Be Thankful For Small Favors: New Hampshire Is Not Texas

Just when you get frustrated about some lunatic New Hampshire state Representative who believes SMOG is the major threat to Hampton, New Hampshire (sort of like the Dr. Stranglove character, Base Commander, Jack D. Ripper, who thought fluoridated water was the greatest threat to America), you have to get some perspective when you see real life in McKinley, Texas on youtube. However bizarre things may seem in New Hampshire, we do not hold a candle to Texas. 

Really, we have to be grateful to be living in a time when every citizen has a video camera and all the spin and fluff and obfuscation by which police cover up what they actually do in the wild can be quickly exposed.

So much can be seen on youtube which could never be understood in conventional newspaper reports and the limits of print media and of news media can be seen in bold relief when you see the unedited events, the raw data as it were, on you tube. 

There is also a very useful posting with a narrator, Cenk Yugar, of "The Young Turks," who makes no pretense of being non judgmental, but who gives an unusually complete account of what happened.  He does not need to comment on the nature of the white adult women who apparently initiated the altercation at the swimming pool where the episode began. Once you get a look at those white women, no  more need be said. 

The short summary is a Black teenager invited some Black friends to what appears to be a neighborhood pool for a party and white adults using the pool objected to Blacks using the same water. They hurled insults at the Black adolescents, telling them to go back to their Section 8 (welfare) housing where they belonged. (No matter, the Black kids were just as affluent as their white antagonists and in fact, most of them lived in the same neighborhood.) It was just raw racism, which, given the fact this is Texas is not surprising. And once you look at the women who started things by  slapping the adolescents, you do not need a whole lot more explanation. They look like candidates for some of those postings called, "Shoppers At Walmart" which document the extent of American grotesque.

But the best part is when the police arrive and you can see the star of the show, a policeman named Eric Casebolt, is not the sharpest blade in the drawer.  He throws an apparently innocent Black teenage girl in a bathing suit to the ground, pulls his gun and the Black males around her sensibly retreat.  No attempt to discern the facts is made. It is clear for Officer Casebolt the Blacks are guilty of Bathing while Black, Breathing while Black and  Speaking while Black. 

It's all there, bare, unvarnished and very real.

Fred Rice, it turns out, is small potatoes. 

Fred Rice's Alternative Universe

Mad Dog continues to marvel at the functionality of representative democracy. Tonight he attended a meeting called by the Rockingham County planner who has labored for over 5 years trying to get a dedicated bicycle path built from Portsmouth through Hampton all the way past Seabrook to the Massachusetts line. Many communities have accomplished this sort of "Rails to Trails"  project, which allows people, in particular children with their parents, to  bicycle along a bicycle friendly surface with no automobiles around to threaten imminent death to any seven year old who swerves off the path.  Washington, DC has a particularly well developed bike path, far from incursions the maddening automobile, a sanctuary for families on bicycles, and wherever the trail wends its way,  it is filled with parents and children like some latter day village square. Wherever they build it, the people come, on bicycles, spending quality time together. 

But that is not the vision of the representative to the New Hampshire House of Representatives from Hampton, the Hon. Fred Rice, whose mission it is, Mad Dog divines, to protect Hampton from the threat of SMOG.

Downton Hampton, NH As Mr. Rice Sees It

What has apparently eluded Mad Dog is that cars come to idle at the intersection of Rte 1 and Rte 27 and a line of traffic can build up at busy hours, sometimes as many as eight cars long! All those idling engines befoul the air and create a health hazard for the women and children of Hampton.  They are breathing in particulate matter, right there in front of the Old Salt.

Mr. Rice explains there is no way to widen the road there into four lanes, two north, two south, but if the abandoned railroad bed can be purchased as part of the bicycle path Rails to Trails plan, the bypass road be built along that portion which runs through Hampton from  Rte 27, behind the Old Salt clear up to Rte 1 at the bridge to North Hampton, and the problem of Hampton air pollution could be solved, because those cars would not have to idle but could fly along, not polluting the air one bit! Moving automobiles, everyone knows, are even cleaner than bicycles.

Hampton as Mad Dog Sees It

Of course building a road along this stretch of what the planners hoped would be the bicycle path would mean the bicyclists would have to "share the road" with their motorized brethren, but surely this is not too great a sacrifice to ask for clean air. 

Mr. Rice with his Soul Mate

Mad Dog was able to ask Mr. Rice if Mad Dog had understood him correctly: Mr. Rice was proposing to place a motorway smack in the middle of the route of the bicycle trail, cutting off North Hampton from Seabrook with the sound of motors and the smell of tail pipe exhaust along the Hampton stretch of "greenway."  The chairman of the committee intervened to separate Mad Dog from Mr. Rice before Mad Dog could fire off the salvo he so yearned to voice: "Fred, in the over 300 years since Hampton was founded has there ever been one, single day of smog in Hampton, New Hampshire? In what alternative universe are you living?"

