feminist blogs in english

(Crossposted on “Alas” and on “TADA.”)

In The New Yorker, Atul Gawande has an excellent article on how the American health care system treats dying patients.

In 2008, the national Coping with Cancer project published a study showing that terminally ill cancer patients who were put on a mechanical ventilator, given electrical defibrillation or chest compressions, or admitted, near death, to intensive care had a substantially worse quality of life in their last week than those who received no such interventions. And, six months after their death, their caregivers were three times as likely to suffer major depression. Spending one’s final days in an I.C.U. because of terminal illness is for most people a kind of failure. You lie on a ventilator, your every organ shutting down, your mind teetering on delirium and permanently beyond realizing that you will never leave this borrowed, fluorescent place. The end comes with no chance for you to have said goodbye or “It’s O.K.” or “I’m sorry” or “I love you.”

People have concerns besides simply prolonging their lives. Surveys of patients with terminal illness find that their top priorities include, in addition to avoiding suffering, being with family, having the touch of others, being mentally aware, and not becoming a burden to others. Our system of technological medical care has utterly failed to meet these needs, and the cost of this failure is measured in far more than dollars. The hard question we face, then, is not how we can afford this system’s expense. It is how we can build a health-care system that will actually help dying patients achieve what’s most important to them at the end of their lives.

Gawande ends up strongly favoring hospice care.

The difference between standard medical care and hospice is not the difference between treating and doing nothing, she explained. The difference was in your priorities. In ordinary medicine, the goal is to extend life. We’ll sacrifice the quality of your existence now—by performing surgery, providing chemotherapy, putting you in intensive care—for the chance of gaining time later. Hospice deploys nurses, doctors, and social workers to help people with a fatal illness have the fullest possible lives right now. That means focussing on objectives like freedom from pain and discomfort, or maintaining mental awareness for as long as possible, or getting out with family once in a while. Hospice and palliative-care specialists aren’t much concerned about whether that makes people’s lives longer or shorter.

Like many people, I had believed that hospice care hastens death, because patients forgo hospital treatments and are allowed high-dose narcotics to combat pain. But studies suggest otherwise. In one, researchers followed 4,493 Medicare patients with either terminal cancer or congestive heart failure. They found no difference in survival time between hospice and non-hospice patients with breast cancer, prostate cancer, and colon cancer. Curiously, hospice care seemed to extend survival for some patients; those with pancreatic cancer gained an average of three weeks, those with lung cancer gained six weeks, and those with congestive heart failure gained three months.

In our current system, patients typically have to choose between attempting to cure their problems, or explicitly admitting that they’re going to die and choosing hospice care. Interestingly, giving patients the option of doing both — that is, both having home hospice care and allowing patients to pursue all the curative treatment they want — saved money.

So Aetna decided to let a group of policyholders with a life expectancy of less than a year receive hospice services without forgoing other treatments. A patient like Sara Monopoli could continue to try chemotherapy and radiation, and go to the hospital when she wished—but also have a hospice team at home focussing on what she needed for the best possible life now and for that morning when she might wake up unable to breathe. A two-year study of this “concurrent care” program found that enrolled patients were much more likely to use hospice: the figure leaped from twenty-six per cent to seventy per cent. That was no surprise, since they weren’t forced to give up anything. The surprising result was that they did give up things. They visited the emergency room almost half as often as the control patients did. Their use of hospitals and I.C.U.s dropped by more than two-thirds. Over-all costs fell by almost a quarter.

The point isn’t that saving money is all that matters. The point is that these patients got more choices, better care, and better quality of life, and it didn’t cost the system — or the patients — anything extra. Why isn’t that exciting news? Why aren’t insurance companies, and legislators, running to make this the standard treatment?

According to Gawande, a lot of the problem with our system is that many or most patients die without ever having an explicit, in-depth conversation with their doctors about the possibility of dying, and how they’d prefer to die. Just talking, Gawande argues, can make an enormous difference.

