Life as an Extreme Sport

Category: …and everything else

Mostly everything else in a brain-academic way.

Vigilante Justice and Gender

...and everything else, Tilting at Windmills

This is via the LATimes:

Like a character from a graphic novel, he dresses in black, has unusually blond hair ”” and kills bus drivers who sexually assault women.

In a place like Ciudad Juarez, known for its years of brutal killings of women, the story has inexorable appeal. But how much of it is true?

Authorities are taking the reports seriously enough to investigate and have posted undercover cops on buses. Women’s advocates say they wouldn’t be surprised if someone finally had taken long-denied justice into his own hands.

Two bus drivers were slain in the last week, and over the weekend an electronic message claiming responsibility was sent to several news outlets.

“You think because they are women they are weak, and maybe they are,” the message says. “But only to a certain point…. We can no longer remain quiet over these acts that fill us with rage.

“And so, I am an instrument who will take vengeance.”

Signed: David, Hunter of Bus Drivers.

The message says women who work the night shifts in Juarez’s enormous maquiladora industry repeatedly fall prey to the bus drivers on whom they must rely to get home in the dark.

For now, at least, there is no way to verify the veracity of the message, whether it was written by the actual killer or killers of the bus drivers, whether David the Hunter really exists, or even whether he is a he.

Of course, that’s not the actual copy – I’ve gone through and changed gender names and pronouns, to make clear the point that Kate Clancy made to David Dobbs on Twitter:

I find it interesting they question the gender of the killer here. Were it a man, no question.

And she’s right. Take another look at the actual paragraph versus the paragraph I modified:

For now, at least, there is no way to verify the veracity of the message, whether it was written by the actual killer or killers of the bus drivers, whether Diana the Huntress really exists, or even whether she is a she.

vs.

For now, at least, there is no way to verify the veracity of the message, whether it was written by the actual killer or killers of the bus drivers, whether David the Hunter really exists, or even whether he is a he.

“Or even whether he is a he” sounds strange to our ears, because we default to a gendered notion of vigilante justice, one rooted in Batman and strong men taking action, rather than the idea of a woman being capable of the violence inherent within the action.

This is the kind of insidious sexism that creeps into even the most progressive or liberal of newsrooms, and is the sort of thing that should be highlighted and pointed out. Those responsible—in this case, Tracy Wilkinson, Cecilia Sanchez, and their editors—should be held accountable for their gendered bias and gendered reporting, in order to move towards the elimination of both.

Revisiting Frontline’s Racial Bias in Stand Your Ground Laws

...and everything else, Politics

Almost a year ago, Frontline ran a detailed article of how Stand Your Ground laws fare when broken down by race, based on the work of the Urban Institute’s Justice Policy Center. The study used FBI data on homicides from 2005-2009 (43,500), singling out the cases of single shooters targeting a single stranger. So, then, with all the data, is there a racial bias in the laws?

Sometimes, a picture – or, in this case, a graph – really is worth a thousand words.

Note: the single problem I have with this study (or at least the single one I can think of right now, but I’m low on both caffeine and sleep) is that the researcher conducting the study did his limitations in such a way (single shooter targeting a single stranger, which worked out to about 5,000 cases) that it seems plausible that many Stand Your Ground cases that have roots in domestic violence have been ignored in the data.

That said, the data is damning, and I doubt adding in domestic violence-related SYG cases would radically change these numbers.

Long-term Antipsychotics May Be a Medical Mistake

...and everything else, Bioethics, Chronic Pain Bites

I’ve debated whether or not to post this since seeing Robert Whitaker’s lecture slides and heard about the results of his talk to NAMI from friends who were there, but ultimately decided that since this is an actual personal issue for many people, due to your own health or those of people you love, it’s worth making sure the information is available as far and wide as possible. Consent to medication needs to be informed, blah blah bioethics stuff.

Before the TLDR, the gist is this: evidence suggests that the best treatment for schizophrenia is not continual medication, and that

a significant percentage of those with schizophrenia who did not receive antipsychotics or took them for a very limited time had better long- term outcomes than those who took them on an ongoing basis.

And perhaps even more importantly, there’s significant evidence that the long-term use of antipsychotics creates a vulnerability to future psychotic episodes.

It’s important to note that Whitaker isn’t saying antipsychotics shouldn’t be taken, or aren’t needed by all people who are on them. But he’s gone over something like 60 years of data, a lot of which is from longitudinal studies spanning 20-30 years, and it looks like fully 50 – 75% of patients could make a complete functional recovery sans long-term antipsychotic use:

Medication compliant patients throughout 20 years: 17% had one period of recovery.

Those off antipsychotics by year two who then remained off throughout next 18 years: 87% had two or more sustained periods of recovery.

The data was so compelling by 1992 that Finland switched to a selective-use of antipsychotics that year… and now has the best long-term outcomes of anywhere in the world. Fully 79% of people – not just schizophrenics, but anyone who might be given a neuroleptic for psychiatric issues – are asymptomatic at five years, with 80% either in school or the workforce.

A lot of the issue appears to be what is known as “oppositional tolerance.” Anyone with chronic pain recognizes the concept if not the phrase: it’s what requires a gradual dose increase in medication to continually receive the same pain management. Essentially, the brain compensates for blocked dopamine or serotonin receptors in two ways. In the case of dopamine, postsynaptic neurons increase their receptors for dopamine as presynaptic neurons increase their firing rate. The opposite happens for serotonin: as the presynaptic neurons decrease their firing rate, the postsynaptic neurons decrease the density of receptors. In each case, the brain is trying to compensate for the effects of the drug being released into the system. Depending on the kind of drug being taken, we change the structure of the brain making it even more (or less) sensitive.