Mr. Rice did address the unspoken questions: "Studies are ongoing."

The Dog was dragged off, frothing and growling,  and Mr. Rice excused himself from the meeting. 

Hampton As It Ought to Be

This is the way representative democracy works. Mr. Rice gets elected to represent the citizens of Hampton and he spends a lot of time going to meetings and driving to Concord, where he pursues the things he thinks are important, like smog and air pollution in Hampton and the need for four lane highways through downtown. Meanwhile, most of those citizens he represents are blissfully unaware what his priorities are, what he is hoping to achieve for them. Oh, the apathy! Oh, the indifference to that insidious threat to the quality of life in Hampton, ozone run a muck. 

Some believe we should just humor Mr. Rice, and he will go away.  But Mr. Rice has a history with that intersection of Route One and Route 27.  Rumor has it there was an opportunity to bury all those unsightly power lines which make that intersection look like a power plant, but Mr. Rice scuttled that effort. Aesthetics weren't worth the cost.
And a bathroom, even a port o' potty, for Plaice Cove--Mr. Rice drew the line. He is all about containing costs. 

But smog prevention, now that is worth every penny. 

Flibanserin: Female Libido--Even the Score Fights to Win

J.S. Sergeant Egyptian Girl 

Here's a story which made it above the fold in today's New York Times: "FDA Panel Backs 'Viagra for Women.'"

"The move was immediately hailed by some women's organizations as a step toward sexual equality by, in effect, giving women their counterpart to Viagra, the widely prescribed drug for male erectile dysfunction."

Flibanserin 

"The controversial campaign by some women's groups to win federal approval was waged under the banner Even the Score, which accused the FDA of gender bias because it had approved Viagra and other drugs to help men have sex while leaving leaving women without options."

"Susan Scanlan, chairwoman of the Even the Score coalition, hailed the vote, saying in a statement, 'Today we write a new chapter in the fight for equity in sexual health.'"

Oh, we wrote a new chapter, but I'm not sure it was the chapter Ms. Scanlan describes.

Let us examine the many ways in which wrong has ascended here.

1. The FDA is supposed to function to protect the public health by approving drugs which have met two criteria: 1. They are safe.  2. They are effective. 
The study of 5,000 women in which half got a placebo and half got flibanserin and were then interviewed about how many satisfying sexual encounters they had had during the month was unconvincing on many levels. It is not like you can actually do a blood test and generate a number for the effect of a drug on libido. Many women will report their sexual appetite increases with a martini or two, and that can be convincing testimony, but with drugs we like to measure something beyond recall and testimony. The difference between the two groups was barely one additional night of good sex and there could have been many reasons for that. The placebo group increased their sexual encounters almost as much as the treatment group and that ought to tell us something.

2. The fact the FDA has not approved a drug to improve libido in women who have low libido does not mean the FDA doesn't care about low libido in women; it means nobody in the drug industry, at the FDA, in medicine, in endocrinology or gynecology, in the whole wide world really understands female libido. 
Males are pretty simple: give them enough testosterone and they are looking for action. 
Give women testosterone, or estrogen or any hormone you care to mention and nothing happens. 
We simply do not understand the basic physiology of female libido or the pathophysiology of it's absence.  
So, if women who lack libido were left without options, it was not because of indifference or wrong doing by the FDA.  It was because science has not provided options. The failing, you see, is not a failing of the FDA. Got that? Is that really so difficult?

Flibanserin may act on neurotransmitters, may accentuate the dopamine and dampen the serotonin but nobody really understands if or how these transmitters work in female sexual libido.  
A similar outcry arose in the early days of HIV, when activists cried out the reason there was no cure was nobody cared about gay men dying. That was untrue. The reason there was no cure was the doctors didn't know what to do. Spending more money did not solve the problem; science eventually did. Sometimes money cannot buy insight.  The response of non scientists in Congress to a problem like AIDS or almost anything scientific they don't understand is to vote for more spending, but that's because they are ignorant Congressmen.

3. Flibanserin, even if it were effective at increasing female libido would not be a female Viagra. Viagra and its fellow travelers do not increase male libido. Viagra improves erections. To have good erections you need working blood vessels, working nerves and adequate levels of testosterone. Viagra takes care of the blood flow.  Testosterone is what usually drives libido in males and there is no such agent for driving libido in women.

