Category Archives: skepticism

science gone wrong, pt 1: are vaccines really causing higher infant mortality rates?

This study, purporting to show that greater numbers of vaccines in the first year of life are associated with greater risk of infant mortality, came across my radar recently. I thought I’d take a moment to look at it in part of a series of posts on the emotionally fraught relationship between science and our everyday lives. This post is the one that has the most to do with parenting; the ones that follow will be more about a health scare I had recently and some of the changes it’s wrought on our life.

Neil Miller and Gary Goldman claim to have found a correlation, on a population scale, between the number of vaccines children receive in the first year of life in a given country and that country’s infant mortality rate. (Full text of the paper in PDF here.) Their work is riddled with conceptual and procedural problems, and of course whenever someone asserts a correlation without establishing a concrete causal mechanism, we should be skeptical. (Using the phrase “synergistic toxicity” over and over again does not count as establishing a causal mechanism.) But since this kind of “research” frequently gets turned into news items that get circulated among worried parents trying to make good decisions for their kids, I thought I’d delve into it a little bit, leaning gently on a couple of excellent analyses from David Gorski at Science-Based Medicine and Catherina at Just The Vax.

A summary of the problems addressed by Catherina and Dr. Gorski:

1. The paper is inconsistent in its definition of a “dose.” Catherina lays it out neatly:

[T]he way Miller and Goldman are counting vaccines is completely arbitrary and riddled with mistakes.

Arbitrary: they count number of vaccines in US bins (DTaP is one, hib is separate) and non-specific designations (some “polio” is still given as OPV in Singapore), rather than antigens. If they did that, Japan, still giving the live bacterial vaccine BCG, would immediately go to the top of the list. That wouldn’t fit the agenda, of course. But if you go by “shot” rather than by antigen, why are DTaP, IPV, hepB and hib counted as 4 shots for example in Austria, when they are given as Infanrix hexa, in one syringe?

Mistakes: The German childhood vaccination schedule recommends DTaP, hib, IPV AND hepB, as well as PCV at 2, 3 and 4 months, putting them squarely into the 21 – 23 bin. The fourth round of shots is recommended at 11 to 14 months, and MenC, MMR and Varicella are recommended with a lower age limit of 11 months, too, which means that a number of German kids will fall into the highest bin, at least as long as you count the Miller/Goldman way.

(If you’re bored and want to check their work, here are the vaccine schedules from Europe that Miller and Goldman claim to have relied on. They cite UNICEF’s website as their source for non-European countries, although, since they don’t provide a URL for a specific page on the site, I’ve been unable to find that data.)

The definition of a “dose” is critically important here. If you want to entertain the hypothesis that vaccines are in some way “toxic” because of, for example, preservatives or other foreign material, then the number of antigens matters less than the number of shots or vials. On the other hand, if you want to say that the antigens are the toxic substance, then as Catherina points out you have to account for different levels of antigens in different types of vaccines for the same diseases. Miller and Goldman’s vague and confusing approach does little to tease out or account for these differences.

2. Countries don’t all count dead infants the same way. Dr. Gorski quotes Bernardine Healy, former director of the NIH:

[I]t’s shaky ground to compare U.S. infant mortality with reports from other countries. The United States counts all births as live if they show any sign of life, regardless of prematurity or size. This includes what many other countries report as stillbirths. In Austria and Germany, fetal weight must be at least 500 grams (1 pound) to count as a live birth; in other parts of Europe, such as Switzerland, the fetus must be at least 30 centimeters (12 inches) long. In Belgium and France, births at less than 26 weeks of pregnancy are registered as lifeless. And some countries don’t reliably register babies who die within the first 24 hours of birth. Thus, the United States is sure to report higher infant mortality rates. For this very reason, the Organization for Economic Cooperation and Development, which collects the European numbers, warns of head-to-head comparisons by country.

Miller and Goldman claim to have accounted for these differences and quote a CDC paper which says that “[I]t appears unlikely that differences in reporting are the primary explanation for the United States’ relatively low international ranking.” Of course, this statement in itself is quite vague, giving no idea what percentage of the difference in rankings the reporting problem plays. But it also begs the question, “What is the primary explanation?” The same CDC paper gives a perfectly reasonable answer, to which we shall return later.

In the meantime, this paper commissioned by the Congressional Budget Office on the subject of America’s seemingly awful infant mortality stats provides more detail on the difficulties of accurately comparing IMRs:

In countries where physicians are more aggressive about attempting to resuscitate very premature newborns — of which the United States is probably the leading example — extremely small neonates are more likely to be classified as live births than in countries with less aggressive resuscitation policies. Thus, for example, if little attempt is made to resuscitate newborns weighing less than 500 grams (1 pound, 2 ounces), these births may be classified as fetal deaths and not be included in either the live birth or the infant mortality statistics. By contrast, when attempts are made to resuscitate the tiniest newborns, they are more likely to be classified as live births, although most will subsequently die and then be included in the infant mortality statistics.

(We’ll get back to this idea of aggressive treatment in the final section.)

3. Miller and Goldman selected data from a single year, 2009. But why? Surely an analysis over multiple years, or multiple decades, would be more useful. We could be more certain that the IMRs in 2009 weren’t some sort of statistical fluke. And we could watch IMRs move (or not) according to changes in vaccination schedules. As Catherina points out,

For example, in the early 1980ies, Germany’s infant mortality was about 5 times as high (10000 infants died per year) than it is today (2000 died in 2009 with approximately the same birth rate), however (in Miller’s and Goldman’s twisted logic), the vaccination schedule contained far fewer vaccines in the first year (essentially just DT and polio, since the whole cell pertussis was not given between 1974 and 1991, the aP not yet introduced, the MMR given in year 2, no hib, nor hepB, nor PCV given either), while Germany was already very much a “developed country”.

4. Miller and Goldman do not consider the whole world. It’s tempting to say that they’re on stronger ground here — that you want to compare wealthy, industrialized countries to other wealthy, industrialized countries. But they don’t seem to be particularly interested even in other industrialized and/or wealthy countries whose IMRs fall below that of the U.S. — say, countries in Eastern Europe, or the wealthy Arab states — to see whether their correlation holds up further down the list. Gorski:

[S]ince the focal point of the analysis seems to be the U.S., which, according to Miller and Goldman, requires more vaccine doses than any other nation, then it would make sense to look at the 33 nations with worse IMRs than the U.S.

Be that as it may, I looked at the data myself and played around with it. One thing I noticed immediately is that the authors removed four nations, Andorra, Liechenstein, Monaco, and San Marino, the justification being that because they are all so small, each nation only recorded less than five infant deaths. Coincidentally, or not, when all the data are used, the r2=.426, whereas when those four nations are excluded, r2 increases to 0.494, meaning that the goodness of fit improved.

In other words, even among the countries above the U.S., Miller and Goldman cherry pick the data, dropping small countries that don’t make the data fit the way they want it to. (4 countries out of 33 is an 8th of the data being excluded, in case you were counting.)

Are these decisions reasonable? Would including Russia or Andorra have made the data clearer, or muddied the waters? I’m not sure, but in light of other methodological decisions, this is questionable at best.

5. What’s with the grouping? Why sort the countries into groups based on the number of vaccines, and then plot the average IMR of each group, instead of just plotting all the data points separately? Gorski again:

[F]or some reason the authors, not content with an weak and not particularly convincing linear relationship in the raw data, decided to do a little creative data manipulation and divide the nations into five groups based on number of vaccine doses, take the means of each of these groups, and then regraph the data. Not surprisingly, the data look a lot cleaner, which was no doubt why this was done, as it was a completely extraneous analysis. As a rule of thumb, this sort of analysis will almost always produce a much nicer-looking linear graph, as opposed to the “star chart” in Figure 1. Usually, this sort of data massaging is done when a raw scatterplot doesn’t produce the desired relationship.

Indeed. Of particular note is Group 2, countries with a vaccination schedule of 15-17 “doses” in the first year. Group 2 only includes 5 countries, and one of those countries is Singapore, which has the best IMR in the world (2.31) and calls for its infants to receive 17 vaccines doses in their first year, according to Miller and Goldman’s counting. Because Group 2 is so small, Singapore is clearly dragging down the average IMR of the whole group — from 4.30 to 3.90. Take out Singapore, which is clearly an enormous outlier, and Group 2 has about the same IMR as Group 3, which makes the linear relationship a lot less neat. Also, 4.30 is very similar to Denmark’s 4.34, and Denmark only requires 12 vaccines in the first year. And speaking of Singapore, if this linear correlation based on vaccination schedules is so strong, why does Singapore have such a drastically low IMR with 17 vaccine doses in the first year, when Italy and San Marino have drastically high IMRs (5.51 and 5.53, respectively) with only a single dose more (18) per year? Naturally, there will be outliers in any linear regression, but it seems that when you get done smoothing out the outliers here by dropping data points and sorting the data into bins, you’ve essentially hidden half the statistical reality.

6. They fall prey to the “ecological fallacy.” Gorski once more:

The ecological fallacy can occur when an epidemiological analysis is carried out on group level data rather than individual-level data. In other words, the group is the unit of analysis. Clearly, comparing vaccination schedules to nation-level infant mortality rates is the very definition of an ecological analysis.

In other words, measuring correlations between variables on the population level tells you nothing about the correlation on an individual level, and indeed is likely to vastly overstate the likelihood of such a correlation. For example, let us suppose that Italians have fewer heart attacks than do Englishmen, and yet eat pasta at a much greater rate. Can we conclude that pasta is preventive against heart attacks? No, because, among other things, you haven’t demonstrated that the pasta-eating individuals in the Italian population are the ones getting fewer heart attacks. Perhaps there’s a smaller subset of Italians who eat hardly any pasta at all, yet get plenty of vigorous exercise, and therefore drag down the national average incidence of heart disease.

Similarly, if you want to find out if a heavier vaccine schedule in the first year correlates with higher infant mortality — or, to be even more specific, whether it correlates with higher rates of SIDS, since Miller and Goldman argue that SIDS and unexplained deaths caused by vaccine “toxicity” are probably the real culprit here — you should do a study following outcomes for individual kids who receive different schedules of vaccines. Trying to track a phenomenon, if there is one, by comparing different whole populations is both inefficient and brutally error-prone.

