It’s the holy grail of contemporary marketing: getting consumers to pay more for something that is worth less. When it comes to organic food, marketers have hit the jackpot.

How have consumers have been enticed to pay more for products that are potentially less safe than their conventional counterparts? The organic food scam depends on tapping into cultural myths about nature, playing upon widespread misunderstanding of risk, and flattering consumers into believing that those who choose organic food are “empowered.”.

The word “natural” is widely used to sell products. In Packaging as a Vehicle for Mythologizing the Brand researchers explore the connotations of “natural” in contemporary culture and the ways in these connotations are exploited to sell products.

Marketers of organic products depict the modern world as a deeply distorted reflection of what it originally was – the garden before agro-chemical technology. While the values of the past include family, tradition, authenticity, peace, and simplicity, the current era is associated with broken family ties that need to be restored, scientific “advances” that pose threats, constant pressure on the well-being of humans, and unnecessary complexity in everyday life.

Consider the concept of “naturalness”:

Naturalness appears as a rich emotional construct that connects with positive contemporary images of nature… People do not want to remember that nature can also be destructive as in deadly hurricanes and poisonous mushrooms … In a natural health context, Thompson also finds nature to be a positively framed powerful mythic construction; and his informants attribute magical, regenerative powers to nature. They firmly believe that aligning with what nature has to offer for one’s health lets them assert control over their lives and bodies versus losing control by being complicit in a scientized medical system.

There is nothing inherently better about “natural,” but contemporary mythology assumes that there is. The organic food industry exploits this mythology to imply that organic food is inherently better.

In addition, marketing professionals exploit the lack of understanding about risk. We routinely panic about insignificant health risks (high tension wires, X-rays) and routinely ignore large health risks (driving without a seatbelt, tanning). Hence, consumers routinely obsess about insignificant health risks that have never even been shown to occur (pesticides, hormones) and routinely ignored large health risks (foodborne illness caused by bacteria like E. coli and salmonella in the animal waste used as fertilizer) that have been associated with widespread outbreaks of illness and even death.

David Ropeik discusses the causes of misperception of risk in his article The Consequences of Fear. Two factors, control and origin, are especially relevant for understanding the misperception of food risks.

Risks over which we feel as though we exercise control are routinely perceived to be smaller than risks that are imposed from outside.

… Roughly 20% of Americans still do not wear safety belts in motor vehicles… [T]his is, in part, because we have a sense of control when we are behind the wheel, and the risk of crashing is both familiar and chronic—factors that make risks seem less threatening…

In other words, people not only tolerate the substantial risk of not wearing a seatbelt, but they perceive the risk to be relatively small, when, in fact, it is relatively large compared to risks that evoke more fear, like the risk of a plane crash or a terrorist attack. Similarly, consumers of organic food tolerate the real and substantial risk of illness from pathogens in manure, but fear the effects of pesticides, which have never been shown to cause illness.

Origin is important to consumers, too. The risks of technology are widely perceived to be greater than risks from nature, neatly dovetailing with the culture mythology surrounding “nature.” For example:

…many people fail to protect themselves adequately from the sun, in part because the sun is natural … However, solar radiation is widely believed to be the leading cause of melanoma, which will kill an estimated 7,910 Americans this year.

Hence the imagined and undocumented (and possibly non-existent) risk of pesticides in food are perceived as greater than the real and documented risks of serious illness and death associated with the bacteria found in manure fertilizer.

Ultimately, these myths are joined in service of the over-arching myth, that of the “enobled and empowered” consumer:

… [A]ll the significance attached by [marketing professionals] to the products transforms otherwise powerless consumers into the powerful marketplace players. As a result, newly empowered consumers can temporarily escape imposed world conditions by shaping their personal myths and servicing their individual lives. Thus, myths of the past are meaningfully used to serve the present.

Marketers of organic food are not allowed to claim that the food is safer or more nutritious, since it is neither. However consumers are led to believe that by choosing “natural” food grown with “no pesticides,” they are making an “empowered” choice of safer and healthier food. In that way, they can be induced to pay more for food that may actually be worth less.