4. Libido is one thing, but having enjoyable sex is another. Libido is the first step down the road. We understand even less about what drives female libido in chemical terms than we understand about what allows women to achieve orgasm. 

5. Voting for approval of a drug aimed at a problem which vexes women is not the same thing as actually solving that problem, if the drug is ineffective, which, may be flibanserin's problem.  
One of the doctors who voted for approval explained: "The unmet need seems to be so strong that even for a drug with rather modest benefit, I think approving the product ...seems to be the right step at this point." 
Which is to say, "We were taking a lot of heat to approve something, anything, so we caved to political pressure, even though the public health service and the FDA is not supposed to cave to political pressure. We are supposed to do the right thing."

6. People who earn their salaries by winning fights in the halls of Congress or the FDA were able to make this decision not a consideration of the science but a test of intentions and "a fight for equity in sexual health."

The fact is, I wish we had an effective pill for low libido in females. 
I wish we had an effective pill for baldness and for obesity and for breast cancer and for lung cancer and for melanoma and for diabetes and for a whole lot of problems for which we do not have cures or even effective management. 

But you cannot vote a cure for medical problems. You cannot win a fight against inequity in sexual health if there is no science to help you.  Parsing uplifting phrases does not help in medicine. 

We have allowed moneylenders in the temple when it comes to allowing Even the Score to  bully the members of an FDA panel into voting through a medication not because it works, but because it satisfies the needs of the board of directors of Even the Score.  Activists simply do not deserve a seat at the table when it comes to medicine. 

Which is not to say we should not sympathize with their cause. When Act Up picketed Building 32 at the National Institutes of Health, the head of the Institute for Allergy and Infectious Disease was Tony Fauci. (He still is head of that institute.) He walked by the pickets, took the elevator up to his office and asked his secretary why anyone would picket a building at the NIH. She told him, "They're picketing you, Dr. Fauci."  He sent for the pickets and brought the whole lot of them into a conference room and asked them what they wanted and what they expected him to do. 
They told him the reason there was no cure for AIDS was nobody cared about patients who got AIDS because it was thought of as a gay disease. 
Fauci replied he had a lot of very good scientists who were working hard on an antiviral agent both on campus at the NIH and spread out across university health centers across the country. He described the units he had set up at the Clinical Center where patients with AIDS were dying in beds attended by nurses and doctors who were risking their lives just starting IV's and doing routine care on those patients. "If you think nobody cares, you've never talked to any of the men or women who come to work every day at the Clinical Center." 
The activists listened and were convinced. They came as angry men and women with a cause; they left Fauci's office understanding anger and passion are not the answers in medicine. They had been educated in the reality of disease and the realities of medical care.

Someone should do the same for Even the Score. 

Stepping Through the Time Portal: You Really Can't Go Home Again

So we beat on, boats against the current, borne back ceaselessly into the past.
--The Great Gatsby

At some point, probably when your own children are beyond schools and into careers and families and other people, your own past seems less important.  Scott Fitzgerald's most famous book was about a man who was ruined by his past, who could never get beyond it, but that was a pathology, a case of arrested development. 

For most people, the past does not constrain them, if they are lucky and healthy.  Deangelo, in "The Wire" reads Gatsby in prison, and immediately understands it, because he has not been able to move beyond his own past--prison, after all, is a place you are mired in the past; you are there because of things you did in the past.

The Times has been carrying obituaries of men in their late 80's and early 90's who were accused of Holocaust related crimes, but despite the determination to Never Forget, the fact is memories are fading, less so for the victims no doubt, than for the perpetrators, who may well have managed to bury and destroy memories of what they did so long ago.

People who struggled to be the winners in the game of elite educational meritocracies often cling to the past--there are those Princeton grads who will only marry other Princeton alums believing that part of the past is so important it ought to be prologue, but they are clearly clinging to a neurosis.

For most healthy people, you go through each phase of life and you take what you can from the experience, then move on, and realize, that is now behind you. That old story about the Yale coach who tells his players before the Harvard-Yale game, "Gentleman, you are about to play Harvard: If you live to be 90, you will never do anything more important than what you are about to do in this game today," was enunciating the conceit of the Old Blues who wanted to inflate the importance of a Yale education, when in fact, it was just four years at college, and for most people only marginally formative and not really life changing. William F. Buckley was particularly pathetic as he injected his Yale pedigree into every conversation to remind his listeners he was an aristocrat and one of the chosen--of course, his own pathology was transparent. 

The emphasis on schools and creating a record which will follow you through life is specious--the fact is, that great school record simply gets you from point A to point B. Once you start that next school, grad school or professional school or once you start that job, you start over, and what came before really doesn't matter much and cannot hurt you or save you.