To their credit, Miller and Goldman attempt to address this problem in a section titled “Ecological Bias.” To their discredit, their explanation is simply awful:

Although most of the nations in this study had 90%–99% of their infants fully vaccinated, without additional data we do not know whether it is the vaccinated or unvaccinated infants who are dying in infancy at higher rates. However, respiratory disturbances have been documented in close proximity to infant vaccinations, and lethal changes in the brainstem of a recently vaccinated baby have been observed. Since some infants may be more susceptible to SIDS shortly after being vaccinated, and babies vaccinated against diarrhea died from pneumonia at a statistically higher rate than non-vaccinated babies, there is plausible biologic and causal evidence that the observed correlation between IMRs and the number of vaccine doses routinely given to infants should not be dismissed as ecological bias.

[emphasis mine]

So after admitting that they have in no way correlated these higher rates of infant mortality with actual vaccination on the individual level, Miller and Goldman attempt to razzle-dazzle the reader with a lot of scary-sounding stuff. But, for example, the “lethal changes in the brainstem” occurred in a single child after a vaccination — to infer anything from that would be a classic case of “post hoc, ergo propter hoc” reasoning. I’m sure you can find a single case of a child who died of bullet wounds after being vaccinated, too.

And the babies who died of pneumonia at a statistically significantly higher rate after receiving the rotavirus vaccine? That was in a single study out of eight studies conducted on the safety of Rotarix, the vaccine in question. When you compile all eight studies, the relative risk of pneumonia between Rotarix and placebo is exactly 1, according to this exhaustive FDA briefing (PPT — skip to slide 59).

I’m not going to bother batting at the other examples, but you see where this is going. And the problem of the ecological fallacy is probably the most damning, because even if all the other problems in this paper were fixed, this alone would be enough to keep it from making any sense as science.

Finally, I’d like to discuss that CDC report I promised to come back to, and pile on a criticism of my own that neither Catherina nor Dr. Gorski really dealt with. Namely, we know the risk factors that bring the U.S.’s IMR up. Alice Park discusses them in a 2009 article for Time:

Starting in 2008, the March of Dimes began tracking three of the major contributors to the high preterm birth rate — lack of insurance among women of childbearing age, rates of cigarette smoking and the rate of babies born preterm, but at the tail end of pregnancy, between 34 and 36 weeks….

By far the biggest contributor to the high premature birth rate is the rate of so-called late-preterm births. About 70% of babies born too early in the U.S. are born between 34 and 37 weeks. There are many reasons for these early deliveries, making it particularly difficult to target one or even a few factors and address them head-on. The increase in multiples — twins, triplets or more — is one contributor. The rise in assisted reproductive technologies, such as in vitro fertilization, is another; these techniques are associated with both an increased risk of multiples as well as a higher risk of premature delivery, even of singletons….

This is relatively undisputed, as far as I can tell from reading through literature on America’s woeful infant mortality rate. What do Miller and Goodman make of this? From the paper:

Preterm birth rates in the United States have steadily increased since the early 1980s…. Preterm
babies are more likely than full-term babies to die within the first year of life. About 12.4% of US births are preterm…. Preventing preterm births is essential to lower infant mortality rates. However, it is important to note that some nations such as Ireland and Greece, which have very low preterm birth rates (5.5% and 6%, respectively) compared to the United States, require their infants to receive a relatively high number of vaccine doses (23) and have correspondingly high IMRs. Therefore, reducing preterm birth rates is only part of the solution to reduce IMRs.

There are several squirrelly points packed into this paragraph. First, note the phrase “within the first year of life,” which, while part of a technically correct definition of infant mortality, leads us to the question: why are we counting all deaths in the first year in this study anyway? Surely the correct measure of whether vaccines influence mortality would exclude all deaths prior to the first vaccine — i.e., all deaths that occur at or immediately after birth.

Second, the cherry-picking of Ireland and Greece as countries with low preterm birth rates and high IMRs, and then imputing those figures to vaccination rates is obviously putting the cart before the horse. If you’re trying to draw correlations of this kind, why not include a table of preterm birth rates and use them to factor out that difference in IMRs before trying to measure a difference attributable to vaccine schedules? I mean, if you have those preterm birth rates handy, which Miller and Goldman seem to, although they don’t provide a footnote for the Ireland and Greece numbers.

Anyway, here’s an interesting graphic from that CDC paper Miller and Goldman cited to show that reporting differences did not account for the bulk of the difference in IMRs. It shows what the US infant mortality rate would look like if we had Sweden’s level of preterm births:

What does this tell us? It tells us that, exactly as the CDC, the CBO, and the March of Dimes have concluded, much of the difference in IMR between the U.S. and other countries can be attributed to pre-term birth rates. And what does that tell us about this supposed correlation between vaccination and IMR?

It tells us that having an aggressively interventionist medical culture in the U.S. leads, somewhat paradoxically, to higher IMR. Remember that many of those preterm births are the result of fertility treatments. And U.S. physicians are more aggressive about attempting to resuscitate very small babies, even though most will die anyway; this leads to a much higher count of live births followed by death than in countries that treat those unbreathing preemies as still births. And aggressive monitoring of fetal health, and a greater willingness to either induce early labor or perform caesareans, may also play a role.

And then there’s this interesting paper from the New England Journal of Medicine that finds that, paradoxically, the rapidly increasing numbers of new neonatal ICUs in the U.S. may be responsible for at least some of the rise in infant morbidity and mortality:

In regions with a greater supply of beds and neonatologists, infants with less serious illness might be more likely to be admitted to a neonatal intensive care unit and might be subjected to more intensive diagnostic and therapeutic measures, with the attendant risks of errors and iatrogenic complications, as well as impaired family–infant bonding.

In short, if there is a correlation between vaccination schedules and IMR — a fact not proven here — there may be a simple explanation (e.g., a more aggressive approach to medicine overall) that does not require invoking unproven and unexplained “toxicity” in vaccines.

Where does all this leave us, in terms of what I was talking about at the beginning, the relationship between science and our everyday lives? Well, it counsels skepticism, certainly, when “news” of a disturbing “scientific” discovery shows up on parenting forums or in our inboxes. And of course it challenges each of us to become more scientifically literate in our reading — which is why I occasionally undertake these close examinations of scientific subjects related to parenting.

But this process is exhausting. To really delve into this paper, to take it apart and understand it to my own satisfaction, has taken two days and 3500 words. I can’t possibly do this with each piece of scientific information (or misinformation) that comes my way. For the most part, I’m forced to shrug and rely on professionals at the CDC, the FDA, and the doctor’s office to steer me the right way. But what happens when the professionals start to seem untrustworthy or themselves misinformed? What do you do when your need for expert knowledge is undermined by an almost paranoid sense that the experts are not on your side? And how do you avoid going too far in the other direction and falling victim to things like vaccine denialism?

I’ll try to talk more about that in the next couple of entries in this series.


christopher hitchens is a creep

It’s not that it wasn’t obvious from the title of his weirdly vindictive book God Is Not Great, itself a deliberate poke in the the eye to the world’s Muslims, who, of course, affirm that God is great every time they pray.

And sure, I read him. It’s entertaining, in a gruesome way, when he goes after popular icons like Mother Teresa. And I don’t mind keep an eye on his column just to know what an unrepentant Iraq war hawk thinks about things like attacking Iran, because it’s useful to know what arguments crazy people will soon be presenting you with.

But his column this week in Slate, titled “The taming and domestication of religious faith is one of the unceasing chores of civilization,” is an even more bilious stew of pomposity and historical blindness than his usual stuff. This column makes it more clear than ever that Hitchens, often wrongly lumped into the New Atheist camp with the genuinely areligious Richard Dawkins and Daniel Dennett, is in fact nothing more than a bigot whose atheism seems driven largely by a desire to rationally justify his visceral loathing of certain religious groups.

Hitchens starts the article by asking, in light of recent discussions about the Park 51 center and American Islam in general, whether he supports the “free exercise of religion.”

The unsurprising answer: No. No he does not.

The reader may well hope that this is a rhetorical device, that Hitchens will say something like, “Of course, what I mean is that there are certain inherent constraints on religious practice that even a free society must adopt, just as there are certain inherent constraints even on free speech. ‘Fire!’ in a crowded theater, and so on. But naturally outside of actual harm people are free to practice whatever they are called to and believe whatever they find convincing, because the free marketplace of ideas — both practical and metaphysical — is worth whatever number of wrong and foolish ideas it necessarily permits.”

Nothing like that is ever said.

Hitchens does sporadically find real harm done by actual religious beliefs, and he properly points out that, for example, we do not generally allow Christian Scientists to deny their children medical care. Hitchens notes that parents who do so “can be taken straight to court.” Fair enough — the standard is applied: real harm is met with legal limitations. But he then goes on to add, “Not only that, they can find themselves subject to general disapproval and condemnation.” Here I am no longer sure what his argument is. The very phrase “free exercise of religion” is a legal term, a slice of the First Amendment. What do “general disapproval and condemnation” have to do with anything?

We find out in another paragraph, this one dealing with the Mormons:

[I]n 1963, the Mormon church had not yet gotten around to recognizing black people as fully human or as eligible for full membership. (Its leadership subsequently underwent a “revelation” allowing a change on this point, but not until after the passage of the Civil Rights Act.) This opportunism closely shadowed an earlier adjustment of Mormon dogma, abandoning its historic and violent attachment to polygamy. Without that doctrinal change, the state of Utah was firmly told that it could not be part of the Union…. Thus, to the extent that we view latter-day saints as acceptable, and agree to overlook their other quaint and weird beliefs, it is to the extent that we have decidedly limited them in the free exercise of their religion.

See, then, the line from Hitchens’ “disapproval and condemnation” to the legal restriction of religious liberties. Mormons are racists and practice polygamy; therefore we must use the power of the law to bend them to something Hitchens finds more acceptable. Of course, polygamy (at least, consensual polygamy) harms no one — the “violent attachment” Hitchens refers to was seen by Mormons as the vigorous defense of their liberties, and they were at least partly right. Mormons were victims of violence over the issue of polygamy at least as often as they were perpetrators. And if modern intellectuals (including, I assume, Hitchens) take the matter of gay marriage as a settled point of social equality, it’s hard for me to see how anyone can justify using legal force to exclude a faith community from the union because it advocates for alternative family arrangements.

Harm, then, is something of a floating target in Mr. Hitchens’ world. It can mean actual harm, or it can simply mean things he finds weird or discomfiting.