Sometimes an event is so ineffably sad that it almost defies comprehension. That was how I felt after a phone call on a bright Saturday morning in my last year of medical training.

As a chief-resident in obstetrics and gynecology, I was responsible for handling phone calls from patients who did not have a gynecologist of their own. On that Saturday morning, I took a call from a local women who was in her early 20’s. She sounded distraught, and at first, I couldn’t understand why she was calling.

“It’s about my 5 year old daughter,” she said. “I’m having a disagreement with her doctor and I want you to talk to him.”

“Okay,” I replied warily, “but I’m a gynecologist, so I’m not sure I could be very helpful.”

“No, no, you’re the right kind of doctor,” she insisted. “It’s a female problem.”

The mother proceeded to describe her daughter’s symptoms, vaginal itching and a greenish, malodorous discharge. The little girl’s pediatrician had examined her and gently taken a sample of discharge to look at under the microscope. When he returned to talk with the mother, he was very grim.

The microscopic evaluation of the discharge had reveal that the little girl was suffering from gonorrhea. It would not be difficult to treat; a simple shot of antibiotics should do the trick, but it could not end there. The pediatrician enquired if the mother knew where her daughter had contracted gonorrhea. It could only have come from sexual contact, which meant that someone had been sexually abusing the child.

The mother was aghast. She insisted that there was some mistake. There was no way her daughter could have been abused by anyone. The doctor disagreed.

The pediatrician informed her that, under the law, he had no choice but to file a “51A.” The mother understood that a 51A was a legal document alleging child abuse. It would set in train an investigation by child protection officials, and might result in her child being removed from her custody. The mother protested, but the doctor was adamant.

Now she wanted to know if it were possible that her daughter’s vaginal infection was something other than gonorrhea. I explained that seeing the bacteria under the microscope was quite reliable, but, in any case, the doctor had taken a culture. That meant that the laboratory would also identify the bacteria. The culture results would be virtually 100% accurate, and, I cautioned her, would almost certainly confirm the diagnosis of gonorrhea.

“Well, even if she has gonorrhea,” inquired the mother, “couldn’t she have picked it up from a towel or a toilet seat?”

I explained that that was highly unlikely. The gonorrhea bacteria could not survive outside the body for very long. Neither towels nor toilet seats were likely to be the source of gonorrhea.

Suddenly, her voice brightened.

“I know, I know,” she said, “My little girl got it from me!”

“From you?” I didn’t understand.

“Yes, from me,” she replied. I had gonorrhea a few weeks ago. My daughter and me, we take baths together all the time. That’s how she must have gotten it.”

She was quite relieved. “I knew it,” she declared. “No one has been messing around with her. She caught it from me.”

I wasn’t so sure.

“You had gonorrhea?” I asked with trepidation. “How did you catch gonorrhea?”

I knew what was coming.

“Oh, I caught it from my boyfriend. He had it and he gave it to me. We both got antibiotic shots and now it’s gone.”

My heart sank.

“No, Ma’am, your daughter didn’t get gonorrhea from you.”

“She didn’t? Of course she did,” the mother protested. “Who else could have given it to her?”

I tried to be gentle, but how can you gently tell someone that her boyfriend has been sexually abusing her daughter?

The mother burst into tears. “That means the doctor is right, doesn’t it?”

“Yes, he is probably right.”

The mother continued sobbing. “I’m sorry,” she said. “I’m so sorry I bothered you. I just thought that there had to be some other way.”

I assured her that it had been no bother, though I had been shaken to the core.

“I’ve got to go now,” she wept. “I can’t talk anymore. I don’t understand. I just don’t understand. What am I going to do now?”

Every so often I get an e-mail forwarded to me recounting the story of a friend or acquaintance recently diagnosed with ovarian cancer. The cancer is almost always far advanced, and the prognosis is very grim.

