Author: ken

“It’s an Emotional Topic”

What is the meaning of the upsurge in resistance to vaccination this year?  Why is the public fighting more vigorously than ever those who are trying to help them avoid serious infections?

The Times reported that a conference organized by the National Vaccine Information Center, an anti-vaccinator activist group, attracted “675 people, more than double the number at the group’s last conference….  Unlike most people associated with the center. . . the newcomers were not traditional skeptics.”  The President of the Center noted that the swine flu vaccine campaign “breathed new life” into the cause. (See “Swine Flu Shots Revive a Debate About Vaccines.”)

There has always been an undercurrent of suspicion towards medical treatments, grounded in the fact that they are invasive and they can’t guarantee success.   But most people accept them because of the authority of physicians – an authority, in turn, based upon the quality of our medical education and the ethical standards the professions uphold.

Then there is suspicion of government.  Those entrusted with protecting us by regulating banks and investment firms have turned out to be more corrupt and self-interested than we ever imagined.  And this comes on top of FEMA’s disastrous incompetence in the wake of Katrina.  Faith in government has been seriously eroded.  According to the polls, most of us approve of Obama,  but he presides over a vast, entrenched bureaucracy we have all-too-many reasons to doubt.

I wonder, though, if the intense public debates about health care reform may not have tipped the scales this year.  As the various components of the health care industry – the drug companies, the insurance companies, the HMOs, the hospitals and professional associations for doctors, nurses, etc. — have all lobbied to protect their distinct interests, they have also exposed the degree to which they are competitive with each other and self-serving.  The public’s exposure to this political struggle, displayed relentlessly in the news, makes it clear that the health care industry’s primary focus is not the public interest.  It’s hard to imagine that this has not had some impact on the trust the public feels towards those it traditionally relies upon.

The makers of vaccines have profits to protect – and sometimes inadequate trials to hide.  The physicians earn a fee for every injection, even if is administered by a nurse.  Pharmacies make a profit too.  The regulating agencies that approve the vaccines have been shown to be not entirely above political influence.  As they fight with each other, their credibility declines.

The Times quoted one mother who feels there is “something different” about this vaccine. “I go back and forth on this every day. It’s an emotional topic.”  But, perhaps, the difference this time is not in the vaccine.

“A Silent Epidemic”

Every so often – but never often enough – we are reminded of the frequency with which children are sexually abused.  Roman Polanski’s arrest and continuing legal struggles brings this to our attention again, and in last Saturday’s New York Times Charles Blow reminded us:  “nearly 70 percent of all sexual assaults are committed against children,” according to a Justice Dept report.  “While the age with the greatest proportion of assaults reported was 14, more than half of all child victims were under 12. And of those under 12, 4-year-olds were at the greatest risk.”

Blow went on to say:  “According to a Unicef report released this week, ‘5 to 10 percent of girls and up to 5 percent of boys suffer penetrative sexual abuse.’ Up to three times of those numbers experience some type of sexual abuse.”  But that’s only what’s reported, Blow noted.  It’s likely that, in fact, “up to 3 in 10 girls and 3 in 20 boys are still being assaulted.”  He concludes, “these are epidemic proportions. And, if most cases are never reported, it’s a silent epidemic.” (See, “No More Suffering in Silence.”)

But silence is the least of it.  Blow argues for a public health campaign that alerts the entire citizenry to the existence of this epidemic, encouraging children who are victims to overcome their fear and shame and speak up about what has happened.  That’s good and would be useful.

But the problem is usually buried deeper than silence.  For one thing, the memories of abuse, the feelings, the consequences for the victims often end up barricaded deep in their unconscious minds.  For another, the accusations can be buried as well:  few family members want to know that a relative, friend or, even, a parent sexually abused a four-year old child. They can’t bring themselves to remember or repeat what they saw or heard.

And then the public itself does not want to think about it – except in sensationalistic cases where a celebrity is involved, such as Polansky.  And then, usually, the public discussion is polarized and hopelessly stereotyped.  Horror and condemnation vie with naive calls to forgive and forget.

The experience of professionals teaches us that this is a very complex and difficult problem to address — not just another public health problem.  The solution to overcoming the fear and shame of sexual abuse may be, paradoxically, to normalize it.  If the facts were more widely reported, if more of the stories were told, if books for children were written about it, TV shows produced, if it became the topic of a national dialogue and adults were encouraged to talk about it, then, we might be better able to help the victims – and the victimizers.

As Blow points out, it is an epidemic, but there are many different forms it takes and some forms are worse than others.  The motives vary, the experience varies, as do the effects.  Could we talk about it, we might be able to come to recognize it for what it is:  a widespread problem that is made worse by our fears and taboos.

Finding the Correct Category for This War

Some pundits suggest Korea is the right analogy for the war we find ourselves fighting:  it will end in a stalemate.  Some suggest Vietnam:  we will be forced to abandon a quagmire.  The underlying question seems to be:  which war are we losing?

But the unspoken consensus is that we are stuck.  My colleague Ralph Biggadike, at the Columbia Business School, puts it this way:  “I’m wondering if we all know that there is nothing the US and NATO can do in Afghanistan but we haven’t admitted that into our consciousness. We don’t know that we know continued engagement in Afghanistan is a path to disaster.”  On the other hand, “Pulling out of Afghanistan is the unthinkable.”