Aetna ran a more modest concurrent-care program for a broader group of terminally ill patients. For these patients, the traditional hospice rules applied—in order to qualify for home hospice, they had to give up attempts at curative treatment. But, either way, they received phone calls from palliative-care nurses who offered to check in regularly and help them find services for anything from pain control to making out a living will. For these patients, too, hospice enrollment jumped to seventy per cent, and their use of hospital services dropped sharply. Among elderly patients, use of intensive-care units fell by more than eighty-five per cent. Satisfaction scores went way up. What was going on here? The program’s leaders had the impression that they had simply given patients someone experienced and knowledgeable to talk to about their daily needs. And somehow that was enough—just talking.

But our system isn’t set up to encourage doctors and patients to have these conversations; it’s set up to fight to the last bitter breath. And even providing funding to pay for health care to include having conversations about dying well is fraught with difficulties, as Democrats found out last year when they had to back away from sensible, humane policies that conservatives labeled “death panels.”

This is a case that should be low-hanging fruit. Reforming the way the US health care system treats dying patients is something that could give patients more choices, let some patients live longer, let many patients live better, and save everyone money.

But is our health care system — and our political system — capable of grabbing even the low-hanging fruit? I don’t know. But it should be possible.

Previews, for those of you who don’t know, is the monthly catalog of available comics sent to comic book stores all over the USA (and I think Canada as well?). Each month is a huge, glossy brick of more comic books than anyone could ever read — so it’s easy for a new and unknown comic to get lost.

(Unless, of course, people like you call your local comic book store and ask them to carry Hereville. Hint, hint.)

So I’m relieved and thrilled that in the August issue, Hereville will be one of seven “Staff Picks.” Woo!

Here’s what Kate Henning wrote in her review of Hereville:

Witches, trolls, talking pigs, and knitting lessons — yup, Hereville brings the goods. With its heroine growing up in a blended family, an orthodox Jewish community, and a rich fantasy world, there are a few different gimmicks this book could lean on, but Deutsch neatly balances these elements rather than belaboring them, making for a fun and endearing story.

Eleven year-old Mirka Hirschberg is a sympathetic, dynamic protagonist who will appeal to fans of Raina Telgemeier’s Smile, Jone Yolen’s Foiled, and even Joe Kelly’s I Kill Giants. As a sister, daughter, and aspiring dragon slayer, she joins the heroines of these other works as an appealingly imperfect character learning to understand her own goals. She’s also very bright, and it’s entertaining to watch her start debates with her stepmother Fruma, who is not so much wicked as wickedly clever.

Hereville: How Mirka Got Her Sword is only the first chapter in a story that promises much more fantastic adventure and social tension. Highly recommended to anyone with an interest in Orthodox Jewish culture, sword acquisition, or trolls with an affinity for needlecraft.

See PREVIEWS page #218

Thanks so much, Kate!

I loved both Smile and I Kill Giants, so it made my day to be listed in that company. (I haven’t read Foiled, but now I think I really must.)

By the way, that last line — “PREVIEWS page 218″? That’s what you tell your local comic book store, when you ask them to stock Hereville – they can find it in the current issue of PREVIEWS, on page 218. And, of course, you’re going to call them and ask them to carry Hereville, right? Please? Pretty-please? Do it today? Pretty-please with sugar on top?

(I’m not too dignified to beg. Heck, I love begging.)

Of course, you can also buy Hereville in bookstores (on shelves November first), or you can pre-order it from Amazon and other web outlets. In addition, I’ll be making pre-orders available in the next week or two for people who’d like to buy autographed and/or sketched-in copies — I’ll post once I’ve got the details worked out.

This might make a fabulous setting for a science fiction novel. From Esri.com:

If earth ceased rotating about its axis but continued revolving around the sun and its axis of rotation maintained the same inclination, the length of a year would remain the same, but a day would last as long as a year. In this fictitious scenario, the sequential disappearance of centrifugal force would cause a catastrophic change in climate and disastrous geologic adjustments (expressed as devastating earthquakes) to the transforming equipotential gravitational state.