The e-mail reveals that the cancer might have been diagnosed much earlier if only the woman had been given a simple blood test (CA125 test) or had an ultrasound. Readers are exhorted to press their doctors for both tests, so that if they develop ovarian cancer, it can be diagnosed early, when treatment is more likely to be successful. The e-mail makes it sound like the means of diagnosing ovarian cancer is here, but doctors are ignoring the possibilities.

The situation is far more complicated. Yes, a simple blood test or an ultrasound can lead to early detection of ovarian cancer. Unfortunately, though, it also leads to tremendous numbers of unnecessary surgeries and the complications that result. In fact, it is entirely possible that screening for ovarian cancer is more dangerous than not screening for ovarian cancer.

That is the central message of a new study published today in Lancet Oncology, Sensitivity and specificity of multimodal and ultrasound screening for ovarian cancer. You might not realize that if you read newspaper accounts of the study, which emphasize the number of cancers diagnosed. Many newspaper accounts don’t mention that for every woman diagnosed with ovarian cancer, many more had unnecessary major surgery and quite a few suffered serious complications as a result.

The study screened more than 100,000 postmenopausal women for ovarian cancer. Half had ultrasound and CA125 tests (multimodal screening); the other half had ultrasound alone. Ovarian cancer was detected in 87 women, 42 in the multimodal group and 45 in the ultrasound alone group. That sounds pretty good until you learn that in order to make those diagnoses, 942 women had surgery. In other words, 855 women had major abdominal surgery for no reason. Of those, 24 experienced major complications including perforation of an organ (requiring surgery for repair), hemorrhage, deep vein thrombosis, and pulmonary embolus.

There was a big difference in unnecessary surgery between the multimodal group and the ultrasound group. Of the 942 women who had surgery, 845 were from the ultrasound group. In other words, adding the CA125 blood test made the screening more accurate. Even so, for every woman in the multimodal group who had ovarian cancer, 2 additional women had surgery that they did not need. In the ultrasound group, for every case of ovarian cancer diagnosed, approximately 19 women underwent major abdominal surgery that was unnecessary.

Screening hurt far more women than were helped. For every woman who was diagnosed with ovarian cancer, 9 more had surgery that they didn’t need, and 2.8% of women who had unnecessary surgery sustained serious, life threatening surgical complications. That is a pretty dismal record for a screening test.

If we leave aside the ultrasound only group, the results in the multimodal group are far more encouraging. Only 97 underwent surgery, of whom 42 had ovarian cancer. As mentioned above, for every case of ovarian cancer diagnosed in the multimodal group, 1 woman had surgery that she didn’t need. Of those women who had unnecessary surgery, 4.2% sustained serious, life threatening complications.

What would happen if we instituted multimodal screening for all post menopausal women. For every 1 million women screened, 866 cases of ovarian cancer would be diagnosed, 1034 women would have unnecessary major abdominal surgery, of which 43 would sustain major, life threatening complications.

In addition, we do not know if the early diagnosis of ovarian cancer in these patients would improve outcome. Over half of the women diagnosed by screening already had advanced disease, so it is unlikely that screening improved their prognosis. Moreover, even early stage ovarian cancer is a dangerous disease, and many of these women are going to die anyway.

The ultimate value of a screening test is in lives saved, and that information is beyond the scope of this study. It is already clear, though, that for every life saved, 4 or more women will have unnecessary major abdominal surgery, some women will sustain life threatening complications, and inevitably, some women will die from complications of surgery that they did not need.

This study is large, comprehensive and well done, but it does not support mandatory screening for ovarian cancer. It demonstrates that large-scale screening is possible, and that early ovarian cancer can be diagnosed by screening. Unfortunately, it also shows that large-scale screening efforts results in substantial harm to more people than are helped. When the screening test is potentially more dangerous than the disease, it makes no sense to implement mandatory screening.

A sharply divided Massachusetts Supreme Judicial Court recently issued a ruling with head spinning legal and ethical implications. The question at issue: do statutory rape charges discriminate against boys? According to the SJC, that claim can be raised in a defense against the charge of statutory rape.