And, in fact, it’s the very recognition of concept that makes me wonder if Whitaker’s results can be extrapolated beyond neuroleptic use for management of mental health related illnesses and into chronic pain management; perhaps it’s better to treat acute instances of pain (“flares”) and then gradually decrease dosing until the patient is off medication than to continually dose the body with drugs “just in case.”Of course, I also have some admitted bias towards this idea, because it matches my experiences. We could easily call this revisionist history attempting to establish narrative control, too.

Anyhow, the very accessible and easy-to-read slides for Whitaker’s NAMI presentation can be found at this link, which includes detailed citations for those who’d like to read the journal literature. There’s also a good mother-of-patient perspective from Kathy Brandt at Mad In America. And if you really feel like having a sad today, you can read Carl Elliott’s comprehensive coverage of the death of Dan Markingson in the Seroquel studies, which should be required reading for anyone contemplating participation of themselves or a loved one in a drug study, or exposure to contemporary antipsychotics.

Rape Kit vs Abortion – Educating Jodie Laubenberg

...and everything else, Bioethics, Politics

One of the first things I saw when I got off the plane in Philadelphia Sunday night, after a trans-Pacific flight, was this statement from Rep. Jodie Laubenberg:

In the emergency room they have what’s called rape kits where a woman can get cleaned out. The woman had five months to make that decision, at this point we are looking at a baby that is very far along in its development.

This is Laubenberg’s justification for why Texas SB5, which seeks to limit abortion services even further in Texas, including banning abortion after 20 weeks (and currently being filibustered by the amazing Wendy Davis), does not have an exception for rape or incest victims.

I’ve seen a lot of statements that Laubenberg is clearly confused, and a lot of very pointed comments about her lack of knowledge on a subject she seeks to legislate – all of which are true. But what I haven’t seen is the very simple differentiation between a rape kit and an abortion. So here, let me make a tiny contribution to the growing body of evidence that Rep. Laubenberg is in no way qualified to sponsor bills on or otherwise discuss rape kits, abortions, or women’s health issues.

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Being Media Savvy Shouldn’t Be Criteria to Receive a Donated Organ

...and everything else

Edited to add: in the time since I wrote this draft post, Kathleen Sebelius stated that she would not grant an exception for Sarah Murnaghan. While I take some issue with Sebelius stating that she prefers a process set by “medical science and by medical experts”, given her ruling regarding Plan B, in this case she is correct. Especially since the Pennsylvania representatives were specifically asking for “an experimental variance.” We have human subjects research protections for a reason.

When people find out that my mother died of non-small cell lung cancer, almost invariably, the first thing they ask is, “did she smoke?”1 It’s a truism that holds today, and it started shortly after she was diagnosed – even from people who should have known better. In other words, every bioethicist, save one, flat-out asked me that. The horror as they realized what they implied right after they said it always amused me, because we as a whole tend to agree with the idea that people shouldn’t be punished with death for mistakes, but there’s still that struggle to identify and name what a person is being “punished” for.

This came to mind today when I read the on-going coverage of a Philadelphia-area family who is protesting the lung transplant guidelines for children because the guidelines are preventing their daughter from receiving a transplant as quickly as she might otherwise. Since an exception isn’t being made for them2, they’re basically pitching a media fit in an effort to get the rules changed – or at least changed for them.3

Solid organ transplants, though, are a matter of scarcity of resources. Approximately 117,000 people in the United States are waiting for an organ at any given time; only about 30,000 solid organ transplantations are done in that same year, and over 6,000 people waiting for transplant will die. You can do the math there. And this notion that organs are a scarce resource does come in to play in how people are selected for transplant: only the sickest adults receive other adult organs. The sticking point for the Philadelphia-area family is that adults who are less sick than their daughter are able to receive donated lungs before she is, because at her age (10), the child needs a donation from another child, significantly lowering the pool of available donors. The OPTN press release goes into very clearly explained details about how this works, and also reiterates the fact that organs are a scarce resource.

So imagine my surprise to get to the end of the philly.com article to see Art Caplan saying that children should be prioritized over adults

because many adult transplant patients need new lungs because of their own actions, like smoking, while children are “non-culpable.”

Erhm. Hmm. Well, it’s a paraphrase of a quote from NBC News. Obviously I should…

Adult lung transplant recipients are frequently people who need transplants because of what Caplan called “bad behavior,” including smoking.

Children should get priority partly because they’re “non-culpable,” Caplan says, but also because he believes that most donors would want their organs to go to kids.

Oh.

Uhm. So, stop me if you’ve heard this one before. Once upon a time, there was this group in Seattle who was set up to decide who should or should not be allowed access to an experimental, life-extending dialysis treatment. They judged men more worthy of receiving this treatment than women. They judged people based on their income and worth, and their religious beliefs. They judged people based on perceived character – and on skin color. As is frequently quoted from the article on the Seattle God Squad,

On the basis of the past year’s record, a candidate who plans to come before this committee would seem well-advised to father [emphasis mine] a great many children, then throw away all his money, and finally fall ill in a season where there will be a minimum of competition from other men dying of the same disease.

This first patchwork attempt at allocating scarce resources led to a lot of things, including modern hospital ethics committees and the criteria for how need is determined in transplant patients – and once a person is on the list,4 who receives an organ is primarily determined by illness, type matching, and distance between the donated organ and the people in need. There are currently 40 adults just within Pennsylvania who are seriously ill and in need of lung transplants; in Philadelphia alone there are three children under 12 who also need transplants – and I doubt anyone is comfortable saying that Murnaghan is more deserving or special because her family has managed to effectively mobilize the media.

Organ allocation sucks. The solution is to not look for exceptions, is not to moralize or justify illness as “punishment” for “bad behaviour”, or to create criteria beyond that which is scientifically and medically sound. The solution is simple: make sure there are enough organ donations for everyone.5