In the vein of actual harm: A professional titillator, Hitchens does not fail to bring up sexual crimes against children, because nothing wins an argument faster than averring that your side is against child abuse, and therefore the other side — those wacky “free exercise of religion” people — must be for it. A few ultra-radical Orthodox mohels use direct oral suction to stop the bleeding after circumcision. So barbaric! So icky! And they give the children herpes!!! (Or maybe they don’t. The New York Times article he links to is less certain.) Also, did you know that some Catholic priests engaged in pederasty?! Because Christopher Hitchens knows it. HE THINKS ABOUT IT ALL THE TIME.

Of course, clerical pedophilia is not an actual doctrine of Catholic Church, and foreskin-sucking is about as much a part of Judaism as snake-handling is of Christianity. There are some valid points buried in these paragraphs somewhere about the legitimate role the state can play in correcting institutional excess in faith communities. But mostly it seems Mr. Hitchens is interested in reminding you of THE TINY PENISES AND THE CRIMES AGAINST THEM. Because if you dare to stand against his program of sectarian cleansing and “taming,” you must be in favor of rabbinical cock-sucking.

Hitchens seems to live in a world separate from the actual mainstream of political debate: “We talk now as if it was ridiculous ever to suspect Roman Catholics of anything but the highest motives,” he writes, as though anyone has ever said any such thing. “[Y]et by the time John F. Kennedy was breaking the unspoken taboo on the election of a Catholic as president, the Vatican had just begun to consider making public atonement for centuries of Jew-hatred and a more recent sympathy for fascism.” It’s not at all clear what this sentence is supposed to mean, or whether the “centuries of Jew-hatred” somehow justify the social and legal oppression of Catholics for most of this country’s history by Protestants who were not, themselves, exactly Jew-boosters.

But all this is just the warm-up for talking about the religion that freaks Chris Hitchens out most of all: Islam. (Oogie-boogie!)

Some of its adherents follow or advocate the practice of plural marriage, forced marriage, female circumcision, compulsory veiling of women, and censorship of non-Muslim magazines and media. Islam’s teachings generally exhibit suspicion of the very idea of church-state separation. Other teachings, depending on context, can be held to exhibit a very strong dislike of other religions, as well as of heretical forms of Islam. Muslims in America, including members of the armed forces, have already been found willing to respond to orders issued by foreign terrorist organizations. Most disturbingly, no authority within the faith appears to have the power to rule decisively that such practices, or such teachings, or such actions, are definitely and utterly in conflict with the precepts of the religion itself.

Now, I happen to agree with Hitchens that many very disturbing concepts are floating around the idea pool of Islam. But to complain that there is no centralized Muslim authority seems to me to betray a fundamental distrust of democratic processes. If there can be many toxic and foolish ideas about, for example, what America ought to be (or the Netherlands or Uganda) without the idea of free political speech being cast into the sea, then surely we ought to be able to concede that there can exist in the world many terrible ideas about what Islam ought to be, without our pining for some sort of autocrat to banish the bad ideas and uplift the Hitchens-approved ones. Personally, I’m glad of the wild range of opinions within Islam, and I hope that the more we encourage the free exchange of ideas in American Islam, the more Muslims will feel they can embrace humanism and modernity without betraying their faith. (For an excellent example of how a centralized theological authority in Islam would actually work, please see Saudi Arabia or Iran.)

But Hitchens believes that Islam is more-or-less irredeemably murderous, and while he has found much of the debate surrounding the Park 51 center in Manhattan distasteful, he nonetheless fundamentally shares with the “Ground Zero mosque” protesters a belief in the collective culpability of all 1.4 billion Muslims for the crimes of a few dozen:

Reactions from even “moderate” Muslims to criticism are not uniformly reassuring. “Some of what people are saying in this mosque controversy is very similar to what German media was saying about Jews in the 1920s and 1930s,” Imam Abdullah Antepli, Muslim chaplain at Duke University, told the New York Times. Yes, we all recall the Jewish suicide bombers of that period, as we recall the Jewish yells for holy war, the Jewish demands for the veiling of women and the stoning of homosexuals, and the Jewish burning of newspapers that published cartoons they did not like.

This paragraph is sort of astonishing for a number of reasons — foremost because it implies that if the Holocaust had happened a few years later, when Zionist Jews in Palestine were absolutely carrying out terrorist attacks against British and Arab targets, that it would somehow have been justified. Anyway, depending on your definition, Mossad could be seen as carrying out state-sponsored terrorism even today. As for stoning, well, as recently as last year ultra-Orthodox, erm, activists were organizing stoning attacks against a bus line in Israel for the crime of not enforcing sex-segregation on their vehicles. That these Orthodox wingnuts are the fringe of the fringe is exactly the point. The number of Muslims engaged in purely religious terrorism, as opposed to politically motivated terrorism bound up in disputes over territory, is fantastically small.

(The longstanding dispute over Palestine is perhaps the clearest example of a dispute over territory that has over time become a “Muslim” cause. No less a figure than David Ben-Gurion admitted as early as 1936 that “The fear [among Palestinians] is… of losing homeland of the Arab people, which others want to turn it into the homeland of the Jewish people. There is a fundamental conflict. We and they want the same thing: We both want Palestine.” Palestinian terrorists have by no means all been Muslim — George Habash, who organized the Dawson’s Field hijackings, was a Christian — and, indeed, Israel initially supported Islamist Hamas as a counterweight to the secular PLO. Hitchens knows all of this perfectly well, of course, but it’s much more fun to paint Islam as a religion of suicide bombers than it is to acknowledge that terrorism is a tactic employed by practically everyone, everywhere.)

Hitchens glumly concedes at the end of his essay that “Globalization, no less than the promise of American liberty, mandates that the United States will have a Muslim population of some size.” But, he says, in order to be fully integrated into American society Muslims must “abandon certain presumptions that are exclusive to themselves.” This is very odd phrasing indeed. To ask every American citizen to forswear terrorism and violence against civilians is, I think, uncontroversial — but to insist that they give up their “presumptions”? Why? Should Straussian anti-tax libertarians, who believe as firmly as any caliphate-seeking Islamist that their views and methods ought to prevail worldwide, similarly be forced to conform to the dictates of Hitchens’ “civilization”? Should secular polyamorists, who presumably offend Hitchens’ moral sensibilities as much as Mormon polygamists, be forced to give up their ideas as well? What about Arthur Jensen, the social scientist whose work largely goes toward legitimizing racism?

As long as the answer to any of these questions lies in the power of eloquent speakers to influence opinion against ideas they find immoral or incorrect, so be it. But Hitchens seems suspicious of and displeased by the raucous marketplace of competing philosophies. His tendencies are authoritarian and distinctly monoculturalist, and his celebrated “idiosyncracies” read every day more and more like sheer prejudice and crankery.

seating arrangements

So we bought H. a baby seat, because, you know, the state troopers told us we couldn’t strap him to the hood of my truck anymore. Car seats are kind of a bummer — they’re marketed as the difference between life and death for your baby, but ONLY if they’re installed correctly. There’s a common meme that floats around the internet that “[X]% of child safety seats are installed incorrectly!” — where X is some alarmingly high number, usually between 75 and 90.

Now, if that turns out to be true, I think we can safely say that the problem lies not with installers but with the manufacturers. If 90% of seat belts were worn “incorrectly,” I don’t think we’d be satisfied with manufacturers sending us to police stations to get properly belted in.

But where does that statistic come from? Top Google results for “car seats installed incorrectly” cite the National Highway Traffic Safety Administration, but none of them link to it. (They also cite wildly different numbers.) It’s true that the NHTSA throws around the figure “3 out of 4” in at least a couple of places. But nowhere does that agency bother to cite a specific study or explain how it arrived at that number.

A few state law enforcement agencies have provided real statistics about car seat installation shortcomings: Pennsylvania inspected 619 vehicles in September of 2008 and found that 80% of those were installed incorrectly; Nebraska, inspecting 7,900 vehicles over the course of a year, found an almost unbelievable 89% failure rate.

But are these numbers representative? Both states relied on a self-selecting pool of parents who went out of their way to have their car seats inspected. It’s hard to say whether that group overrepresents people who know they’ve put the car seat in wrong, or whether it actually skews toward people who are super-conscientious about safety. I’m also not sure I believe that a state trooper who took a four-day course in car seat installation really has some magic technique that my wife and I were unable to divine in the many seat-strapping sessions we’ve taken part in since having a baby and acquiring a passenger car.

The standard for “correct installation” given in nearly every car seat manual in America is that the seat should no more than an inch in either direction “along the belt path” — i.e., from side to side. But because the seat is basically cinched down by a semi-circle of slippery nylon seatbelt, that standard is rank bullshit. I issue the following challenge to all car seat proponents everywhere: I can, with my arms of average strength, easily rock any car seat on the market, installed by whatever expert you choose, more than an inch along the belt path. And if I can do it, so can a Buick in a side-impact crash.

Which is not to say child safety seats are useless. There’s plenty of evidence that, for infants and young toddlers in particular, they’re quite effective at reducing injury and mortality in car accidents. But the “correct installation” phantom is representative of the way we think about child safety — we tend to want to make it into a measure of personal dedication, so that a parent who buys an expensive car seat and takes it to the technician to have it installed can feel like a “good” parent. But as this cranky mom points out, a system that lets people feel like they’ve won Safe Parent Of The Year is not necessarily a system that makes sense in terms of child safety:

It seems that auto manufacturer Volvo has partnered with carseat manufacturer Britax-Romer to create a custom-made carseat model that fits and works perfectly only in Volvo vehicles. The intention was to create a carseat that would be supremely safe when used in Volvo vehicles. The National Highway Traffic Safety Administration will not allow that carseat to be sold in the U.S. because the “NHTSA has mandated that child seats cannot be vehicle-specific”…”every child seat must fit in every car”….

[W]hat could be the NHTSA’s motive for denying the new product to be sold in the U.S.? Are they being irrationally bureaucratic? Are they trying to protect the consumer by not letting the market become flooded with vehicle-specific seats? Is inspection and regulation of so many seats too much of a logistical nightmare for all truly concerned with child safety? And wouldn’t the whole bloody mess just evaporate if all cars had the option to come pre-built with integrated safety seats?

Amen, sister.