Some of this desire to connect to the past may be at play as people visit their dead in cemeteries. There is the desire to hold on to what is actually now gone, alive only in memory. But there is no boat bearing us back. When you walk around places which were important to you in the past, it may bring those memories back vividly, but there is also the empty feeling of realizing even though the physical shell of a building may be there, it is no longer alive; that school yard or church or coliseum is just an empty husk, the hollowed out remnant of the living organism.  

We are not, should not be, borne back ceaselessly into the past. We move forward, and the wake remains behind us. The effort to return is the effort to claim something enduring in the face of impermanence. 

Scott Walker's Really Cool Sonogram Idea

Not a Real Cowboy

Gail Collins alerts us to a remark by the governor of Wisconsin, Scott Walker, who is running for President, in defense of his support for a law which requires a woman who is scheduled for an abortion to undergo a sonogram, so she can see what it is inside her she is "killing."
Of course, the intent of this law is confront the woman with something that looks alive, looks human, looks like a miniature baby, so she will decide against the abortion.

Not An Actual Calf

But Scott Walker denies he is trying to shame or guilt anyone, and he points out that sonograms of pregnant uteri are done all the time and parents carry them on their smart phones and post copies on their refrigerators, which is a really cool part of pregnancy. The parents start bonding at six or eight weeks with their unborn children.

The problem is:   sonograms are not babies. 

They may, with some imagination, look like babies, but they do not actually even look a lot like what is inside that uterus, which is about the size of a lima bean and very red and undifferentiated looking. 

Clouds may look like babies, or cowboys or calves but they are none of these things. An image is not the object it looks like. It is just an image. 

Not An 8 Week Fetus

Sonograms magnify and schematize the objects they penetrate.

6 weeks

Not to mention, they are black and white, except for the Doppler flow parts, which are orange and blue.  They require a mental reconstruction to make anyone bond with them. 

8 weeks

As the fetus gets older, the sonogram may look more like a baby, but what they are actually imaging would surprise most people, if they actually saw the real thing imaged--at 6 weeks the conceptus looks more like a red lawn grub, fairly difficult to imbue it with much humanity, on a visual basis.

7 weeks 

And the photos here do not even really convey how much like a clot of blood much of this material actually looks like. 
Having said all this, I'll never forget seeing a 21 week fetus delivered in what was then called a "salting out" procedure when I was a medical student. That  looked like a baby to me. The procedure which was done in those days was called an "abortion" but it looked more like infanticide to me. The fetus could not have survived outside his mother's body in those days, but the reason it was outside his mother's body was because they had pumped in a concentrated salt solution into the uterus.  I found that profoundly disturbing. They whisked the thing away from the operating room so the mother did not see it. I could see why. I stood in an adjoining room with it and half expected it to take a breath. Of course, if it had been anencephalic (without a brain) I would have hoped it would never take a breath. Some deformities are so horrific, you just think it a blessing if that breath is never taken or is it's last.  

8 weeks

So, I am not in favor of everything which is called an abortion. As my favorite ethics professor once asked me, "If you meet a fetus on the way down the birth canal with a scalpel, is that an abortion?"

His point was the difference between an abortion and infanticide is all about drawing lines. 

One way of doing that is to try to assess how much potential the conceptus has actually realized and how much it is just a mass of tissue with a lot of potential, mostly unrealized. 

But showing untutored women ultrasound images is an exercise in deception. You can instruct her however you want but they haven't really been educated until they've seen the real tissue. 

The reason parents are shown all those ultrasounds in their private obstetricians' offices?  Commerce, not medicine. There is demand for those ultrasounds, but most often, no good medical reason for doing them--unless you are looking for substantial abnormalities, which might prompt a decision for...abortion.

There are no easy answers, when it comes to abortion. The only real answer is we are poorly served whenever we have simple, mindless answers. Those are almost always wrong.

One of the great virtues of absolutism is clarity and elimination of ambiguity:  If you believe life begins at the two cell conceptus, that makes everything an abortion after conception. It's simple, clear and, at least to my mind, incorrect.

Likely 40% of conceptions are lost early, before more than a thousand cell divisions, before the mother is even aware she is pregnant. Is this a natural process wasteful of life? And, if you're Catholic, what about all those souls who have not been given last rites (because nobody knew they existed in the first place)?

Abortion is not one of those topics which affords a lot of middle ground. Never has. For centuries, defining when life begins has vexed theologians. Scientists do not define when life begins. They simply describe what they see. But sometimes, what they see is not what you think you see. 

