people who just snap. The people like Robert Dear and Jason Dalton who were “quiet neighbors” and “loners” without any real red flags going up will continue to elude us. We also won’t capture the accidental shootings that happen at the rate of 5 A DAY in this country. And so we need to ask ourselves whether the need to protect the rights of regular citizens to shoot at cans and deer and ducks a few times a month is worth it. We need to weigh gun enthusiasts’ right to recreation against the rights of the rest of us to not get shot randomly. There is no other item of leisure that compares in its lethality to that of a gun, and I, for one, am willing to forego my right to bear arms so that other members of society can live without fear of harm or death at the hands of someone who was, up until now, a “responsible gun owner,” but they snapped, or they forgot to lock up the gun, or they got pissed off because the other driver didn’t signal that lane change.

As a nation, I would hope that we have progressed past the point of needing to arm ourselves against our own government. I think that we have come far enough and developed tools enough to band together and make our will known without worrying about soldiers coming to our door to force us to do something we don’t want to do. Besides, if our government was truly determined to quiet us, they have weapons much worse than guns and your personal stash of firearms won’t do much to stop them if the drones come.

Fear v. Hope: I Choose Hope

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I know from fear.

I grew up an anxious, perfectionistic little kid, afraid of new things and new people and situations I couldn’t control.

I spent the first years of my parenting life terrified that I was doing everything wrong, that my children would get terribly sick or my husband would leave us.

I know from fear. And my life began to turn around the day I decided I would no longer be ruled by it. It wasn’t a sudden thing, just a gradual dawning that I had a choice to make, and once I recognized that I had been choosing scarcity and fear for most of my life (all the while wondering why happiness and contentment weren’t showing up at the door), it was pretty profound.

I have been watching with amusement the growing concern over the Zika virus “outbreak” and, until yesterday, was mildly confused. Yesterday, NPR broke a story about the World Health Organization saying that this virus had “explosive, pandemic potential” and it was all over my Facebook page. Really? This virus that most people never even know they have because it causes mild cold-like symptoms is all of a sudden something we are cautioned to freak out about? Yes, I understand that it has major implications for women who are pregnant, although as of yet, there is no causative connection that has been established. And I get that, in many countries where there are no options to control whether or not you get pregnant, this is a conundrum.  Wow. Nothing like stirring up fear of something that is likely to not really cause any problems for the vast majority of us.

This morning, NPR had one of their correspondents in Iowa interview Republican voters regarding last night’s GOP debate and I was struck again by how the front-runners have stoked the fears of people in order to gain votes. Over and over again, I heard people talk about terrorism, ISIS, and the fear that, if a Democrat were elected to the presidency, their guns would be taken away and they would be left altogether defenseless against “meth addicts in my front yard with guns.” Huh? In Iowa? Is there some sort of terrorist cell network in Iowa that I don’t know about? Are there lots of armed, methamphetamine-addicted folks running around at night burglarizing towns in Iowa?

A little later, on the Tavis Smiley show, there was a political analyst who was talking about the odd phenomenon that is Donald Trump and when Tavis asked him about the “best way to fight Trump,” his answer was, “I’m curious why you’re focusing on fighting Trump and not supporting Hillary.”

Yes. Not that I’m a Hillary supporter. To be honest, I am pretty firmly in Sanders camp, but that’s not something that we need to discuss here.


I was reminded of the knowledge that what we fight against grows in power, if only because we are giving it our energy. The key is to direct our energy toward the thing we desire, not against the thing we are afraid of. That is not to say that there aren’t things to fear in life, but if we take a step back and really think about it, what are the odds that any one of us in this country is likely to be touched by terrorism, contract the Zika virus, or be shot by a meth-addicted robber? We are more likely to suffer slowly from income inequality, domestic violence, and pollution. And in the meantime, when we let our daily activities and choices be dictated by fear of things we won’t likely ever encounter, we are wasting our energy. When we make the choice to rail against the things we are afraid of (most of which will never come to pass, and even if they did, we have almost no control over them, anyway) instead of creating space for the things we do want to see in our lives, everyone is hurt.