Nonetheless, the debate over car seat safety occasionally produces interesting tangential results. Steven Levitt, the University of Chicago economist and co-author of the much-debated Freakonomics books, caused a stir in 2008 by claiming in the New York Times Magazine that for children over the age of two, seat belts are as effective as after-market car seats in reducing mortality and serious injuries. That’s a bold claim, and Transportation Secretary Ray LaHood attacked Levitt’s work as an attempt to be “provocative,” which it probably was. But he also claimed that Levitt’s work was based on a single set of data, the U.S. Department of Transportation’s Fatal Accident Reporting System, and that he used an overly broad timeframe in his study, reaching back as far as 1975, when there were no child car seats. (LaHood, not a scientist, derives these criticisms from a paper in the Archives of Pediatric and Adolescent Medicine which attempts to refute Levitt’s claims.)

It’s true that in Levitt’s early work on the subject he did rely exclusively on the FARS, and he acknowledges the limitations of his data set. (Levitt in fact goes further than his critics, noting that:

[I]n order for a crash to be included in the FARS data set, there must be at least one fatality. For those crashes in which a child is the only fatality, if that child would have survived the crash had he or she been differently restrained, the crash would have been absent from FARS. Similarly, for crashes in which no one dies, but a child would have died had he or she been using a different restraint, the sample composition depends upon the child’s restraint use. As demonstrated by Levitt and Porter (2001), this sample selection is likely to cause the benefits of effective safety devices to be systematically understated in the analysis presented above.

(You have to admire the cheek of a guy who cites his own studies when determining whether he has any blind spots in his data selection.)

But between 2005, when the first study was published, and 2009, when LaHood was complaining, Levitt had undertaken an additional study with Joseph Doyle, mining data from three additional databases: the General Estimates Survey, the New Jersey Department of Transportation’s figures, and the Wisconsin Crash Outcome Data Evaluation System (CODES). The newer study also restricted itself to more recent, car-seat-utilizing years. And the new study confirmed the results of the earlier study: seat belts are approximately as safe as after-market car seats for children over 2.

Levitt responded to LaHood’s criticism with all the social grace you might expect from a University of Chicago economics professor: he accused the Secretary of Transportation of not really caring about safety. Fair enough, since LaHood had said as much about Levitt, but what I found interesting were the comments on Levitt’s various blog posts on child seat safety. Some people, of course, reacted emotionally to the issue: this fellow celebrated the joy his son felt when his father illegally turned his seat forward on a lonely back road, while this anonymous commenter tastelessly brought Levitt’s dead child into the discussion. But other commenters, it seemed, were really inspired by the emotional intensity of discussing child safety to broaden their knowledge of science and to try to read and understand outside their comfort zone.

I find it heartening, in a weird way, that many non-scientists have waded into this discussion and tried to apply critical thinking to a technical issue in which they are not experts. For example, there’s this thoughtful comment arguing that we can’t test the effectiveness of car seats or seat belts under laboratory conditions (i.e., properly installed) — we have to test them as they’re actually used. And even this guy, who’s such a huge douchebag he brings up his law school class ranking (and misspells “Summa Cum Laude”) when someone wounds his pride, is at base defending his right as a layman to wrangle with science, to try to understand it and become better informed about its methodologies.

I find this invigorating. I’ve been a parent for just over six months, and already I’ve run into a lot of areas, like co-sleeping, where public health authorities make sweeping proclamations based on really sketchy and inadequate science. And I don’t necessarily blame them — science is often cautious and unsure, while pamphlets and billboards need to be bold, certain, and unwavering. But I do dream of a world that encourages a little more skepticism and curiosity and “What’s your source for that?”

(Elana has an idea that everyone should take a kind of personality test that would enable you to encode your own degree of scientific curiosity vs. your level of trust in authority. So if you’re a big fat jerk, like me, you could go to the doctor or the supermarket or wherever and say, “I’m a 2-F,” and they’d say, “Oh, all right. Here are the studies supporting this conclusion.” Or if you didn’t care and just wanted someone to tell you what to do, you could say, “I’m a 7-A,” and they’d say, “Here’s your pamphlet. It’s in bullet points!”)

I’ve just got to get these last few ibexes in….

Today I was channel-surfing in order to find something suitable for Henry to watch, and I saw something on the “American Life Network” called Ancient Secrets of the Bible: Noah’s Ark — Fact or Fable?. It was being billed as a documentary, so I sort of assumed it would come down on the side of “fable,” but that’s because I still tend to think of documentaries as stodgy, fact-laden things. Whereas even full-fledged evangelicals reviewing Ancient Secrets of the Bible on Amazon warn that

[I]f one is looking for unbiased viewpoints and for an actual academic bible study, the series title is very misleading…. Even my friends who are ministers saw the series more as entertaining propaganda than revealing any actual historical or scientific secrets….

Anyway, this one was about the story of the Great Flood, and it had a number of, erm, scientists talking at length about how the Ark would have been super seaworthy, and how you wouldn’t really have needed every animal on earth to fit in the Ark — whales, for example, could just have kept swimming!

I find stuff like this irritating, because it seems to me that people spend HUGE amounts of time trying to prove that a book like Genesis is some sort of true and factual history of the Earth — which efforts are, of course, really aimed at proving that Genesis is the literal word of God, even though the Bible itself makes no such claim.

And so, in a quest to prove that the Bible is exactly the sort of document that it isn’t, the video parades by a series of people in coats, some of them claiming to be scientists, to testify to the seaworthiness of the Ark, or to explain that “two of every living thing” doesn’t mean as many as it sounds like, because, for example, all breeds of dog have a common ancestor.

These arguments always tend to be specious or irrelevant, though this guy, for example, goes to pretty extraordinary lengths to ignore the text in order to make the text sensible. Claiming that by “clean animals” God only means the ten kosher mammals mentioned in Deuteronomy 14:4-5 is reasonable, but to then claim that by “every unclean animal” God is referring specifically and only to the unclean animals mentioned here and here — to include rabbits, rock hydraxes, and pigs, but not hippos or kangaroos — takes a certain amount of narrow legalism, and it certainly flies in the face of the obvious meaning of Genesis 7:17-21:

I am going to bring floodwaters on the earth to destroy all life under the heavens, every creature that has the breath of life in it…. You are to bring into the ark two of all living creatures, male and female, to keep them alive with you. Two of every kind of bird, of every kind of animal and of every kind of creature that moves along the ground will come to you to be kept alive. You are to take every kind of food that is to be eaten and store it away as food for you and for them.

I have highlighted the Lord’s multiple uses of “every” and “all” because I’m an asshole and I’m making a point in a snarky way. But, seriously, here is that guy’s argument:

The broad words of Genesis 6:19: “And of every living thing of all flesh, you shall bring two of every kind into the ark” and a similar phrase in Genesis 7:15 are clearly inconsistent with the sacrifices of Genesis 8:20 and the seven pairs mentioned in Genesis 7:2-3. Since the phrase “two of every kind” is an overgeneralization, the preceding phrase “every living thing” can also be treated as an overgeneralization and be interpreted narrowly to mean every living thing of importance that Noah owned or had custody of. If Noah was asked years later how many animals he took on the barge, Noah may have replied, “Every one; I took them all.” In such a remark, the words “every” and “all” would mean only that he did not leave any of his animals behind, not that he took every species on the planet….

Noah’s clean animals included cattle, sheep and goats. His unclean animals included raven, swine and eagles. They were his inventory, his stock in trade. But most of the world’s animals were not included. Exotic zoo animals such as elephants, giraffes, hippos, lions, apes and kangaroos are not mentioned in Genesis or Deuteronomy and were not included in Noah’s inventory. Since it would be impossible for Noah to attract millions of animals from all over the planet, he did not do so. The animals came to the ark because local herdsmen brought them to the ark.

This argument is nonsense from the get-go. Noah kept eagles as part of his stock-in-trade? Well, that explains why he needed the rock hydraxes, I guess: eagle food. And the last line flatly contradicts the Lord’s assertion that every kind of animal “will come to you to be kept alive,” as well as providing some tragicomic scenes just before the flood:

HERDSMAN: Hey Noah, that’s one big boat.

NOAH: Yup. The Lord God’s gonna destroy the world by unleashing the floodwaters.

HERDSMAN: You don’t say. And you’re gonna float it out in that thing?

NOAH: Yes, that’s right.

HERDSMAN: Oh. Can I come?

NOAH: ‘Fraid not. You’re sinful and God is grieved that he made you.

HERDSMAN: Oh. Well, would you take my camels with you? They’re good animals, and I’d hate to see anything happen to them.

NOAH: No — I’ve already got two camels. Do you have any hoopoes? God seems to think they’ll come in handy.

These people seem, at first glance, to have a more scientific approach — at any rate, they have a lot more numbers on their website. Also, they take the novel, if completely unwarranted, approach of claiming that “kind” doesn’t mean species — it means genus or even family:

The word species and the biblical word “kind” are often used interchangeably. This is incorrect since they are not synonymous. The biblical word “kind” denotes an organism that reproduces others like itself…. The word kind is probably closer to the modern taxonomic unit of genus, and in some cases the larger taxonomic unit, family.

The Canidae (canine) family includes about 14 genera of dog like animals. These include the coyote, dog, wolf, jackal, etc. The ark did not have to contain the hundreds of species of canines that make up this group. In reality, these were all represented by a few “kind.” These “kind” would then produce all the animals that make up the Canidae family.

Gosh. I thought evolution took too long as it was. Who knew it was actually so speedy?

Anyway, after excluding fish — because, you know, fish live in water, don’t they? — these folks also decide to leave plenty of other animals off the Ark, too:

Noah would not have to be concerned with the aquatic mammals such as the dolphins, whales, porpoises, sea lions, and walrus. There are also many aquatic reptiles that could survive outside of the ark. These would include many types of snakes, alligators, crocodiles, and sea turtles. There are almost a million species of arthropods that would survive the flood. Animals such as the following: shrimps, crabs, lobsters, and many other crustaceans. All of the insects could survive outside the ark. Mote than 35,000 species of worms and nematodes would also survive the flood.

All right, first of all — insects drown. There’s actually a mosquito trap that depends on it.

Second of all, these guys are still failing to account for the Lord’s emphatic instruction to take two of “every kind of creature that moves along the ground.” (Emphasis mine, not the Lord’s.) That means, I’m sorry, every snake, lizard, beetle, ant, scorpion, hedgehog, and so on.

But let’s assume for a second that they find a way to wriggle out of those problems. There’s still the basic fact that their idea of how things “survive” is that of A CHILD. Noah stays on the Ark for a year, and the waters cover the Earth completely for at least 150 days. No land creature on earth can hold its breath for that long, but even if it could, let’s say, float, how could it live for five months to a year when its entire ecosystem has been destroyed? What would it have eaten? How would it have plausibly reproduced? The life cycle of the painted lady butterfly is 21 days, and during that time it relies intensively on specific types of plants as part of the process.