The facts of the case are not in dispute. According to The Boston Globe:

The case … involved a high school freshman football player who is accused of engaging in various sex acts from August to October 2007 with three girls. Two were 12, and the other was 11.

“None of the complainants reported being afraid of the boy’s behavior,” Chief Justice Margaret Marshall wrote for the majority.

The law on statutory rape is quite clear:

Whoever unlawfully has sexual intercourse … [with] a child under sixteen years of age shall … be punished by imprisonment in the state prison … [or] any term in a jail or house of correction …

Additional case law has further refined the requirements of the statute:

The offense of statutory rape … may be committed with or without any knowledge on the defendant’s part of the age of the victim.

Consent is not a defense to a charge of statutory rape.

The only elements the Commonwealth must prove are (1) sexual or unnatural sexual intercourse with (2) a child under sixteen years of age.

Based on the facts of the case, and the law, the District Attorney charged the boy with statutory rape. There is no question that the acts occurred, no doubt about the age of the girls, and no defense in claiming that the acts were consensual. Therefore, the boy’s lawyer offered a novel assertion: Since all parties were under the age of consent, prosecuting only the boy is sexual discrimination.

The boy’s lawyer should be commended for offering a novel defense. The SJC should have their collective heads examined for agreeing with it.

The theory behind statutory rape law is that children under the age of 16 are incapable of giving legal consent to sexual activity. They may desire such activity, and they may be willing participants, but their consent carries no legal weight. That’s because they are too young to understand the implications of sexual activity, and, by virtue of their age, are easily manipulated by those who are older. Although the law traditional was originally intended to protect young girls, it has been extended to protect boys as well.

In recent years, the dramatic increase in teen sexual activity has led to a reappraisal of statutory rape laws. So called, “Romeo and Juliet” exceptions have been added in many states. Generally, these exceptions allow consensual sex between partners over age 15, provided that one partner is not substantially older than another. In states with “Romeo and Juliet” exceptions, sex between a 15 year old girl and her 17 year old boyfriend is not statutory rape, but sex between a 15 year old girl and her 45 year old softball coach would still be considered statutory rape, regardless of whether the girl consented.

The statutory rape laws are gender neutral. Sex between a 15 year old boy, and his 45 year old coach is also statutory rape. Most prosecutions for statutory rape are against men and boys, because the male is usually the older party and because the male often initiates the sexual contact. The Massachusetts SJC has essentially ruled that this disparity in charges is evidence of sexual discrimination.

The boy’s defense received the support of an amicus (friend of the court) brief filed by the Women’s Rights Project and the Reproductive Freedom Project, which are part of the American Civil Liberties Union. According to ACLU lawyer Sarah Wunsch:

“We should not be enforcing the law based on stereotypical notions about girls as not being capable actors in the same way that boys are… They are doing what teenagers are doing today. They are fooling around sexually, and the girls are participants in the same way that boys are.”

Wunsch said statutory rape laws are rooted in an old concept that a daughter was the property of her father. Echoes of that thinking can be found today when prosecutors criminalize sexual activity involving girls, she said.

“Our view is that there is still a very strong pattern of district attorneys charging based on the notion of having to protect girls,” Wunsch said. “But girls can enjoy sex and be sexually active. They are not simply victims.”

Have these people lost their minds? The three girls in this case are in elementary school! Claiming that girls in elementary school  “can enjoy sex and be sexually active” is a willful misrepresentation of everything we know about children and their decision making abilities.

It is instructive to consider why lawyers for the Women’s Rights Project are willfully misrepresenting the ability of young girls to give consent to sexual activity. In their minds, they appear to believe that they are striking a blow for women’s rights. Hence Wunsch’s mention of outmoded ideas of girls as the father’s property and women as incapable of enjoying sex.

In an effort to protect women, Wunsch, and the SJC are willing to sacrifice young girls. Both willfully ignore the contemporary pressure toward early sexualization of young girls, and the cultural pressure for girls to accede to the demands of boys, whatever those demands might be.