The lack of the centrifugal effect would result in the gravity of the earth being the only significant force controlling the extent of the oceans. Prominent celestial bodies such as the moon and sun would also play a role, but because of their distance from the earth, their impact on the extent of global oceans would be negligible. [...]

If the earth stood still, the oceans would gradually migrate toward the poles and cause land in the equatorial region to emerge. This would eventually result in a huge equatorial megacontinent and two large polar oceans.

(Via Boing Boing.)

(Crossposted on “Alas” and on “TADA.”)

In an op-ed in the Boston Globe, Richard Schmalensee and Robert Stavins (of MIT and Harvard, respectively) lament the Republican Party’s newfound opposition to market-based environmental solutions.

LAST WEEK, the Senate abandoned its latest attempt to pass climate legislation that would limit carbon dioxide emissions, putting off any action until the fall at the soonest. In the process, conservative Republicans dubbed the cap-and-trade system “cap-and-tax.’’ Regardless of what they think about climate change, however, they should resist demonizing market-based approaches to environmental protection and reverting to pre-1980s thinking that saddled business and consumers with needless costs.

In fact, market-based policies should be embraced, not condemned by Republicans (as well as Democrats). After all, these policies were innovations developed by conservatives in the Reagan, George H. W. Bush, and George W. Bush administrations (and once strongly condemned by liberals).
In the 1980s, President Ronald Reagan’s Environmental Protection Agency successfully put in place a cap-and-trade system to phase out leaded gasoline. The result was a more rapid elimination of leaded gasoline from the marketplace than anyone had anticipated, and at a savings of some $250 million per year, compared with a conventional no-trade, command-and-control approach.

In June 1989, President George H. W. Bush proposed the use of a cap-and-trade system to cut by half sulfur dioxide emissions from coal-fired power plants and consequent acid rain. An initially resistant Democratic Congress overwhelmingly endorsed the proposal. The landmark Clean Air Act amendments of 1990 passed the Senate 89 to 10 and the House 401 to 25. That cap-and-trade system has cut sulfur dioxide emissions by 50 percent, and has saved electricity companies — and hence shareholders and ratepayers — some $1 billion per year compared with a conventional, non-market approach.

Frankly, in the 1980s the Republicans were right. All else held equal, it’s better to use market mechanisms to cut carbon (or other needed changes) rather than issuing inflexible and crude regulations. The government can, and should, decide on overall goals such as “we need a big cut in sulfur dioxide emissions.” But the market is much better than government at finding the most affordable and efficient ways to achieve such goals.

Unfortunately, today’s conservatives no longer believe in market-based solutions; instead, they believe in denying that problems exist at all. We’ve seen this in health care, when a market-based approach to universal healthcare that conservatives favored in the 1990s has been overwhelmingly rejected by conservatives. And we’ve seen this in the conservative argument that cap-and-trade isn’t needed, because global climate change is probably just a conspiracy of liberal climate scientists, or even if it does exist then it’s not worth spending any money to mitigate.

Incidentally, the result of conservatives opposing market-based approaches isn’t that nothing will happen on carbon. It’s that instead of market-based approach like cap and trade, we’ll have direct “command and control” regulations from the EPA. Is there any conservative who thinks that we’re better off with more EPA regulations than we would be with a market-based approach?

Ezra points out that this sort of thing is the inevitable result of obstructionism and a routine super-majority requirement to pass any legislation through the Senate. When Congress is made useless and incapable of action, other, less democratic agencies take over.

This is, more often than people realize, the end game of the filibuster: It’s not that the issue is tabled, but that it is handed over to the executive branch, or an independent agency, or the courts. It is handed over, in other words, to an institution free from the filibuster.

Comics Alliance has a lot of fun photos from the counter-protest against the homophobic, America-hating, horrible-in-every-way Westboro Baptist Church, which was in San Diego briefly to protest Comic-Con.

Aqueduct Press — a small publisher that specializes in “bringing challenging feminist science fiction to the demanding reader” — has published “Through the Drowsy Dark,” a collection of poetry and short fiction by Rachel Swirsky, also known to “Alas” readers as Mandolin.

