News & Views

Quick takes on news stories, newly released research and new ideas of all kinds.

 

July 25, 2017 So Senator McCain, American Hero, came riding into Washington on his big white horse yesterday with the mission of saving the Republican “health care” vote – the vote to begin passing a bill that will take health care away from millions of Americans. Did he see the irony? He is getting cancer treatments that cost hundreds of thousands of dollars and he wants to deprive his fellow Americans of access to primary care. Some hero.

July 23, 2017 McCain, war and the human condition. I just read this thought-provoking article by Bob Tedeschi: “McCain was a warrior. But is that the right metaphor for his struggle with cancer?”  The comments at the end are important to read; people living with cancer speak out about wishing to die with dignity, and how the ‘battle’ language demeans their experiences.

All humans are mortal; we all die. So are we all “losers”? To my mind, this is the flip-side of the dangers of “pinkwashing” breast cancer. We end up with a devil’s choice between: ‘breast cancer isn’t so bad; it’s a natural life stage for women’ and ‘real warrior women beat cancer; it’s only the weak who “give in” or “succumb”.’ Two equally bad choices.

When I read the article about McCain I remembered how Trump belittled McCain during the campaign, saying he (Trump) likes “winners” and that McCain’s history as a POW makes him a “loser”.

Overall, we as a nation are far too attached to military metaphors (and actions). I wrote about this in relation to the Ebola outbreak in Africa here: “Why Can’t US Help Solve Ebola Outbreak without ‘Waging War’ and ‘Sending Troops’?

July 21, 2017 (a busy day in the world of misogyny) This article about a Tennessee judge offering prisoners 30 days off their sentences in return for sterilization seems to have flown under the radar.

I find this problematic on many levels. First, note that a far higher percentage of women than men “consented” to the offer. This suggests to me that more pressure was put on women.

Second, true consent is not possible in a prison situation: any “request” is by definition coercive.

Third, this idea suggests that prisoners are genetically damaged and that it’s in the interest of the state to limit their breeding potential. We’ve been down this path in the US with the racist eugenics movement (that also picked on people with disabilities as “unfit to breed.”

Fourth, this plan too easily leads to a slippery slope. Why not offer prisoners a deal of early release in return for being a “good citizen” and donating a kidney? Or a retina?

And last but not least, the whole idea is unconstitutional.

July 21, 2017 please read this article by Sarah Boseley in The Guardian  “How Trump signed a global death warrant for women”. And be sure to look at the photo. In this case, a pictures does tell a thousand words, and they are all bad.

The experts interviewed by Boseley carefully explain how the radical anti-abortion rule will lead to deaths of women, infants and children around the world, and particularly in Africa. Not to be snide (okay, I’m going to be snide), maybe that’s why Steve Bannon seems to be trying hard not to laugh in the photo.

July 21, 2017 Responsibility without authority makes people sick is a theme I’ve thought about and written about for a long time (“Bitch at the Welfare Office” and What Makes Women Sick: Maternity, Modesty and Militarism in Israeli Society). Today I came across an article – in USA Today of all places! – illustrating this insight vis-a-vis women who work at Hooters and similar places. Citing research by  Dawn Szymanski and Renee Mikorski, the article states:

“The researchers concluded that women who work in “sexually objectifying restaurant environments,” where they wear revealing clothing and are encouraged to flirt with customers, were at greater risk for anxiety and eating disorders. That was not only because their bodies were displayed and scrutinized, in some instances with their appearance “graded” by customers and supervisors, but also because they lacked power at work to control their own environment, such as with sexual harassment.”

Using the responsibility vs. authority model, I see this as a dramatic instance in which women have the responsibility to please customers (a burden on wait staff everywhere; after all, who gets blamed if the food is late, cold, bad, misrepresented on the menu, etc.) in manners that go beyond simple food service. Hooters waitresses are responsible for looking good and behaving suggestively but not aggressively sexy. But they have no authority over anything that goes on in the restaurant. Indeed, in the USA Today article the point seems to be made that the waitresses are not even empowered to defend themselves against aggressive customers; rather, they are expected to rely on management to take care of the situation.

No power over policies but tons of blame for anything that goes wrong: that sure does sound like a formula for making people sick.  Not just a theoretical musing — I suspect that this dynamic is the fertile ground for the upsurge of opiate addiction and overuse at this time in history.

July 19, 2017 Women, water and zika Right after I posted my thoughts on the Human Rights Watch report on how Zika impacts women and girls I came across this article on a UNICEF report that 2.1 billion people around the world do not have consistent access to clean, safe water in their homes. Bethany Caruso at Emory University goes on to make the point that women continue to carry most of the zillions of gallons of water that need to be lugged from public pumps and other less suitable sources everyday.