Moreover, the SJC and Wunsch willfully ignored the ages of the girls and the age difference between the girls and the boy. The boy was charged because he was older, significantly older. He was in high school; they were in elementary school. He was not charged because of repressive ideas about female sexuality, and it is disingenuous at best to make that claim.

This case is about child protection, not about female sexuality. Elementary school girls are incapable of giving consent to sexual behavior, period. Elementary school girls can and should be protected against the sexual advances of older boys and men, period. It is astounding that the majority on the SJC could not tell the difference. In their misguided attempt to advance women’s rights, and fight sexual discrimination, the SJC has willingly sacrificed young girls to the predatory advances of older boys and men.

I’m surprised to find myself upset about a reality TV star having a very uncomfortable brush with reality. The incident could an unexpected benefit, though. The embarrassment of having a personal failing caught on camera might cause Jon to consider how his eight children feel about their televised lives.

Jon Gosselin, of Jon and Kate Plus Eight, has been photographed partying with young women, none of whom are his wife. Evidently, while visiting his mother, he crashed a local college party to play beer pong and was also seen in local bar with some of the college girls. An apparently very drunk Jon was photographed with two of his “fans.”

Jon is not a friend of mine, but I feel like I know him. After all, he and his wife invite me into their home on a daily basis to watch the trials and tribulations of raising twins and sextuplets. My kids love the show and I often watch it with them. The children are terrific, it’s easy to sympathize with the parents, and they leave their fundamentalist Christianity out of the show (though not out of their book, website, etc.). Admittedly, I find it a little tough to take the way that Kate is constantly berating Jon; but I figure that if it works for them, it shouldn’t matter to me.

Why is the incident so upsetting for a total stranger? Jon and Kate surely have their problems, like all married couples, but in an extraordinarily stressful situation, they appear to have created a happy marriage and a loving home. They emphasize their partnership and they clearly dote on their children. In short, they present the ideal of family life: challenging, complicated, but ultimately rewarding and satisfying.

It is disappointing to learn that the stress has become too much, that the ideal is no longer ideal and to imagine the resultant pain for Kate, their children, their families and their friends. It would be bad enough if the incident were relatively private, but Jon is a celebrity, and the news is being flashed from coast to coast, dramatically escalating the humiliation potential for Jon, for Kate, and for the children.

Yet if the incident has a bright side, it may be that it brings home for Jon and Kate, the price of the celebrity that they sought and enjoyed. When you are a reality TV star, the entire reality of your life is fair game, not just the carefully manicured part presented to the public. Jon and Kate consciously chose the life of celebrities, and have created some clear boundaries around themselves, even within the context of a reality show. Their eight children, on the other hand, couldn’t possibly give consent, and can’t possibly understand the ramifications of being displayed on television on a daily basis.

Jon and Kate have been honest about the fact that they agreed to the show in order to make enough money to support eight children and provide them with all the extras of a middle class life, while allowing Kate to remain at home. Yet they have made the children celebrities without their consent, and they have allowed their lives to be displayed in intimate detail without considering the ultimate consequences to the children themselves.

As Jon and Kate have just learned, probably to their great shame, fame comes with a very high price. You cannot go anywhere without being recognized. You cannot make mistakes without being photographed. And you cannot keep your transgressions private, to be resolved between yourself in whatever way you deem best.

The children are still small. The embarrassment of having their toilet training broadcast to the public may bother them when they are preteens, but it is unlikely to have any lasting effect. However, as they grow older, the foibles and issues may become more serious, and they will surely become more invested in their own privacy.

Jon’s drinking and partying with young girls is now public knowledge. Jon and Kate will not be able to protect them from it, as they might have done if they were any other couple. That is going to have a harmful impact even though they were not the perpetrators of the deed. How much more harmful will it be to have their own lives laid bare to the public?

