ECHIDNE of the snakes

Men are more concerned with their partner's body type than women but they also seem to value family more highly, according to a new survey released on Tuesday.
Nearly half of men questioned in the poll of 70,000 people said they would ditch a partner who gained weight, compared to only 20 percent of women.
Two-third of men also said they had fantasized about their partner's friends, while only one-third of women had done so.
"Even as men are getting more comfortable with meeting their girlfriends online and less anxious about who she's 'friending' there, other romantic behaviors have proven to be timeless ones: chivalry isn't dead, size matters, and women forgive while men forget," said James Bassil, editor-in-chief of AskMen, which conducted the poll jointly with Cosmopolitan.com.
While only 18 percent of women said they would want their mate to be better endowed, more than 51 percent of men said they wished they themselves were.
But the survey also found 39 percent of men chose family as their top choice of the ultimate status symbol. By contrast, 43 percent of women selected a beautiful home, compared to only 6.5 percent of men. One-quarter of women named a successful partner as a top status symbol.

Twenty miles up the road from my adopted home, the Espanola Valley fans out between the wealthy enclave of Los Alamos and the forests of the Sangre de Christo mountains. The main street of Espanola looks like any dry, dusty burnout of a town west of the Rockies; except for the Indian casino plunked down on the main drag, you might as well be in Barstow, Bakersfield, Yuma, or Calexico. Turn right off the highway toward the shrine at Chimayo and you’ll still find the greenbelt of apple orchards that my father remembers from when he lived here sixty years ago. And inside the trailers and flat-roofed chicken-wire-and-stucco abodes that line the highway, you’ll find the highest rate of opioid use, abuse, and overdose in America. Welcome to the heroin heartland.

In the Espanola Valley, heroin is tradition, it is familial, it spans generations, it is passed down like genes and heirlooms, it is entrenched like the Maginot line. The valley lies on a historical trade route where heroin has been brought from Mexico for the last six or seven decades, and the disproportionate availability of the drug has been compounded by the concurrent push to move old land-grant families off their 500 year-old homesteads, in no small part because of up-pricing of land and housing in response to the locating of the Los Alamos National Lab in an otherwise notably remote part of the nation. Much has been written to try to explain the unique patterns of addiction in northern New Mexico; most recently, an expatriate anthropologist came home to write Land of Disenchantment – an ethnography of his own home territory, and a 360-degree critique of those who blame the lack of highbrow culture, the snobbery toward lowbrow culture, the dislocation from the old familial land grants, and a dozen other one-note knee-jerks as simplistic explanations as to why this little valley beats out the Bronx, urban DC, Los Angeles, and the entire border zone for the dubious distinction of the heroin capital of the United States. The New Yorker published Kristin Valdez Quade’s stunning short story The Five Wounds, which tackled drugs, teen pregnancy, the old-time Penitente faith, low-riders, and a tightly-woven mosaic of a dozen other themes that makes this region seems like another planet unless you’ve spent at least a couple of years wandering around the countryside here. Similarly, there is the mystery of why hepatitis C is so shockingly prevalent here and yet HIV so rare; as good a guess as any is that hep C roared into New Mexico with the big first wave of globally mobile northern New Mexicans in 500 years – the rapid outflux and influx of locals who went to fight in Vietnam – but that HIV never entrenched in a pattern of drug use marked by tight familial bonds and the rarity of sharing needles with outsiders…but then again, that’s just a guess.

Here on the ground, the health care workers who man the front lines of the drug addiction and treatment are an eclectic crew of general practitioners, community health workers, and the very rare addictions specialist, made common by one principle: if it works, then by all means, use it. And the classic means of treating addiction just don’t work here.

The old wisdom says that to kick a habit, you have to go away to rehab, and when you come out, you best not go back to the place you came from – your old friends, habits, dealers, and a rip-roaring relapse are there waiting for you. This works for the globally mobile; I’ve got three or four cities I could equally call home, and if I were to pick up a coke habit in one of those, it wouldn’t be too much trouble after recovery to resettle in another one where I haven’t any connection to the local scene but do have job prospects, a few old friends still on Facebook, and the ability to start a new life fresh the way I have a dozen times before. This does not work for the provincial backwaters of America, where the old urban drug centers are filtering out to these days, and where those in recovery may have nowhere else they have ever called home – nevermind the fundamental lack of funds to pay for inpatient rehab.