Newsweek tells this week of a reference Gen. McChrystal made to a plan called Chaosistan, essentially allowing Afganistan to become a “Somalia-like haven of chaos that we simply manage from outside.”  After some confusion about the origin of that radical suggestion, the general’s aides clarified that it came from a recently published, and secret, CIA analysis…. [that] explains how forces inside Afghanistan—from hostile ethnic groups to intrusive neighbors to societal damage caused by past Taliban rule—work against the notions of a central Afghan government.” (See, “Chaosistan”)

That is yet a different model for the war.  But it seems unlikely we could abandon the country now, after intruding so forcefully.  On the other hand, neither can we win, lacking the political will to mobilize the resources necessary for the job.  Meanwhile the war is shifting across borders we ourselves can’t so easily cross.  It looks hopeless, and I think sub-consciously we all know it, as Ralph suggests.

In the same issue of Newsweek that reported McChrystal’s comment, Fareed Zakaria put a different spin on the whole issue, noting “the assumption that we are failing in Afghanistan. But are we really? The United States has had one central objective: to deny Al Qaeda the means to reconstitute, train, and plan major terror attacks. This mission has been largely successful for the past eight years.” (See “The Case Against a Surge.”)  Vice President Biden has apparently been pushing a similar point of view in the Obama administration, with some success – though it is not clear how he proposes we extricate ourselves.

It is tempting to think it is all a matter of perception:  Korea, Vietnam, Somalia – or a great success.  I don’t know which set of lenses is more correct, but I am in favor of making conscious the underlying assumptions that govern our thinking.

Obama’s Nobel Prize

Everyone was shocked.  The radical right was outraged and incoherent.  The President’s supporters, taken off-guard, were bewildered.  The President himself seemed wary: “To be honest, I do not feel that I deserve to be in the company of so many of the transformative figures who have been honored by this prize.” (See “Surprise Nobel for Obama Stirs Praise and Doubts.”)

The confusion stems from the assumption that the Prize is a reward for accomplishment, like the prizes in physics and chemistry.  To be sure, sometimes it is.  In 1978, it was given to Anwar al-Sadat and Menachem Begin as a reward for their work inaugurating the peace process at Camp David.  In 1953, George Marshall received it for his far-sighted and successful efforts to rebuild Europe.  But the 1984 award to Desmond Tutu occurred well before apartheid was abolished in South Africa, and the award to the Burmese dissident leader Aung San Suu Kyi occurred in the absence of any significant change in that country.

The hard thing to see here, I think, is that the Nobel committee is trying to give Obama an assist.  Their assumption must be that he needs it, like some of the other recipients over the years.  For us, this is cognitive dissonance.  It doesn’t compute.  How can the most powerful man in the world need help?  And, even if he does, how would it be possible to help him?

Among many Americans, it stirs up feeling of intrusion or meddling.  Those who support Obama wonder if it will really help him or just be an embarrassment.  Perhaps it is a clumsy and misguided effort that may even solidify resentment and opposition.  Those who seem to be fighting him every step of the way, are responding by trashing the Nobel committee and the prize itself.  They are true to form.

But it may help him abroad in his efforts to reestablish diplomacy as a solution to international conflicts.  The prize may be hard for us to understand, but it was given by Europeans and it plays well in Europe.

The peace it celebrates may be the cease fire between us and our allies.

Why?

Why have so many law-abiding citizens come to resist the census?  What are they afraid of?

Those hiding from the law, clearly, don’t want to be seen and counted.  That explains the worries of illegal immigrants – but they are not the ones resisting the census.  And those who fight the presence of the illegals or resist their acceptance into our society might argue that including them in the census is a step towards normalizing their existence.  But that’s just a fraction of the problem as a recent Newsweek article points out (see “Anti-Census Sentiment”).

Most of naturally resist scrutiny. We all like our privacy, and most of us have some secrets we’d rather keep hidden.  We don’t want our phones tapped.  The many thousands of surveillance cameras that dot our streets make us uneasy, that is if we become aware of them. It’s not so hard to be suspicious of what others want to know, or why they want to know it, or to worry about what will be done with that knowledge that’s collected.  Such “normal” suspicions don’t make us paranoid.

Moreover, we all have learned to mistrust government.  We have been lied to and misled.  The ways in which I suspect the government may be different from the ways others do, but I can hardly affirm that we should take what our elected officials say at face value or trust them to have our best interests at heart.  So as the Census Bureau probes into our lives, it inevitably arouses such fears.

But maybe the underlying problem is not so much our anxieties about being known as it is about knowing.  Perhaps the resistance has to do with what we fear finding out about ourselves.

The Census is mandated by the constitution, and its primary purpose is to up-date the apportioning of our congressional representatives.  But over the years it has been seen as a valuable opportunity to find out much more about ourselves, information useful to government as it keeps track of the population.  But maybe we don’t want to know what we could know about ourselves, how different we are from what we’d like to think.

Decades ago, it was an opportunity to find out how many residents owned their own homes, had refrigerators, cars and bathrooms.  But, today, do we want to know how racially and ethnically varied our households are?  what new forms of co-habitation and child rearing we have improvised?  how our employment histories have played out?  how wide the gap is between the rich and poor?  our general levels of health?  education?  indebtedness?

Frankly, I am inclined to believe that the professionals entrusted with the survey do a good job conscientiously, but it may well be that their good faith effort to tell us who we are goes against the grain.  What we don’t know we know may be exactly what we resist finding out.