Oh, dear — plants. Why did God forget about the plants? 150 days of complete immersion in water would be enough to turn the earth’s surface into a complete desert. And although I’m sure someone will argue that Noah could have brought enough seeds to repopulate the earth with plants (even though, you know, he had no access to several of the continents, and even though this is supposed to have have happened just a few thousand years ago), this again shows an extremely childish understanding of how individual organisms relate to their ecosystem. A plant does not exist in isolation, nor can you just stick it in some dirt and hope for the best. Destroy the environment completely, and you destroy the ability of each individual creature to feed itself, reproduce, and go through its life cycle.

Then there are the fishes, whales, and other waterbound creatures that the authors of Genesis, and our ersatz scholars, don’t even bother with. Genesis tells us that the mountaintops were covered (7:20) to a depth of 20 feet, which means that the waters must have covered Everest. Assuming that the seas prior to the flood were at about the same height they are today, this means that there must have been enough water to cover the surface of the earth (510.07200 million km2) to roughly the height of Everest (over 8km), or about 4,513,117,056 km3. That’s about 3 times the volume of the earth’s oceans now. So suddenly all the earth’s water creatures are living in a space 4 times the size of the space they were living in previously — meaning predators and prey, herbivores and their food, are now much farther apart. The ocean, formerly teeming with life, is now fairly empty, and many if not most creatures would starve.

Coastal water ecosystems, meanwhile, which rely extensively on photosynthesizing and photosensitive organisms, would of course be obliterated. And while we’re pondering this — does it rain salt water or fresh? If it rains fresh water, most of the sea creatures would die, but if it rains salt water, most of the freshwater fish are goners.

In the end, I prefer the first guy’s theory, in which God is more interested in saving Noah’s property than in preserving genetic diversity. It contradicts the text, but it doesn’t contradict basic biology. Of course, there’s a simple solution to all of these logistical issues with the flood story — God just uses magic to recreate life anew at the other end. That almost has to be the solution, because there’s an olive tree growing somewhere even before Noah gets out of the Ark.

But as soon as God starts using magic powers, we’re immediately struck by the ridiculousness of the whole story. If God regretted how men turned out (somewhat undermining any claims to omniscience or wisdom), why didn’t He just wink all the evil men out of existence? Why does He go out of His way to “destroy all life under the heavens, every creature that has the breath of life in it”? On the other hand, if the entire creation is unsatisfactory, why bother repopulating it with “two of every creature”?

And finally, and most damningly, why is God unaware that His plan isn’t going to work?? God makes a covenant with Noah, supposedly the most righteous of men — and then not four verses later sin returns to the world in a particularly embarrassing and squalid fashion: Noah gets passing-out drunk, Ham checks out his father’s “nakedness,” and when Noah wakes up he petulantly curses Ham’s lineage. These are the people You chose to save? Why not just start over entirely?

None of it makes sense if the God of Genesis is the all-knowing, all-seeing, all-wise, and yet completely benevolent God we like to think of today. On the other hand, the story of the flood makes some sense if the God of at least that particular story is an older, more mythological god, a god who makes mistakes, who can’t see or even imagine the future, who is carried away by human passions like grief, regret, and anger. And the aftermath makes sense, too, as a crude and obvious Just-So Story cooked up to make it okay to enslave Canaanites. In other words, this story makes perfect sense as an ancient myth welded with some clumsy tribal propaganda. It makes not a lick of sense as a story about any sort of loving, or even moderately humane, uber-Deity.

All of which is only by way of saying that I hope my son doesn’t waste his life trying to defend a collection of obviously man-made myths as the literal transcription of the words of an anthropomorphic (and apparently very confused) God. So we’re not going to watch Ancient Secrets of the Bible in our house. I know how impressionable young people can be — I was terrorized out of my gourd by Orson Welles in The Man Who Saw Tomorow when I was about ten. Welles, hosting a supposedly nonfiction investigation into the predictions of Nostradamus, made what sounded to me like very convincing arguments that the French astrologer had predicted just about everything in history, and that his latter predictions strongly suggested a coming apocalypse precipitated by a Middle Eastern madman. My mom and my sister laughed it off when I came upstairs, white as a sheet, convinced we were all going to die in the very near future. But I kept it in the back of my mind for years, waiting for the inevitable, and even today it’s hard for me to be sure that this guy isn’t going to destroy us all:

(That is Ahmedinejad, isn’t it?)

Anyway, I’ve been trying to figure out what I might tell my son about God, or, in keeping with the context of this post, what I might let him watch on TV to form an accurate opinion of how the world works and what kind of being or force might be running it. My own agnosticism and inability to stay firmly within the religion in which I was brought up stems at least in part from the horrific displays of cruelty and suffering you can see in, oh, Disney and the BBC’s earth. Or, as my wife memorably put it, “All this natural magnificence makes me want to die.”

I can accept human suffering within a religious framework. I can accept that as generally moral creatures we’re here to be a balm and a comfort to one another, and without suffering there wouldn’t be much basis for morality or balming or comforting. I get that. But that doesn’t really explain the overwhelming viciousness and selfishness that the entire world both exhibits and suffers from. Most sentient creatures are born to eat or be eaten by other creatures, and not in a nice way, and there’s no getting around that. Everything gets sick, everything suffers, everything dies (and rarely in bed).

Fervent literal-Genesis Christians will tell you it’s because of the Fall without stopping to work out the implications of what they’re saying. God made tiny baby birds to be eaten by snakes and cows to become hosts for insect larvae and great noble-browed bears to lie down and die of starvation and exhaustion in the Arctic circle because some human woman ate some fruit she wasn’t supposed to before she even had the knowledge of the difference between good and evil. I’d rather have an indifferent God than a God who behaves like that.

And I’m not alone. Jesus says, in Luke 11,

Which of you fathers, if your son asks for a fish, will give him a snake instead? Or if he asks for an egg, will give him a scorpion? If you then, though you are evil, know how to give good gifts to your children, how much more will your Father in heaven give the Holy Spirit to those who ask him!

In other words, we can’t hold God to a lower standard than we hold ourselves. If we, who are evil, wouldn’t think of condemning thousands or millions of men and other creatures to die for the act of a single person, how can we believe in a God who would do the same? Or, to approach another theological briar patch the same way, if we sinners, who are low, angry, and vengeful, wouldn’t punish someone infinitely for a finite lifetime of transgression, how can we believe that the loving and just Creator would do the same?

My wife is not bothered by many of the traditional theological bugaboos. Recognizing the fragmentary, mosaic nature of the Bible, she believes in the good words of Jesus and ignores most of the rest and is a contented Christian. I’m in a somewhat different boat. The Baha’i Writings are harder to take piecemeal (at least, according to Baha’is), and anyway, as I said above, the natural world inclines me to disbelieve in a personal God who manipulates things on a day-to-day basis for anyone’s benefit.

But at the same time, I miss the sense of having a personal, conversational relationship with the universe. And I would feel dreadful and ashamed if I inhibited any budding sense of the divine or the ideal within my children. (Or anybody else, really.)

So. You see. I start out this post smug and playful and end up humbled and serious.

Here is what I say, then, to my son: do the best you can. Put your faith in reason and science and our shared experience and do not seclude yourself in burrows of illogic and bigotry masquerading as faith in something higher, and do the best you can. If there is a God worth meeting, He won’t fault you for it.

Mr. Sysco, Ms. Time-Warner, won’t you please have some tea?

Warning: This is pretty far outside the normal purview of this blog, except inasmuch as unfettered corporate power is one of the major reasons our health care system is as broken as it is. If you came for baby news, there’ll be some in the next post, I promise.

A few weeks ago, the Supreme Court ruled, in Citizens United v. Federal Election Commission, that Congress may not restrict the amount of money that corporations spend on ads advocating for or against a specific electoral candidate. I’ve been struggling with my own feelings about this, because it seems like a complicated issue, and because it seems the ramifications of the decision can’t yet be fully seen.

Not everyone felt they had to think it through. Keith Olbermann felt pretty confident declaring it the worst danger to the republic since Dred Scott:

Then Ezra Klein came on Olbermann’s show and reminded him that corporations could already contribute to ads that say, “Ask Congressman So-and-So why he voted for the puppy-stomping bill.” This decision just allows them to tack “And don’t vote for him!” on the end.

Olbermann has also been going around proclaiming that his show might not be around for much longer, because the corporations will take over the government and quickly eliminate their progressive critics. Which is, I think, an overly simplified understanding of how corporations operate. NBC, GE, and the Sheinhardt Wig Company are making quite a bit of money on Olbermann, and today’s social mandarins are in any event too adept to go in for brute totalitarianism. Corporations are masters of soft power and the use of persuasion, and I don’t see them eliminating the likes of Olbermann, if only because the polarized political debate he helps encourage is a useful distraction, keeping the proles divided into political tribes instead of united to fight for their own best interests.

Meanwhile, on the other side, the usually worthwhile Glenn Greenwald, defending the decision, went embarrassingly negative in the comments section of his own column, calling his readers ignorant for disagreeing with him and accusing Ghost in the Machine‘s Kevin Murphy of working for the MiniTru.

(I always wonder whether Orwell, in the beyond, wishes he had never written Nineteen Eighty-Four, given the way his imagined Oceania has become such a convenient cudgel in high school debates and, apparently, the comments section of Salon magazine.)

So maybe there’s been some craziness on all sides of the debate.

But there’s a serious point lurking in there somewhere: the Court’s decision strengthens a couple of dubious legal concepts: the personhood of corporations, and the equation of money and speech. (The Court also added a third hilariously dubious proposition: “[T]his Court now concludes that independent expenditures, including those made by corporations, do not give rise to corruption or the appearance of corruption. That speakers may have influence over or access to elected officials does not mean that those officials are corrupt. And the appearance of influence or access will not cause the electorate to lose faith in this democracy.” But that argument is so laughable on the face of it that it’s almost immoral to dignify it with a rebuttal.)