The old model says you abstain from all substances – live drug free – and that includes antidepressants, mood stabilizers, and medications that moderate cravings. This came from the early days of AA when – it is forgivable to say – these options didn’t exist. But it’s been a hard transition to the days when we have methadone, Antabuse, and the understanding that many addictions stem from untreated anxiety, depression, mania, schizophrenia – and that treating the behavioral disease often treats the addiction.

The old model says that addicts can quit, once and permanently, and that a failure to quit is a sure sign of moral failing. Now we understand that addiction has a strong physical component; that the norms of quitting are that is takes many tries and many failures before one finally quits for good; and that moralizing over abstinence and relapse is a fairly futile road to go down.

Altogether these new models fall out loosely into a model that has come to be known as “harm reduction.” In essence, harm reduction understands that the habits we call “vices” are partly harmful because of their innate nature, and partly harmful because of the way they are treated at large. We cannot reduce their innate harm as long as the addiction persists, but we can reduce the modifiable harms along the way, and support abstinence as soon as the addict is ready. Or, alternately, we can make sure that these habits cause the maximal cost and suffering possible to addicts and the rest of society. Really, it’s our choice.

Needle exchanges were the original harm reduction program: can’t stop addicts from shooting until they decide to cut it out, but you can help prevent them from suffering HIV and making the rest of us pay for the indigent care of drug users who then get AIDS. Condoms for teenagers came along next; most of us realize that teenagers have been having sex since the dawn of time, are not going to stop soon, and maybe we would all benefit from the reduction in budgetary and social stress at large if teenagers were not were not also trying to raise children. Thus, condoms.

In rarefied places like the Espanola Valley, harm reduction has been taken to new levels. At the first intake visit for outpatient drug treatment in one clinic, patients are not given anything except a couple of tools: a quick how-to on CPR, and an apparatus containing intra-nasal Narcan – a reversal drug that block opioids at the receptor level and yanks a person wholesale out of an overdose, immediately. And then at the next visit, Suboxone: an opioid that works half like heroin and half like Narcan, Suboxone blocks the cravings of addiction and the skin-crawling tortures of withdrawal without producing a noticeable high. This allows heroin addicts to transition back to the business of being sober in the setting of their own home and their own community, even if their neighbors and cousins are shooting up in the next room. It was invented for the upper class pill addict who didn’t want to be seen at the local methadone clinic; turns out it works spectacularly well for the impoverished heroin addict who can’t afford the niceties of inpatient rehab. (Except that I cannot prescribe Suboxone without special training and DEA waiver. I got permission to prescribe as much Percocet, Oxycontin, and Demerol as I dang well please when I graduated from residency and got my general DEA license; I can addict as many folks as I want to opiates with the meager training I got in residency to write pain medications. To treat addiction with a medication in the same class and a far safer side effect profile, I need eight hours of documented training and special dispensation from the feds. The only other medication I know of with such similarly strict regulation is Accutane, an acne medication so wickedly teratogenic that women are required to swear on paper they are using two forms of birth control before they receive it.)

So we spend so much time to treat addicts who are – needless to say if you’ve ever had one in your circle of friends and family – not always the most gracious or rewarding people to work with. Why? Some people ask, and I’ve heard that asked more than once around these parts. Why spend so much time and effort on folks so far out on the burnout end of the human race? The answer “because they are people” is apparently sometimes not enough, so here’s another reason: because every addict, every overdose, every burnout dysfunctional junkie who crosses the ER threshold blue and unconscious ripples out in a thousand predictable and unforeseeable directions to create an expanding shockwave of harm. Addicts here are not isolated family-less homeless individuals; an overdose here is not a back-alley affair – it’s likely to happen in a home, with extended family nearby, witnessed by children. Post-traumatic stress is endemic here, not in the least because of dealer-on-dealer violence, but also because of witnessed overdoses, the constant fear of police intervention taking away a mother or a father (or CYFD come to take away a sister, brother, or cousin), the eternal wailing siren of emergency services, and the constellation of low-level terror and neglect that surrounds criminalized drug use. Moreover, addicts in rural communities like the Espanola Valley are often not homeless, dislocated, far from family; they are often breadwinners and heads-of-household – and the morbidity and mortality of this demographic compounds the generational poverty which drives a near-guaranteed future of addiction and hopelessness.

