Blog Credo

The whole aim of practical politics is to keep the populace alarmed (and hence clamorous to be led to safety) by menacing it with an endless series of hobgoblins, all of them imaginary.

H.L. Mencken

Thursday, February 2, 2012

Obligatory Komen Post

I'm not sure I have a ton to add (UPDATE: Apparently I do) to the controversy over the Susan G. Komen Foundation being a bunch of useless prigs over their decision to stop funding breast cancer health at Planned Parenthood, but that never stopped me before.

I think there are a few things worth noting beyond the "they have destroyed their brand" analysis.

First, why are they a "brand"?

Why is the pursuit of a cure to a deadly but potential treatable disease left to private charity?  Would you like to know why health care in this country is so damned expensive?  OK, there are a lot of reasons, but one reason is that we don't mobilize the resources of the nation effectively.  We allow drug companies to monopolize their patents and we out the funding of the research in the hands of private charity.

What we don't do is centralize and share all the science concerning breast cancer or MS or heart disease.  Scientific progress - almost by definition - is collaborative.  "If I have seen farther, it is because I stand on the shoulder of giants" can apply to almost all science.  But because of the profit motive involved in drug treatment, we get competition when we should get collaboration.

Let's say we have a disease that might be treated by blocking a certain protein and stimulating a certain immune response from the patient's body.  Merck has a patented treatment for the protein and Pfizer has a patented treatment for the immune system.  The patient pays twice as much for medication.  And the charities to which Americans generously give divide and diffuse their money all over the place.  Not to mention that relatively little of the money actually gets to research in the end.  Most of the money is used to raise more money.

People talk about the inefficiency of the public sector, but is there anything less effective than balkanizing our approach to medical science?  Compare this to the flu vaccine, which is developed by the government and then manufactured privately.  Every year the CDC and WHO monitor flu strains, make a reasonably accurate predictions of which ones will be active in humans and provide a vaccine, which costs relatively little to administer.  The wholesale cost of a flu shot is about $12, and most people pay a slight markup via co-pays or clinic costs.  They would easily spend more than that on over the counter drugs if they got the flu.

A good friend of mine just found out he has heart arrhythmia.  The course of treatment is blood thinners and other drugs, maybe a shock to the heart to get it back in rhythm.  He is on the latest blood thinner, which costs a small fortune and has to be pre-approved by your insurance company.  Or, alternately, he could have a heart attack and spend hundreds of thousands in hospital costs.  Insane.

I suppose I could make the comparison to the Pentagon's budget.  We spend hundreds of billions every year in Afghanistan to prevent the recurrence of an attack that killed 3,000 Americans.  In 2002, 40,000 people died of breast cancer.  The National Cancer Institute (part of the NIH) spent $631 million on breast cancer research in 2010.  According to NPR, the Pentagon spent $20 billion a year in Iraq and Afghanistan on... wait for it... air conditioning.

The second point I want to make is the problem I have with a system that is dominated in many ways by the old noblesse oblige system of charity.  What we are discovering about the Komen Foundation is that it is predominantly run by a group of wealthy women.  While I applaud any and all efforts at charity, I think we're seeing yet another manifestation of the wealth divide in this country.

To the upper crust women who run the Komen Foundation, Planned Parenthood is an abortion clinic.  To many women at the bottom of the economic pyramid, Planned Parenthood is as close to a primary care doctor as they will get.  As has been noted, only 3% of Planned Parenthood's procedures are abortions.  Not having a uterus myself, I can only speak for my wife who treats her Ob/Gyn as her most important doctor.

Put more simply, Planned Parenthood is a women's health clinic.

What we see here is a stunning lack of empathy on the part of women - many of whom are intimately tied to the GOP - who run Komen.  But isn't a lack of empathy really the POINT of modern "conservatism"?

I listened to an infuriating story on NPR about how the new health care law requires employers to cover birth control.  Not abortions, birth control.  The Catholic Church, which consists entirely (and perhaps theoretically) of celibates is pitching a hissy fit.  Are you a school teacher at a Catholic School?  A financial aid office at Georgetown?  A nurse at a Catholic hospital?  Well, Mother Church does not care that you are not personally Catholic.  These men (and a few women) who have renounced sex want to make this decision for you.  (One reason the story was so aggravating was the almost complete absence of any talking heads who weren't Catholic clergy.)

The women who run Komen have no more need of a breast cancer screening or a pap smear at Planned Parenthood than a nun has need of a birth control pill.  And because this is not important to them, it is not important.

I have become addicted - as with so many others - to Downton Abbey.  Wonderful show, well written, tremendous acting.  But at the heart of the show is the idea of noblesse oblige.  Lord Grantham is the very picture of British nobility, kind, understanding, generous.  Yet there are moments when he or his family thinks and acts out of privilege.  When they are caught in these lapses - for instance when they discover the staff is "stealing" food to open a soup kitchen for wounded veterans of World War I - they quickly pitch in and do their part.

It is nobility how we wished it to be.  It is the use of wealth and privilege for both the common good and the specific application of favors for those they like, the ex-footman who is dying and is allowed to die at home.

It's a seductive fairy tale.  It's nice to believe that.  But as we are seeing every day, it seems, the idea of noblesse oblige is not an opportunity to improve our world, but rather a roadblock to real progress.

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