Is money speech? In one sense, it certainly seems to be. You can’t reach an appreciable audience without spending money. (Even supposedly “free” media like blogs and podcasts tend to be the province of those with the luxury time to spend on them, and those that achieve serious popularity are, in many cases, promoted by the moneyed media.) And while I’d like to believe that Bill Gates isn’t entitled to a million times as much speech as I am, the truth is that he can buy airtime on any network he wants, and I can’t. This is even more true of large corporations, whose stores of wealth dwarf even Mr. Gates’s considerable personal treasury.

In other ways, of course, money is not speech at all, and to confuse the two is dangerous. Money, unlike speech, can be converted into goods and services, which is why I’m allowed to send my Congressman a letter, but not a check, to persuade him to change his vote.

Money also isn’t speech because, well, it doesn’t say anything. When Rush Limbaugh wanted to influence the 2008 Democratic primary, he had to make the case to his listeners that they should vote for Hillary Clinton, a woman many of them despised. He had to in some sense make his mind known and stand behind his thoughts as a representation of his character. Paying the same people to vote for Clinton is, in some circumstances, illegal, and certainly uncool. But more to the point, it doesn’t require any moral or intellectual investment by the person spending it. Unlike speech, money does not require its user to engage the minds of its recipients, to convince them, to form a coalition based on shared ideas and shared values. Speech is protected in the Constitution because well-deployed speech binds us together in a common purpose; it is the glue of a civil society. Whereas money paid for the same purposes may achieve seemingly similar short-term results, but at the cost of leaving us as atomized and habituated to looking out only for our own coarse short-term interests.

So money inhabits a shadowy area — in a geographically vast country, it’s clear that speech that reaches a significant portion of the electorate will have money behind it. Yet money is not itself speech. How, then, to regulate the influence of money on our political process while not treading on speech rights themselves?

Perhaps the way to look at money is as a tool for use in the broadcast of speech. There is nothing in the First Amendment that suggests that Congress can’t regulate the mere means of speech. Indeed, carefully constructed regulation of the mechanisms of speech can make speech clearer and more easily heard, as in the case of the FCC regulating the bandwidth and power of radio signals. A case for limiting campaign contributions could be made on that analogy alone — it seems self-evident that the public has a compelling interest in ensuring that a powerful entity’s speech can’t interfere with or drown out the “signal” of weaker entities.

To be fair, the Court considers this argument and rejects it in Buckley v. Valeo: “[T]he concept that government may restrict the speech of some elements of our society in order to enhance the relative voice of others is wholly foreign to the First Amendment.” But what does it mean to “restrict speech”? Here again, Greenwald’s arguments are useful as a starting point:

Anyone who believes that [money isn’t speech] would have to say that there’s no First Amendment problem with any law that restricts the spending of money for political purposes, such as:
“It shall be illegal for anyone to spend money to criticize laws enacted by the Congress; all citizens shall still be free to express their views on such laws, provided no money is spent;” or
“It shall be illegal for anyone to spend money advocating Constitutional rights for accused terrorists; all citizens shall still be free to express their views on such matters, provided no money is spent”; or
“It shall be illegal for anyone to spend money promoting a candidate not registered with either the Democratic or Republican Party; all citizens shall still be free to advocate for such candidates, provided no money is spent.”

Clever, but the above examples miss a crucial distinction between a law that is conditioned on the particular opinion expressed (which obviously violates the spirit of the First Amendment) and one that affects all opinions, including those favored by the ruling party, equally. The modest attempts by Congress to equalize the spectrum on which political opinions are broadcast — so to speak — very obviously fall into the latter category.

Moreover, Greenwald’s own position leads to law that, implicitly if not explicitly, says:

“Citizens shall be entitled to exactly as much speech as they have property; the right to effective free political speech shall be conditioned on the ability to pay for it.”

Which can’t be the way we want to interpret the First Amendment, either.

Justice Kennedy’s majority, quoting Buckley, seems not to be fully engaged with the real world on this point:

The First Amendment’s protections do not depend on the speaker’s “financial ability to engage in public discussion.”

And yet, of course, it’s clear that in a world of unregulated spending on electioneering, one’s ability to speak in any meaningful way depends exactly on the speaker’s financial wherewithal.

Finally, the equation of money with speech — which started with Buckley v. Valeo in 1976 and has been the consistent position of the Court majority right up through Citizens United — leads to some logical problems with the rest of campaign finance law. If I have a right to spend unlimited amounts to influence elections with advertising, why can’t I contribute unlimited amounts to a candidate directly and let her buy advertising with it? Why can’t I spend on that candidate in unlimited ways, especially if I view my campaign contribution as essentially deputizing that candidate to speak for me in the political arena? If my campaign contribution will make Barack Obama or John McCain a more effective spokesman for my point of view, shouldn’t that expenditure also be a form of protected speech? Why allow any limits on campaign finance at all?

Greenwald also argues that the Citizens United decision doesn’t rest on corporate personhood. This is true — at best — only in the most technical and narrow sense. Even Justice Scalia, concurring with the majority, notes that the rights enumerated in the Bill of Rights (or at any rate, in the first eight amendments) are rights of the individual American citizen:

The dissent says that when the Framers “constitutionalized the right to free speech in the First Amendment, it was the free speech of individual Americans that they had in mind.” That is no doubt true. All the provisions of the Bill of Rights set forth the rights of individual men and women—not, for example, of trees or polar bears. But the individual person’s right to speak includes the right to speak in association with other individual persons. Surely the dissent does not believe that speech by the Republican Party or the Democratic Party can be censored because it is not the speech of “an individual American.” It is the speech of many individual Americans, who have associated in a common cause, giving the leadership of the party the right to speak on their behalf. The association of individuals in a business corporation is no different—or at least it cannot be denied the right to speak on the simplistic ground that it is not “an individual American.”

This is, on its face, the strongest argument that corporations have free speech rights — because they are collections of individuals. But consider — surely not all voluntary associations of individuals can be considered as having political speech rights. The city council is a group of American citizens, yet we would doubtless find it improper for the city council to spend its funds on political ads encouraging people to vote for the incumbents on that same council. Likewise, our all-volunteer Army is an association of individual human beings, but it does not follow from that that the Army may invest its money in ads advocating for a specific foreign policy. (Indeed, Army officers are limited even in their individual speech rights — as they represent the armed wing of their society, they may not criticize or undermine the civilian leadership while speaking in their capacity as a representative of the military. In other words, here is a case where membership in a group limits one’s personal First Amendment rights!)

Leaving aside governmental organizations, consider the case of churches: is there any clearer example of a free association of individual Americans based on a common intellectual framework, usually with the intention of changing the society at large? Yet it is commonly accepted that as a result of being granted special privileges by the government (tax-exempt status), and based on a compelling state interest to avoid the appearance of any establishment of religion, churches are not allowed — at least in theory! — to engage in political advocacy. A church may not spend money on candidate ads and a preacher may not urge his flock to vote for a particular candidate.

(That this restriction is frequently flouted or cunningly circumvented by means of technicalities is no challenge to its constitutionality or appropriateness.)

Corporations are similarly granted special privileges by law — and these privileges arguably make them something greater than simply the sum of their shareholders. Corporations are effectively immortal, something clearly not true of ordinary men. They act as liability shields to their members, which effectively reduces an individual shareholder’s moral and financial stake in the social consequences of the behavior of the corporation. And the construction of our tax code makes it far easier for Exxon Mobil to claim its political-speech expenditures as losses (to offset its tax burden) than it would be for an employee of that same corporation to do so on his 1040.

There’s nothing wrong with these privileges, per se — they are all designed to make business more rewarding and the accumulation of wealth easier. (The immortality of the corporation as an entity, for example, makes it possible for people to invest in long-term, costly business ventures together without worrying that the whole deal will fall apart if a single investor passes away.) But because this artificial legal construct receives special statutory consideration from the government — because it is, in a very literal sense, constituted by the government — it is not unreasonable for the government to set certain conditions on the body as a construct, while leaving untouched, obviously, the rights of the shareholders, officers, and employees as individuals. This is especially the case if the rights granted the corporation cause it to behave in ways fundamentally different from the way that the same group of Americans would act if they were constituted as a non-incorporated group.

The for-profit corporation presents special problems as an association of individuals, because it’s not clear, if a corporation spends money on political advertising, whose political beliefs are being represented. Those of the employees? Probably not. Those of the shareholders? Well, that’s hard to say. The decision to spend money will certainly be made by the company’s officers, who are both legally obligated and personally motivated to maximize profit for the corporation. This means that shareholders who may desire political action that reduces those profits — by, say, increasing corporate tax burden, or imposing more stringent environmental regulations — are disenfranchised from this particular kind of political speech. In short, corporate structure forces corporate officers to act in the best interests of the corporation, even if a majority of shareholders in the corporation were willing to reduce their own profits for the public good.

This in and of itself should point to a disconnect between the obvious First Amendment rights of the individual shareholders and the alleged free speech rights of the corporation as a thing. (Or, despite Greenwald’s objections, as a “legal person.”) It cannot be the case that the corporation’s speech enjoys First Amendment protections because a corporation is an association of actual persons unless its speech fairly represents the views of at least a majority of those persons.

(It must also be noted that although a citizen may freely depart from membership in a political party when its advocacy no longer aligns with his own beliefs, it is rather more difficult for a shareholder or an employee to simply walk away from the for-profit corporation, since his livelihood may depend on it.)

Some models to right this problem have been suggested: NYU’s Brennan Center for Justice proposes requiring shareholder approval for political spending.

Finally, I mentioned before that corporations can write off their election spending as business expenses, while spending by individuals does not enjoy similar tax advantages. This is perhaps the most troubling aspect of Citizens United — it appears to actually give corporations a huge tax advantage over individual Americans when it comes to electioneering. A dark horse candidate like Howard Dean or Barack Obama, relying on a grassroots network to gain and sustain campaign momentum, is put at disadvantage, since individuals wishing to spend on ads for such a candidate are not able to put their spending in the “loss” column.

Corporations are also problematic because they do not require U.S. citizenship of their shareholders, officers, or employees. The Court explicitly did not rule on the consitutionality of 2 USC 441e, which prohibits “foreign nationals” from interfering in American elections — the term being defined to include corporations and other associations. But it’s been argued back and forth in the media and the blogosphere whether this includes foreign investors in American corporations, American subsidiaries of foreign companies, and foreign corporations or governments which own stock in American companies through intermediaries. Talking Points Memo covers some of the main concerns here, while Joe Conason here rounds up experts who believe that the ruling definitely allows foreign-owned American companies to spend on electioneering.