The main difference I see between focusing on hope and focusing on fear is that one of them is actually more frightening than the other one. When we focus on what we’re afraid of and put our eggs in the Trump/Cruz/Rubio basket, we are actually less afraid because we think we’re following people who can control or prevent what we’re scared of. When we focus on hope, we are putting ourselves out there in a way that is vulnerable, with the knowledge that it will take some effort on our part to make it happen, and that responsibility is often much more frightening than sitting back and letting someone else do it. But ultimately, that is what this country was built on – groups of people who were committed to working for a better collective future for us all, and that is where I will continue to put my energy. Here’s hoping there are lots more people out there that feel the same way.  Fear is a strong motivator, but it doesn’t ultimately get a damn thing done that is good for all of us.

Free Speech and All That

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Twice this week I’ve heard stories of hateful verbal attacks in public. I am quite certain that there have been dozens and dozens and that these are only two that I have encountered in the news, but it  makes me think about how we ever came to the place where we believed in our inalienable right to share every trivial opinion loudly and vehemently.

The first incident was a woman (I confess, I can’t recall whether she is Muslim or not) traveling on a bus who endured much hollering from a white man, telling her to “go back home” and “get out of our country.” Of course, as it turns out, she was born in the US but, apparently because she is half-Iranian, this man assumed she was both a foreigner and a terrorist, and none of the other passengers on the bus intervened on her behalf. It was only when she could take no more and decided to yell back at him and defend herself that the bus driver finally kicked him off the bus. The second involved a woman in Southern California who was driving her two small children somewhere during the day as she wore a hijab. A man in a large truck sped up next to her car, flipped her off and began spewing curse words at her, intimidating her by swerving his truck next to her car and honking before he finally turned a corner and drove away. She made it clear that the things he was hollering were in regards to her hijab and not her driving skills.

As I think about these stories and consider the number of times I’ve been spoken to in a rude or hateful way by a total stranger, I am left wondering who ever told us that it was okay to talk to other people like that? I am a supporter of free speech, but to me, free means that we are open to expressing our ideas and beliefs in a way that encourages discourse, understanding, and education. Free doesn’t mean unfiltered, unnecessary blathering. I frankly don’t care if you, man-on-the-sidewalk, like my outfit today, or the way my ass moves in my skirt. It isn’t important to me whether you think someone’s Spandex shorts are “gross!” or that guy’s purple mohawk is “faggy.” I’m pretty sure nobody else cares, either. Even if you’re going for a laugh, it isn’t funny. It’s just obnoxious.

What makes us think that our opinions are so important that everyone needs to hear them all the time? Even if you are a person who is nervous around those who practice the Muslim faith, I don’t think it’s important to share that on a bus, especially not in a way that feels threatening to others. I even feel like it is your prerogative to share your off-the-cuff thoughts (and true beliefs) in your social media feed – fine, go ahead. But directing your snotty or disparaging opinions or, worse, propositions or hate speech, at one particular person or group of people does nothing but make you a bully and a narcissist. Maybe you like Donald Trump enough to emulate him in public, but it is really unnecessary. The world doesn’t need more of that.

Perhaps two simple guidelines can help here.

  1. You don’t need to say every single thing you think. Honestly. If it isn’t going to make the world a better place, if you haven’t been asked for your opinion, if it isn’t kind or supportive, maybe it ought to just stay inside. 
  2. Your thoughts are not facts. I know, sometimes that’s hard to wrap your head around, but just because you think something doesn’t make it right. There are many, many things we can’t know about other people’s lives and circumstances, and if you’re at all unsure of whether or not you know for certain that there even IS a “right” and “wrong” in this particular case, maybe it ought to just stay inside.