Made me think how this likely makes women more vulnerable to mosquito vector diseases such as Zika.

July 14, 2017 Trump, Congress and Health Care A lot going on under the radar. As the news follows every political maneuver around ‘repeal and replace’ (or now, just plain ‘repeal’) the Trump administration is quietly going about their business of undermining women’s health and human rights.

According to a report by Jane Kay, “The Trump administration has quietly axed $213.6 million in teen pregnancy prevention programs and research at more than 80 institutions around the country. … Among the programs that lost their funding: the Choctaw Nation’s efforts to combat teen pregnancy in Oklahoma, Johns Hopkins’ work with adolescent Apaches in Arizona, the University of Texas’ guidance for youth in foster care, the Chicago Department of Public Health’s counseling and testing for sexually transmitted infections and the University of Southern California’s workshops for teaching parents how to talk to middle school kids about delaying sexual activity.”

“Health officials say cutting off money midway through multiyear research projects is highly unusual and wasteful because it means there can be no scientifically valid findings. The researchers will not have the funds to analyze data they have spent the past two years collecting or incorporate their findings into assistance for teens and their families.”  Read the full article here.

Not to be too snarky (oh, alright, I’ll be snarky), I wonder how this will impact Trump’s beauty pageants. One would think that teen pregnancy isn’t exactly a selling point for Miss America.

July 11, 2017  VA Cuts This week the Department of Veterans Affairs announced that the VA has fired 525 employees since President Trump took office in January.  These cuts are hard to understand coming at a time in which there are waiting lists for services at VA facilities around the country and calls for the VA to add more providers and facilities. The list of people fired included physicians, nurses and other trained staff.

The cuts are consistent with the Administration’s interest in privatizing or outsourcing the VA.  Privatization proponents argue that private sector is more cost-effective, but it’s hard to see how for-profit entities can provide services at lower costs (after all, someone is profiting in a for-profit entity) other than by providing lower quality services – an ambition greatly helped along by deregulation. The other pro-privatization claim is that the government can’t do anything right. This is an odd claim vis-à-vis veterans who risked their lives and their health to serve their country in the context of government-run military units.

The Administration and Republican Congress tout “personal choice” in health care, and are pushing to expand the use of health care vouchers for veterans rather than expand the VA. But in the 21st century, medical diagnoses and treatments are so complicated that few of us can make truly informed choices.  Rather, we rely on our providers to make those choices for us, and that’s why we want to know that our providers are knowledgeable about our particular conditions.

Veterans organizations have it quite clear that they want to receive coordinated health and social services from providers who are expert in the care of veterans and informed about the latest diagnostic and treatment standards in traumatic brain injuries and PTSD. They also want to receive care in settings where they can connect with their brothers and sisters-in-arms. In other words, they want a stronger and better-funded VA, not a privatized hybrid with vouchers that will make them responsible for figuring out which doctors actually know how to treat the aftermaths of military life.

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July 11, 2017 Nurses on Strike The Tufts nurses are on strike (see my comment on July 7.) I fully support the nurses. They are the front line workers with the ongoing patient contact. They know what they need to do their jobs properly.

I find it particularly troubling that the nurses announced a two day strike, but the hospital has locked the striking nurses out for five days. Tufts President and CEO Dr. Michael Wagner said that the hospital will not even return to the negotiating table before then.

This story gives a pretty good, brief overview of the issues.

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July 10, 2017 Delay in Home Health Care Regulations  A small news story caught my eye today — it’s a dramatic case in point regarding differences of approach regarding government regulations (one of the hot button complains of conservatives). The Trump Administration announced that they will push back Obama-era regulations governing home health agencies that was set to go into effect this week. This will impact that more than 5 million seniors and adults with disabilities receive care through home health agencies. Until now, there has not been a whole lot of oversight or quality control of these agencies, although most Americans express preference for remaining at home through illness and old age. The regulations lay out conditions that home health agencies have to meet to be reimbursed by Medicare and Medicaid. Basically, agencies will be required to inform patients of their rights; will have to notify the patient, caregiver, and physician any time a change is made to their care plan; and will require agencies to evaluate a caregiver’s ability to help out and their schedule when creating a patient’s care plan.

These measures are pure commonsense. In fact, it’s appalling that these regulations were not put in place half a century ago.  I should think all of us would like to know that a home health aid knows our treatment plan and is actually capable of carrying it out.

The push-back is part of a broader Republican opposition to what they consider “excessive government regulations.” While it’s always seemed to me that the role of government is to safeguard the well-being of citizens, the Republican claim is that regulations “kill” jobs. Regarding home health agencies, it’s hard to see that regulations would kill anything. To the contrary, the absence of regulations is far more likely to be fatal.