Brad Smith of the “Center For Competitive Politics” claims that the problem has been overstated:

[T]he FEC’s regulations [11 CFR 110.20(i)] provide that:

A foreign national shall not direct, dictate, control, or directly or indirectly participate in the decision making process of any person, such as a corporation, labor organization, political committee, or poltiical organization with regard to such person’s Federal or non-Federal election-related activities, such as decisions concerning the making of contributions, donations, expenditures, or disbursements in connection with elections for any Federal, State, or local office or decisions concerning the administration of a political committee.

That is an extremely broad prohibition on any involvement in decisions on political activity. 

So what is left? Well, conceivably a group of foreigners could form a U.S. corporation, then hire some permanent legal resident aliens (“green card” holders) to make decisions about spending its money….

If this were really a worry, it could be addressed legislatively simply by broadening the definition of foreign national to include corporations with majority foreign ownership.

There are several problems with this sunny gloss on the issue. First, it’s not clear that corporations with “majority foreign ownership” are the only ones in which undue influence can be exerted. Imagine a corporation whose stock is purchased by three major investors — two domestic, one foreign, none owning a controlling interest. Any two can form a coalition, however, and create a controlling number of votes. Can it really be argued that the foreign investor would not have a dramatic influence over the governance of that corporation, even though he didn’t control a “majority” of the stock? In this case, we might well hope for the board of directors that ignores its shareholders’ wishes, but that’s hardly a guarantee.

Second, to exclude foreign-owned corporations presents its own problems — chief among them that it switches the problem of limited speech based on corporate identity for one of limited speech based on foreign citizenship. But this is arguably even more unfair, and certainly susceptible to constitutional challenge. Now you would have American corporations, with American employees, whose fortunes may rise or fall based on the electioneering of other corporations, yet which have no opportunity to speak for themselves. It can hardly be the case that we want to put some American corporations at a competitive disadvantage based on the identity of their owners. (Or, indeed, their officers — the above FEC regulation is vague enough to make it questionable whether, for example, an American-owned American corporation with a foreign national for a CEO, CFO, or other influential officer could legitimately engage in election spending.)

Third, there is, of course, the practical problem of determining who owns what, and where loyalties lie, given that corporations can own other corporations. For example, we can easily imagine a U.S. corporation, Corporation A, which is owned by Corporation B, whose owners are foreign but which has been incorporated in the United States. Is the owner of Corporation A a “U.S. person” (Corporation B), or a “foreign national” (the investors)? Add a few levels to this scheme — move ownership in and out of the country, hide it in the Cayman Islands, use proxies — and as a matter of enforcement it becomes far more difficult to determine who is exerting control over a given company.

That FEC regulation, which sounds very broad and inclusive, is on closer reading simply vague. What does it mean to “direct, dictate, control, or directly or indirectly participate in the decision making process”? Can we simply exclude “majority foreign ownership,” as Mr. Smith claims? It seems unlikely that that will close the hole, because even if the statute is made perfectly clear, the nature of corporate ownership doesn’t allow for practical identification of who is allowed to spend money to influence American elections and who is not. Corporations are not citizens; they do not carry passports; and tracking influence through a chain of corporate ownership (to say nothing of the composition of the board, which poses its own problems) is a significant impediment for legal enforcers and a practical impossibility for the average citizen who may wish to know what foreign power is sponsoring a given advertisement.

These problems were not created by Citizens United, of course — corporations had a limited ability to spend on electioneering prior to this. But Citizens United raises the stakes and — at least potentially — makes it more attractive for foreigners to use a variety of identity shields to control American corporations for the purpose of pouring money into our electoral communications.

Some have argued that banning foreign influence may itself be unconstitutional. Justice Stevens, as usual, is on point here:

“The notion that Congress might lack the authority to distinguish foreigners from citizens in the regulation of electioneering would certainly have surprised the Framers, whose ‘obsession with foreign influence derived from a fear that foreign powers and individuals had no basic investment in the well-being of the country.’”

So these are the arguments against the majority’s ruling in Citizens United. They are many and compelling. And yet… intuitively, the Court’s decision doesn’t feel wrong, given the facts of the case.

Citizens United, a politically conservative non-profit, made a video called Hillary: The Movie. It was an unabashedly partisan attack on Hillary Clinton, who you may remember was running for president at the time. Citizens United wanted to run ads for the movie, which it would show on pay-per-view channel DirecTV. In January 2008, the U.S. District Court in Washington ruled that they could not run ads for the, uh, film, because doing so would constitute “electioneering communication.”

Despite my personal distaste for Citizens United and its views, I think none of us want to live in a world where a document expressing political opinion is not available to those who wish to purchase it. Buying a movie on pay-per-view is essentially the same act, after all, as purchasing a book at Borders, and it can’t be the case that, say, ads for Sarah Palin’s memoir count as electoral or candidate ads, even if they occur around the election.

Or, a closer analogy: Michael Moore’s Fahrenheit 9/11 played on pay-per-view on 1 November 2004, and Moore himself expressed hope that the film would influence the 2004 presidential election. One cannot imagine a constitutional challenge to the advertising of that pay-per-view broadcast, so what makes Hillary: The Movie any different? The fact that it was produced by a corporation? So what? Moore certainly spent corporate money to make his film.

Trying to determine where personal expression stops and corporate expression begins is a bit of a fool’s errand. An exemption for “media corporations,” the traditional solution, is at best a fig leaf, since not only are media corporations frequently owned by other, larger corporations, but nearly every large corporation today produces some sort of independent content, much of which can’t be neatly classified as advertising.

Perhaps those of us concerned about corporate overreaching ought to accept that campaign finance reform is not the field in which we’re likely to win major victories. Instead, perhaps we ought to rethink the corporation itself — its structure, its legal loyalties, its moral obligations.

The modern corporation, as Mark Achbar, Jennifer Abbott, and Joel Balakan demonstrate quite convincingly here, is not a natural, unchangeable phenomenon. It was created through a series of quite deliberate legislative and court decisions for the public good. The corporation should be considered a machine for making money, whose legal structure requires it to place profit over all other concerns. But if we created a machine to make money, there is no reason we can’t tinker with that machine to make it behave differently — particularly if its own shareholders choose to put other values first. The Brennan Center’s suggestions, which I linked to above, are a good first step. But there’s no reason we can’t expand on that idea and rethink the ground rules for capitalism from the ground up, so that phrases like “corporate money” and “corporate influence” cease to ring so ominously in our ears and corporate management can be tempered with morality and social responsibility.

why I am not a Republican

Hey, look — I’m basically a pretty conservative guy. I don’t like terrorists. I do like shooting guns, when I get the opportunity, and I would like to see a balanced budget and I basically want to be left alone and to leave others alone. Also, thinking about gay sex makes me sort of uncomfortable.

So when you factor in my maleness and my whiteness and my general level of economic frustration, I ought to be pretty much square in the middle of the Republican demographic. I ought to be, at the very least, a kind of sensible P.J. O’Rourke/David Brooks/George Will-style Republican. And yet somehow everything about the post-Gingrich Republican Party strikes me as ridiculous, clownish, disastrously unproductive, and harmful to our country.

Our two electoral parties don’t nearly do justice to the breadth and subtlety of political thought in our country, but they do offer, roughly, two competing stories about the world. In one story, life is a zero-sum game in which paying taxes merely impoverishes you without giving you anything in return, those who fail in the Holy Practice of Business should be punished by “the market,” and any form of collective action inevitably leads to collectivism. In the universe of this story, each of us must spend his every waking moment vigilant — vigilant! — against creeping socialism, terrorists, Mexicans and gay sex. But mostly creeping socialism.

This is where the rubber hits the road, because it’s the creeping socialism argument that screws everybody equally. When we remain Eternally Vigilant against socialism, we declare that we must all hang separately lest we all hang together; that only the cowardly and the weak would act other than in their own self-interest and only the depraved and the avaricious would countenance any modest sacrifice for the public good; that a sliver of safety for all must come at the cost of Forsteresque privation for one; that any admission of the role of chance and misfortune in human affairs necessarily degrades the roles of morality and individual effort; and that all suffering comes on two accounts — the providential hand of God, and the foolish attempts of government to thwart that hand.

In short, Republican ideology appeals to the part of us that is risk-averse. It appeals to the part of us that is small and afraid and wants to hoard everything and most of all wants to feel that there is some measure of control in the world. Republican conservatism offers a fiction that if you do the right things and don’t take chances and keep your head down, you will prosper. The corollary of that proposition, of course, is that in the natural order of things, you’re only poor, sick, or miserable because you deserve to be.

I think that’s why conservatism is often wrapped up in sexual anxiety — sex has the power to make us feel ashamed and uncertain and is that peculiar field in which we’re unusually subject to post hoc, ergo propter hoc fallacy: I had gay sex, so my mom died. And so whenever Americans forget to be afraid of economic failure, conservative rally-horns shrill about lesbian marriage and wanton abortion-seekers, because if you’re subject to shame in one arena you get used to being shamed out of better things in all arenas.

Now, the other story, the one told by Democrats, is far from perfect, and the tellers themselves are by and large useless. (Was there ever a more whey-faced, weak-kneed, wooden, uninspiring cartel to hold power in a great empire? Scott Brown is only the latest in a series of Republican mental vacancies to win on personality and the ability to say something, anything, in a simple sentence.) But the basic story is just this: life is unpredictable, so let’s look out for each other.

That’s it. That’s the whole difference, basically. Republican conservatives want to mitigate risk by circling the wagons and holding onto everything they’ve got for dear life and hoping that rain will fall only on the unjust. Democratic liberals, on the other hand, want to mitigate risk by sharing it. Are you afraid of falling ill, or being poor in your old age, or being unable to give your child a decent education? Liberals — or hell, let’s call them what they are, which is a very milquetoast form of socialist — liberals say, “Hmmm. Let’s see if we can create an orderly way of helping one another avoid those pitfalls.” Republican conservatives, on the other hand, offer you this advice: “Don’t trip.”

And that’s a perfectly legitimate approach to American life, I suppose; I’ve painted this in moralistic terms, but humaneness isn’t a condition of citizenship, and selfish, fearful, risk-averse bullies get up and salute the flag every morning just like the rest of us.