Addiction begets addiction; trauma begets trauma; poverty begets all of the above, and vice versa too. The cycle has to break somewhere, and that breakage begins by cracking the ancillary harms done by drugs: reducing overdoses, treating addiction in the community with substitution drugs like Suboxone, accepting that the old drug-warrior models often cause more rather than less harm, and realizing that the time for innovation has come. The Espanola Valley may hold onto a couple of unique cultural quirks, but it is becoming increasingly representative of addictions in America: rural, occurring inside the family unit rather than in streets and alleys, and completely not amenable to outdated models of prevention, risk-reduction, and treatment.

The old Hippocratic Oath asked that doctors first, before anything else, do no harm. Physicians don’t swear by the Hippocratic Oath anymore (and for good reason – really, go ahead and read it), but that sentiment in particular isn’t a terrible one. Even so, perhaps it’s time to ask more of medical providers as a whole, a new, stronger imperative: first, reduce harm.

It is not enough to stand back and keep our hands to ourselves if we don’t know better what to do. It is time now to end the policy of harm – of jailing low-level offenders, of making HIV a reasonable consequence of drug addiction, of ensuring trauma in the children of addicts - and invoke the means we already know to remove harm. And then treat the problem. We have the means; we have only to invoke the will to do so.

Dedicated to the memory of Amy Winehouse, and to the still-vibrant A.H., who taught me – the hardest way and the beautiful way – the price of addiction, and the meaning of recovery.

Cross-posted from my recently relocated and relaunched blog, America, Love It or Heal It.

There’s a new doll entering the American toy market called the Breast Milk Baby. In addition to the doll, little girls (and boys) get a halter top that they can wear, with two flowers that symbolize breasts.

As the doll’s mouth is brought to the flowers, it makes a sucking sound, as if it is drinking milk. Afterward, the doll cries until it is burped.

“The whole purpose behind a doll is to pretend like you’re a parent,” said Dennis Lewis, the American representative for Berjuan Toys, the Spanish company that makes the dolls. “The dolls are meant to just let kids play as mommies and daddies naturally.”

The abortion debate has left one issue largely off the table: The proper rights of men to prevent the abortion of their children. 
I believe that in those cases in which a man can make a credible claim that he is the father of a developing child in utero, in which he could be a proper custodian of that child, and in which he is willing to take full custody of that child upon its delivery, that the pregnant woman involved should not have the option to abort and should be civilly liable, and possibly criminally liable, for psychological suffering and wrongful death should she proceed to do so.

...

Allow men who want to be fathers, and who could be good parents, to compel the women they impregnate to bring their children to term.

I understand that adopting social policy that gives fathers the right to veto abortions would lead to presently unknown psychological consequences for women forced to carry babies to term. But I don’t know that those consequences are greater than those suffered by men forced to end the lives of their unborn children. 

And I am absolutely certain that no woman needs to become pregnant who wishes not to become pregnant. Women taking full responsibility for their sexual activity and their bodies would mean that no woman would face the prospect of being compelled to bring a child to term.

The recession, which included a collapse in home values and high unemployment, took the greatest toll on minority wealth. From 2005 to 2009, median wealth fell by 66 percent among Hispanic households and 53 percent among blacks, compared with 16 percent among whites. The losses left Hispanic and black wealth at their lowest levels in at least 25 years.
“It’s not so much that the wealthy were busy getting richer – it’s that they slipped back less than those at the other end of the ladder,” says Rakesh Kochhar, a demographer and co-author of the analysis released Tuesday by the Pew Research Center.

In 2009, the median net worth of white households was $113,149, compared with $6,325 for Hispanics and $5,677 for blacks. That gap is about twice as large as the 1 to 10 white-to-minority wealth ratio that prevailed during the two decades before the recession.

The housing crash that began in 2006 reduced home values for most American homeowners, but it hit minority families particularly hard because more of their wealth is tied to their homes.

Planned Parenthood of North Texas said someone threw an ignited container of diesel fuel that smashed the outer glass of the front door and started a small fire around the door and on the sidewalk. The container was not thrown inside the clinic which is located in a small strip mall shopping center.
Planned Parenthood said this is the first time one of its 21 health centers in North Texas has been attacked with some kind of incendiary device and called it "alarming."
The McKinney clinic provides women's health and reproductive services, but does not perform abortions, according to Planned Parenthood.
The clinic opened in June 2008 and frequently draws anti-abortion protesters who have demonstrated without incident.