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July 9, 2017  Repeal and Replace is BAD for Mississippi: Just published in the Hattiesburg (Mississippi) American:  For Mississippi, the Senate bill would spell disaster

In the article I explore how the Republican health care bills would impact folks in Mississippi, a state in which I’ve been doing fieldwork for more than ten years.

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July 7, 2017  Nurses May Strike  I just read that the Tufts nurses are back at the negotiating table. The news coverage of the negotiations and the potential strike has been bothering me.

Tufts announced that the strike would not hurt patient care because the hospital would bring in other nurses. Does the hospital administration really think that a thousand or so temps who don’t know the hospital, its protocols, its patients or its doctors actually can give the same level of care as the long-time Tufts nurses? And where does the hospital think these new nurses will be found? Last I heard there is a shortage of trained and experienced nurses in the US and most of the world. Finally, it’s deeply troubling that a major hospital would turn to “scabs” when we know that unions historically have been responsible for everything from living wages to safe working conditions.

The public conversation focuses on how a strike would or would not hurt patient care. The nurses tend to be presented as “selfish” for wanting a reasonable contract. But over the past decades, nurses’ unions have been as much about patient care as about the nurses themselves. Nurses argue – and rightly so — that nurses deserve good pay and benefits, but their demands equally focus on the need for appropriate and robust staffing.

As anyone who has spent time in hospitals knows, nurses pretty much run the in-patient wards. Doctors pop in, but nurses keep the wards running. However, wards tend to be chronically understaffed. I hear from nurses their frustration with hospital decisions to place only one or two registered nurses on wards per shift, and then to fill out the staffing with assistants. Typically, these assistants have had a couple months (or even less) of training. The result is that nurses spend nearly all of their time supervising and doing paperwork (assistants cannot sign off on charts, etc.) rather than doing the actual nursing work they trained to do.

Studies repeatedly show high levels of burnout among nurses as well as high levels of workplace injuries. This is bad for nurses and bad for patients.

I hope Tufts does the right thing and ensures that nurses have the wages they deserve, the working conditions they require in order to do their jobs well, and a full say in hospital policies.

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July 5, 2017 The Medicalization of gender violence: I just came across a recent study by Paige Sweet of the University of Illinois. Her work addresses the under-the-radar issue of medicalization of gender violence. “Based on interviews with domestic violence medical advocates and health-care providers, I show how domestic violence is being transformed into a chronic disease category . … rather than patriarchy, advocates now explain domestic violence using the language of risk.”

Sweet’s findings resonate strongly with my on-going work with criminalized women. Despite the fact that most of them recognize that the vast majority of incarcerated women have experienced sexual violence, they are schooled to believe that their own victimization was somehow extraordinary – that they personally suffer from a combination of bad luck and poor coping skills.

The full reference for Sweet’s study: Paige L. Sweet, “Chronic Victims, Risky Women: Domestic Violence Advocacy and the Medicalization of Abuse,” Signs: Journal of Women in Culture and Society 41, no. 1 (Autumn 2015): 81-106.


June 27, 2017  Women, girls and the opioid epidemic  An article today in the American Medical Association’s blog makes the point that, “The face of the U.S. opioid epidemic is becoming increasingly white and increasingly female, just as it was some 135 years ago. … While the science and thinking behind addiction medicine has evolved since the 1880s when upper-class women became dependent on the laudanum tinctures prescribed by their physicians, opioid-use disorder treatment still remains mostly gender neutral—even though the impact and effects of the disease clearly are not. The impact of the epidemic has been severe for both males and females, but statistics show greater harm occurring among women and girls. Chief among these are overdose deaths from prescription pain killers. Between 1990 and 2010, these deaths increased among men by 265 percent, while the number grew by 400 percent among women, according to the Centers for Disease Control and Prevention (CDC).”  Read the full article here.

In matters of health – as well as in matters of criminalization — both race and gender are always at play. Yet we walk a fine line between ignoring the real power of race and gender inequality, on the one hand, and over-emphasizing race or gender differences, on the other.  The reality is that both race and gender are social constructions, that men’s and women’s bodies are far more similar than different, and that class mitigates both race and gender status.

The AMA article makes important points about rising rates of addiction among women and girls, yet also could be seen as suggesting that women are psychologically weaker or more likely to be emotionally “sick” than are men. Along the same lines, the focus on white men and women may persuade some politicians that the war on drugs is not the answer to substance abuse, but that has not translated into policies that end the mass incarceration of African Americans.