The Fig Leaf Comes to Hampton

 Let's talk about breasts. The best discussion I've ever heard about breasts was not in medical school, but from Lewis Black, who observed, in his best exasperated style, that most breasts are pretty, whether large or small, and he was perplexed about why women would undergo augmentation procedures.

Friends who are not doctors, male friends, occasionally ask me how I can resist getting turned on by my female patients, especially when I examine their breasts. Women, of course, never have to ask that question.  There is nothing arousing about a woman who is worried she might have breast cancer, and when you are focused on finding something nasty, and examining a breast and probing for lymph nodes in an arm pit, it is nothing close to an erotic experience. Frightened women are not a turn on. 

"Let me ask you, " I  usually reply, "Would a breast laid out on a stainless steel tray arouse erotic thoughts in you?"  The fact is, there is a woman attached to a breast when it becomes arousing and it is her attitude which is arousing, not the physical object, the breast.

Which brings us to a piece of folk art, a sand sculpture,  which appeared recently, on Rte 27 just before The Old Salt,  on a private lot.

The sculpture, a  mermaid, was a bit of whimsy and kitsch, and I liked it. She may have looked sensual, with her hand behind her head, and her face uplifted, but it was the pose, not the bare breasts which conveyed any sort of erotic or sensual content.  That mermaid looked happy to be in Hampton, in the water, soaking up the sun, enjoying the pleasures of our clean water, our clear, invigorating air, the sparkling, rocky beaches which we love. 

Today, however, the mermaid has acquired a bikini top or bra or fig leaf or whatever it is, and one wonders how that happened. Well, we know how what happened--there was a guy out with a trowel, apparently, but the question is: Why?

We ought to write letters to the editor, organize a protest.  Picket. Bring it up with the town elders.  Children pass by that sculpture on their school buses on the way to Marston, Hampton Academy, Winnacunet High. They have seen art defaced! This is what ISIS is doing in Syria, destroying art, defacing sculptures. 

Today, it's a mermaid in a bra; tomorrow it could be veils and head coverings for all females!  Then covered ankles and pretty soon all we'll see of women in Hampton are their eyes. 

And what of Madame Liberty?

I have an old silver dollar, (not the one shown, but like it) I've been saving, at home. Will the Hampton Police come for me in their black helicopters?  

My coin is from 1986. No so valuable

First it's breasts, then they'll come for our guns!

How quickly things get out of hand. 

Gail Collins and Andrew Jackson and the $20 Bill

Gail Collins continues to hammer away at the $20 bill:  She argues Harriet Tubman ought to replace Andrew Jackson.

On a recent visit to Nashville, where Andrew Jackson's statue is prominently displayed, or more accurately, where many different Jackson statues are displayed, Mad Dog inquired with locals about their feelings: Aude alterum partum (hear the other side), that's Mad Dog's motto. Mad Dog was surprised to hear Mr. Jackson has his detractors, even in Nashville, which, it must be admitted is a blue island in a sea of Tennessee red. Fact is, Mr. Jackson killed enough of his fellow citizens in duels to engender much resentment among many of Nashville's local families. Nothing like shooting a great grandfather in the head to leave a bad impression.

Beyond that, General Jackson was the first and most effective American advocate of ethnic cleansing, moving Indians out of their Eastern habitat along "The Trail of Tears" which made the Bataan Death March look like a Sunday school picnic. Four thousand Indians died along the way, by somebody's count.  Suffice it to say, portraits of President Jackson do not adorn the lodges and casinos of native Americans.

Mad Dog is proud to report New Hampshire's own Jeanne Shaheen has recommended the convening of a commission to recommend a replacement for President Jackson on the $20 bill and Gail Collins likes Harriet Tubman for the spot.  Ms. Tubman risked life, limb and liberty by returning to the slave South and guiding many slaves along the underground rail way to freedom. (Presumably, Fred Rice would have paved that rail way to reduce air pollution, but that's another story.)

For Mad Dog's money, it would be Jane Addams, but this is mostly because Maud loves her so: Hull House, a place of kindness and compassion amidst unfeeling and hostile environs, and she earned J. Edgar Hoover's designation as "the most dangerous woman in America." Anyone who made J. Edgar froth and foam at the mouth has got Mad Dog's vote.

Whoever replaces President Jackson, she can hardly be worse than a slave owning, genocidal killer.

While we're at it, the commission might consider replacing Washington and Hamilton, one a slave owner and the other a banker. We could do better. Elizabeth Cady Stanton and Clara Barton should not be forgotten. 

Personally, I'd put in a vote for Emily Dickinson, although I cannot spell her name reliably, or Gloria Steinem, another spelling problem, but a worthy woman.