Think about what’s happening right now. We have a crisis in which the right is making insane demands, while the president and Democrats in Congress are bending over backward to be accommodating — offering plans that are all spending cuts and no taxes, plans that are far to the right of public opinion.
So what do most news reports say? They portray it as a situation in which both sides are equally partisan, equally intransigent — because news reports always do that. And we have influential pundits calling out for a new centrist party, a new centrist president, to get us away from the evils of partisanship.
The reality, of course, is that we already have a centrist president — actually a moderate conservative president. Once again, health reform — his only major change to government — was modeled on Republican plans, indeed plans coming from the Heritage Foundation. And everything else — including the wrongheaded emphasis on austerity in the face of high unemployment — is according to the conservative playbook.
What all this means is that there is no penalty for extremism; no way for most voters, who get their information on the fly rather than doing careful study of the issues, to understand what’s really going on.

It is something one half of the population has long suspected - and the other half always vocally denied. Women really do talk more than men.
In fact, women talk almost three times as much as men, with the average woman chalking up 20,000 words in a day - 13,000 more than the average man.

Women also speak more quickly, devote more brainpower to chit-chat - and actually get a buzz out of hearing their own voices, a new book suggests.
The book - written by a female psychiatrist - says that inherent differences between the male and female brain explain why women are naturally more talkative than men.
In The Female Mind, Dr Luan Brizendine says women devote more brain cells to talking than men.

Mark Liberman, professor of phonetics at the University of Pennsylvania, has turned the demolition of the women-talk-threetimes-as-much-as-men fact into a personal crusade. The 20,000 v 7,000 numbers that appear on the book jacket, he says, "have been cited in reviews all over the world, from the New York Times to the Mumbai Mirror". They are rapidly hardening into fact, but where do they come from?

Brizendine's book runs to 280 pages, of which almost a third are notes. Liberman was sure he would find "a reliable source for this statistic" among this battery of supporting data. Instead, according to a piece he wrote in the Boston Globe, all he found was an apparent attribution to a self-help book - Talk Language: How to Use Conversation for Profit and Pleasure by Allan Pease and Alan Garner. He was not impressed.

In the end, he concluded that the figures were probably based on guesswork, likening the "fact" that women talk more than men to the often stated "fact" that the Inuit have 17 words for snow. Both, he said, were myths. The Inuit actually have only one word for snow; and research shows only minute differences between the amount that men and women talk. "Whatever the average female v male difference turns out to be," he concluded, "it will be small compared to the variation among women and among men; and there will also be big differences, for any given individual, from one social setting to another."

The $1.2 trillion dollars slashed over 10 years in Speaker Boehner’s proposal would devastate programs that we care about – programs like child care, Head Start, K-12 education, Pell grants, job training, family planning and other women’s health services, and services for the elderly.

But that’s just the beginning. Speaker Boehner’s plan also requires an additional $1.8 trillion worth of cuts by the end of the year, which forces Congress’ hand even further. Dismantling the Affordable Care Act, cutting Social Security and Medicare benefits for current retirees, slashing Medicaid, or unraveling other key pieces of the safety net for women and families would be all but guaranteed. All this, without promising a single penny raised through additional tax revenues from those with the greatest means to pay.

Yesterday famed "Christian" pastor Rick Warren, wealthy author and megachurch leader, tweeted the following:

HALF of America pays NO taxes. Zero. So they're happy for tax rates to be raised on the other half that DOES pay any taxes.
After a firestorm ignited decrying this egregious mix of selfishness and ignorance, Mr. Warren deleted his tweet. But the screenshot is preserved for Internet eternity.

Warren holds conservative theological views[7] and holds traditional evangelical views on social issues such as abortion, same-sex marriage, and stem-cell research. Warren has called on churches worldwide to also focus their efforts on fighting poverty and disease, expanding educational opportunities for the marginalized, and caring for the environment. During the 2008 United States presidential election, Warren hosted the Civil Forum on The Presidency at his church with both presidential candidates, John McCain and Barack Obama. Obama later sparked controversy when he asked Warren to give the invocation at the presidential inauguration in January 2009.