Congratulations, Mandolin! This is Mandolin’s first published book (although clearly it will not be her last).

Here’s how Aqueduct describes the 146-page paperback book:

Through the Drowsy Dark collects ten stories and nine poems by Nebula- and Hugo-nominee Rachel Swirsky, “a terrific writer who’s been making a name for herself with a string of intelligent, perceptive stories,” as critic Jonathan Strahan characterizes her. In Through the Drowsy Dark, Swirsky’s characters struggle with too much and too little emotional control, with heartbreak, with grief that has gone deep underground; they search for nothingness, for difference, for oneness. One commits a terrible crime because she believes it’s the moral thing to do, while another digs up a dead dog because the very thought of kissing it on the lips makes her clitoris throb. Swirsky’s explorations of the heart and mind are fearless—and dangerous fictions indeed.

You can purchase Through the Drowsy Dark on the Aquaduct Press website, Amazon, and many other booksellers.

By the way, the cover illustration was drawn by me. Here’s a big version of it, if you’re interested:

(Crossposted on “Alas” and on “TADA.”)

Things are still in flux, but it seems likely that Republicans are going to coalesce around extending the Bush tax plan (the legislation Republicans wrote a decade ago created temporary tax cuts, so they’ll need to be actively extended by Congress in order to continue). Democrats seem likely to propose letting the Bush tax cuts expire for households with over $250,000 in income (about 2% of taxpayers), but cutting taxes for many with household incomes under $250,000.

The Wall Street Journal helpfully charts the competing proposals:

The only persuasive argument for the Republican plan is that it’s foolish to let tax cuts expire during a recession. But tax cuts as stimulus are most effective when the people getting the tax cuts aren’t rich (since poor people are more likely to spend the money immediately, and more consumer spending is the one thing our economy most desperately needs). By moving the tax cuts from the rich savers to middle-class and lower-class spenders, Obama’s tax plan may well be more stimulative.

An argument we’re likely to hear from conservatives is that the top 2% of earners already pay a huge portion of federal income taxes, relative to the rest of the country.. That’s true, but they also own a huge proportion of the country’s wealth — most of it, in fact.

It’s not unjust that the people who own most of everything should also pay most of the taxes. (And in fact, the rich are not as paying as large a portion of taxes as some conservatives claim, once all the other taxes Americans pay — not just Federal income taxes, but payroll taxes, sales taxes, state and local taxes — are included.)

Finally, some Conservatives are going to voice a philosophical objection to the idea that some Americans will wind up paying no taxes at all. But again — we’re just talking about Federal income taxes here. There are plenty of other taxes, especially payroll taxes, that are paid for by a broader slice of Americans.

UPDATE: Actually, the Obama administration has proposed not extending the Bush tax cuts for individual filers making $200,000 or above, and joint filers making $250,000 or above. That’s a bit different from what I claimed above; sorry for my mess-up.

Fantasy Magazine has posted Mandolin’s short story “The Stable Master’s Tale” on their website. Here’s how it begins:

I was born a baron’s daughter in a kingdom that no longer exists.

My father’s stables were the most important part of his holdings. By the time I had ten summers, I could soothe a panicked stallion and help birth a breech foal.

By the time I was fifteen, I’d realized I didn’t want to marry into some tedious house where I’d be expected to dedicate my life to child-rearing and embroidery. I knew this fate would inevitably befall me if I stayed, and so I packed a few things and snuck away in the night.

Head over to Fantasy Magazine’s site to read the entire story! And they also have a brief interview with Mandolin about the story.

[Crossposted on "Alas" and on "TADA." The discussion on "Alas" is open only to feminists.]

Bean emailed me a link to this article about the game Hey Baby, a first-person shooter game intended to educate men about street harassment of women.

The game is pretty unplayable as a game — it’s an exceptionally poorly made first-person shooter (”rubbish“). But that’s not the point. Laurie Penny wrote:

Hey Baby taps into the everyday violation of private space that is part of the lives of most women living in cities.