But economically, does the “every man for himself” philosophy make sense for America? Ayn Rand, patroness to a century’s worth of adolescent blowhards, lionized publishers and businessmen and… um… architects… and other hardy invidualists, without ever quite considering that a modest welfare state actually makes entrepreneurship more attractive. And by welfare state here, I don’t mean bread lines and five year plans for steel and badly made cars. I mean, you know, “We won’t let you die on the sidewalk.” And the simple truth is that a man who’s less afraid of dying like a bum on a ventilation grate is more willing to take the economic risks that starting a business, or even leaving your job for a better job, can entail.

I offer myself as a simple example. Because I’m in the Army Reserve, I have very cheap and nearly bulletproof health insurance. (It’s also subsidized by the taxpayer, so it’s, say, 60% socialist.) It’s portable and not at all dependent on my full-time employer. This offers me quite a bit of latitude. Chances are pretty good I’ll end up in some sort of government job, but it’s by no means certain. I could, if I wanted to, start a business (Elana and I often talk about our future web-consulting service, Or — more likely thanks to that other great socialist victory, the G.I. Bill — I could go back to school and become a lawyer or an agronomist or finally study Arabic at an advanced level. I could develop skills that not only make me a better commodity on the job market but actually add to the total pool of intellectual capital our society has to draw on.

I can take any or all of these paths and ultimately contribute in my small way to the growth of our economy, rather than hunkering down into a dead-end job as an assistant manager at the Taco Bell, because I have cheap, portable health insurance provided by the government. I am a better asset to our great capitalist experiment because of a carefully targeted bit of socialism.

Republicans — at least the vocal ones — want to create an environment in which failure is brutally punished and no one ever takes risks because there’s no safety net. That’s great for large, oligopolistic corporations, who would like laborers to be cowed and willing to take half a loaf because they’re afraid of getting nothing at all, but I don’t think it’s good for innovation or entrepreneurship. If we create a society in which the cost for trying something new and untested is bankruptcy and ruin, what message are we sending to those whose as yet unexpressed genius ought to carry us into the future? How will we foster either labor or capital that can react quickly to changes in the global marketplace, if change is associated with risk and risk is associated with personal doom? Pure-market capitalists love to talk about the motivation that the reward of profit provides, but a hypothetical carrot will hardly overmatch the everpresent threat of a very real stick.

Constructing more and safer paths to success does not impoverish the roadbuilders, nor does it benefit only those who take those roads. Easy access to education and flexible and secure health care and pensions enable those with ability and drive to react to changes in the economic environment, to increase the overall number of business experiments from which we draw our few runaway successes, and therefore to ultimately build wealth for the whole society.

And that is why I am an economic conservative who is in favor of socialism.

Thousand dollar shots

I wrote this two weeks ago. You know what’s weird about having a baby? How your life becomes really fragmented. You get to do things in ten-minute increments, constantly on high alert in case somebody starts complaining loudly. So the measurements are out of date – we took H. for another doctor’s appointment more recently, and he was eight pounds, nine ounces. He probably weighs FORTY-TWO POUNDS by now or something. You should see his jowls. Sometimes I like to kind of tuck his chin into his chest, because I’m a jerk and it makes him look exactly like Winston Churchill.

Key quote: A man does what he must - in spite of personal consequences, in spite of obstacles and dangers and pressures - and that is the basis of all human morality.


But anyway. Here’s a somewhat-out-of-date tale of some stuff relating to our kid, Captain Jowly Gruntles of the RAF:

Henry is seven pounds, 11 ounces today. And he’s 20 inches long. And his head circumference is – I forget, but it’s some number that gets his head ON THE HEAD GROWTH CURVE. In fact, he’s now on the curve for everything: in the bottom 1% for weight and length for baby boys who are 1.6 months old, but in the 4th percentile for head circumference. So if he were in a room with 99 other babies, he could beat up three of them USING ONLY HIS HEAD.

We were at the pediatrician’s office yesterday morning. In addition to getting a set of measurements, we got our kid a shot of antibodies that will theoretically help him fight off Respiratory Syncytial Virus (RSV).

We had a hard time deciding to do this, deciding to agree with his doctor’s recommendation that he get these shots once a month for the duration of cold and flu season. And not because we’re Opposed To Vaccines. (For some stupid reason it is very important to me that everyone understand that I LOVE SCIENCE and do not believe that the MMR vaccine causes ASTHMAUTISM… parenthood is kind of a trip in terms of how it smashes your face into a whole bunch of your less-ignorable character flaws.) And not even because watching your seven pound, 11 ounce baby get a shot is kind of a horrifying experience. Although I freely admit that I am morally weak and it is a horrifying experience.

But because this shot is insanely expensive (and because the experience of being convinced to get it made me feel really bad about a lot of things relating to the American health care system, ahem.)

How expensive, you ask?

Well, of course nobody in the US can actually just say “This is how much Shot X costs”, because it depends on if you’re a sucker who’s paying cash, or if you have an insurance company (partially) footing the bill, and if so which insurance company – the cost of everything DEPENDS. So I couldn’t nail down exactly how much this shot costs. But it’s expensive, somewhere between $1000 and $3300 (the highest number for a cash-paying patient I saw On The Internet) per shot. And your baby gets one shot a month. For up to six months. So you can see how this could add up to quite a lot of money.

Henry’s pediatrician – who is so cool Seth and I wish we could hang out with him on a social basis… you know, maybe go see a movie or something – said of this drug that he recommended it for premature babies, but that it was crazy expensive and that most insurance companies refused to pay for it. And if ours, as he expected they would, refused to pay for it, he wouldn’t advise us to pay cash for it or anything. It wasn’t a disaster if we couldn’t get it, it was just some extra protection for a developing immune system during cold season.

So it was pretty clear that Dr. S- didn’t expect our insurance company to approve the drug. And Seth and I felt fine about that. Even before we got in the car and talked it over, I knew we felt fine about it. Guess how I knew! It was because when Dr. S- first said “This drug costs about a thousand dollars per shot”, Seth and I looked at each other and shared The Gaze Of Cheap/Bad Parents, where both of us were clearly going “HAHAHAHAHAHA” in our heads.

But then Dr. S-‘s biller started calling us. “I’m still working on getting that approval!” she’d say. And we’d go “…oh.” because we had expected our sensible military insurance company to immediately shut this nonsense down, possibly by sending our kid a letter reading “TOUGHEN UP, BUTTERCUP”.

In the meantime, we started Googling this drug and this disease (I know! You should never do this. Who among us hasn’t decided that he or she has a terminal case of TOE CANCER after some late-night Googling?), and discovered the following:

  • Different medical groups have different ways of deciding if this drug is appropriate, but generally, it’s recommended for premature babies during cold and flu season, but only if the babies have one or more added risk factors in addition to being premature. Such as “lungs are not so great” and “lives with a bunch of other babies who bring home illnesses a lot”.
  • RSV is not that big of a deal for the vast majority of people, something akin to a cold. But it can be bad for little babies and end up giving them permanent lung issues. Like wheeziness.
  • The drug doesn’t actually keep your baby from getting RSV. It just tends to make the course of the illness less awful.
  • Bearing in mind our layperson’s ability to read study extracts, it seemed to be the case that this drug did not actually reduce mortality – reduce the number of babies dying from this virus – it just reduced the number of hospitalizations.
  • The drug is super-expensive. HAD I MENTIONED THAT?
  • Most parents of babies, premature or otherwise at elevated risk for this disease, were desperate to get their hands on this drug. They lobbied their doctors, they lobbied their insurance companies, they lobbied their state legislators to make it available, they paid outrageous co-pays gladly, they went into debt to pay for the whole course of shots themselves. Cash. Because their insurance companies said no dice. But apparently, the drug company was sometimes willing to help desperate parents arrange financing. How nice of them.

After some debate, we pretty much decided that this drug wasn’t for us. Henry was premature, but he’s really healthy (yes, I knock wood, typing this) and he doesn’t have any lung issues. And it’s not like he hangs out with a bunch of other babies at baby nightclubs snorting lines of baby coke and compromising the integrity of his airways. It was hard to see how you could justify the cost in his case. We were pretty sure that our insurance company was going to deny the request, which was PERFECT, because then we wouldn’t have to seem like bad, unfeeling parents and actually reject the drug ourselves.


And then, when we didn’t immediately schedule the appointment to get the shot, the company that makes the drug started calling us. Was I Henry’s mother? Was I aware that this wonderful drug had been approved for his use? DID I WANT TO SCHEDULE THE APPOINTMENT IMMEDIATELY? I DID, RIGHT?

It was a hard sell in the vein of talking to a car salesman. It was really bizarre.

Also the company sent us a “starter kit” in the mail. Which was a sales flyer talking about how terrible it would be to HAVE YOUR BABY DIE BECAUSE YOU DIDN’T GIVE IT THIS MIRACLE DRUG.

Finally, cementing my “this is so totally creepy” feeling, the car/drug salesman, when attempting to lock me into a six-shot course for the rest of the winter, told me: “And your co-pay is zero dollars! So it’s free!”

Now, okay, getting really outraged in a moral-high-horse way over that probably means I need to take a meditation class.

But even so, it’s kind of weird. There not being a co-pay doesn’t mean that it’s free. It’s just free to me, the end user. But you know who pays for it? Everyone else in the risk pool. That’s how insurance works. And in the case of our insurance, although we pay into a pot for it, it’s also underwritten by you, THE AMERICAN TAXPAYER. So no. It’s not “free”.

And also, just to get this out of the way, it makes me have COMMUNIST EMOTIONS to think about how this super-expensive drug is available to only some babies, basically at the whim of their parents’ insurer, and it’s available at vastly differing prices, and some parents can get it and some parents can’t, and some parents go into debt for it and some parents don’t have to because it’s “free”.

All of that strikes me as basically not okay.

But. In the end, we got him the shots. Seth got on the phone with Dr. S, who proved his awesomeness by understanding our ambivalence and saying “Would it be better to use this money to get 800 kids a polio vaccine? I don’t know. Maybe.”

Also, Seth pointed out that at this point H. has cost our sensible military insurance company quite a bit of money, so they probably would rather pay for ridiculous shots now than risk a hospital stay later.

Also, Seth’s sensible doctor sister said we should probably do it.

So we did, but I still don’t know if that was the best choice or not: Making medical decisions for someone else is much harder than I would have guessed. And I feel much less qualified to do it than my know-it-all personality might lead you to believe. I keep wanting the answers to be starkly black and white, and I guess they never are, they’re always going to be vague and best-guess-y and sometimes they will involve someone sticking a needle in your baby’s thigh when he’s not paying attention, leading to a serious case of the UNGH GAHs.