The most subversive aspect of the game is the way it translates what men often see as individual compliments or comments into an atmosphere of sustained threat not so different from that of most first-person shooter simulations, where players understand that violent monsters might lurk around every corner.

Seth Schiesel at the New York Times also found the game to be more of a statement than a game:

At first I found myself somewhat offended. In Hey Baby a man says, “Wow, you’re so beautiful,” and that is license to kill him. It should be obvious that a video game in which you play a man who can shoot only women would be culturally unthinkable, no matter the circumstances.

But as I played on, I came to realize that it is equally unrealistic and absurd to suppose that saying, “Thank you, have a great day” is going to defuse and mollify a man who screams in your face, “I want to rape you,” with an epithet added for good measure.

And that is the point of Hey Baby. The men cannot ever actually hurt you, but no matter what you do, they keep on coming, forever. The game never ends. I found myself throwing up my hands and thinking, “Well what am I supposed to do?” Which is, of course, what countless women think every day.

I can already vividly imagine various anti-feminists focusing on the double-standard (”a video game in which you play a man who can shoot only women would be culturally unthinkable”) and ignoring the rest. But of course, the double-standard in gaming exists because a double-standard exists in real life. Men simply do not get sexually harassed on the street in anything like the way women do. A sex-reversed “Hey Baby” would be pointless and contextless, because it wouldn’t be a statement about an actual, real-life problem; it would just be an excuse to blow away women.

My favorite part of the article Bean emailed me wasn’t about “Hey Baby,” but about a consciousness-raising exercise.

One particular sexual ethics program directed at football players asks them to write on whiteboards what they do each day to avoid being sexually harassed. Most stand around scratching their heads.

Random women are then brought into the room and asked the same question. Furious scribbling ensues. “I stand at the back of the lift to avoid being pinched on the bottom.” “I sit in the back of the taxi and pretend to be on a mobile phone.” “I always scan the train carriage and try to sit with women.” “I wear baggy jumpers and pants when walking my dog — even in the heat of summer.” And on and on it goes.

The women are usually shocked to realise the extent to which they have internalised sexual threat as inevitable and omnipresent. The men are shocked to realise the extent to which women have learnt to manage their safety — almost unconsciously.

For men, this is invisible. For women, it’s so omnipresent it’s routine.

When that double-standard is gone, complaining about the double-standard of “why can’t we have a video game in which men shoot no one but women!” might make sense. Certainly not until then.

Over at the Jewish Comics blog, Steven Bergson has posted his very neat Jews-and-Comics Book Montage,” which displays the covers of a whole lot of Jewish comic books. What’s really neat is that you can click on any of the covers to be taken to the goodreads page for that book (and from goodreads there are links to Amazon and other major book sellers). (Hereville is on the top row, fifth from the right.)

It’s personally fun for me to realize how many of those books I haven’t yet read! Something to look forward to.

Steven also very kindly included in his post a capsule review of Hereville (along with six other comics). Here’s what he writes about Hereville:

Hereville tells the fictional story of an 11-year old Orthodox Jewish girl who wants to hunt trolls. Hereville started life as a pay-per-view webcomic at Girlamatic in 2004. Since then Barry Deutsch self-published a 57-page version of his story which he has sold online and at conventions, while still leaving the webcomic online for anyone to read for free. There are so many scenes I’m particularly fond of - the knitting contest, the shabbos and havdalah pages, the explanation of how skirts worn at the school can differ. My favorite character besides Mirka is her stepmother Fruma, who can pilpul with the best when she wants to.

Those who enjoy reading the story (in whatever form you read it in) will likely also like the longer (139 pages) book-length treatment which will be published by Amulet in November.

Thanks, Steven! I can’t wait for you to read the full 139 page graphic novel — which, frankly, I think is a lot better than the original comic. It’s the same basic story, but it’s much more fleshed out; we see more of Mirka’s family (including Fruma), there’s a lot more adventure, and I think I draw better now than I did in 2004.