I love the television show Jon and Kate Plus Eight, but the life of Jon and Kate and their children should not be on display for us, no matter how much we enjoy watching. Jon’s recent experience has illuminated in sharp relief the consequences of opening your life to public scrutiny. Jon and Kate made that choice, and they will live with the consequences, good and bad. The children never chose to be celebrities, and beyond the money, there appear to be no benefits for them in this arrangement.

In addition to reflecting on their marriage, this may be an opportunity to reflect on what they are doing to their children. Surely it would be difficult to walk away from the fame and marketing bonanza, but maybe it’s time to do just that. This could recent incident could have been a sign of problems, in more ways than one.

On Wednesday, the US Supreme Court ruled in favor of Diana Levine in her lawsuit against Wyeth Pharmaceuticals. The victory means that Ms. Levine, a professional guitarist whose lower arm had to be amputated after a Wyeth drug was improperly administered is now entitled to receive the $6.7 million dollars that was awarded to her by a Vermont court.

Ms. Levine has also secured a victory for the rest of us. In attempting to void the multimillion dollar award in this case, Wyeth claimed that once a product, any product, passes Federal guidelines, the maker cannot be sued, regardless of the injuries that the product might cause, a doctrine known as “preemption.”

The case behind this complex legal issue is simple and tragic. Diana Levine, a professional guitarist, lost part of her arm when she received the right drug, in the wrong way. Ms. Levine received Phenergan by IV push (injected directly into the bloodstream to act fast) to counteract the nausea of severe migraines. Instead of injecting the drug into a vein, it was mistakenly injected into an artery, leading to gangrene and subsequent amputation of Ms. Levine’s lower arm.

There is no dispute about the central facts of the case. Ms. Levine did mistakenly received Phenergan into an artery; the health care provider made the mistake; it is well known that Phenergan (like all medications) should never be injected into an artery; Wyeth had labeled Phenergan with warnings, but no specific warning about the consequences of injecting Phenergan into an artery instead of a vein. Ms. Levine has already won a multimillion-dollar judgment in state court against the clinic where she was treated. Then she attempted to sue Wyeth in state court, claiming that the drug label should have warned specifically about the outcome of injecting Phenergan into the wrong place.

Wyeth argued that it could not be sued in state court for an error in labeling because the Federal government, through the FDA, had approved the label. Therefore, any claims in state court are preempted by Federal regulation. If the Supreme Court had accepted this argument, the effect would have been to shut down injury lawsuits, not just those against drugs, but also lawsuits against cars, household products, agricultural products and chemicals.

Doctors strongly supported Ms. Levine’s right to sue Wyeth. The Role of Litigation in Defining Drug Risks, a paper in the January 17,  2007 issue of the Journal of the American Medical Associate (JAMA). championed the value of lawsuits in supplementing the regulatory process.

Most physicians and patients learn about prescription drugs from publications of clinical trials or case reports, promotional materials or alert letters provided by pharmaceutical manufacturers, and formal documents such as the FDA approved label. These sources, however, sometimes provide a limited perspective on a drug’s benefits and risks…

In both the premarketing and postmarketing stages, lawsuits have helped uncover important and previously unavailable data about major adverse events…

Litigation has also helped the medical community reassess drugs by bringing to light new information about adverse effects…

The paper ended with a rousing, and surprising, endorsement of litigation:

… [L]imiting legal involvement in the prescription drug arena is likely to increase the nation’s problem of poorly defined or inadequately presented drug risk information… [C]linical trials and routine regulatory oversight as currently practiced often fail to uncover important adverse effects for widely marketed products. In each instance, the litigation process revealed new data on the incidence of adverse events, enabled reassessments of drug risks through better evaluation of data, and influenced corporate and regulatory behavior. In performing these tasks, lawyers and their clients often find themselves serving as drug safety researchers of last resort.

This case was about a lot more than one woman’s right to sue a drug company because of a drug induced injury. Ms. Levine won a victory for herself, but in a very real way, we won, too. The Supreme Court has ruled that receiving Federal approval does not absolve drug companies of responsibility for injuries and deaths caused by their products. We still have a right to sue drug companies (or the manufacturers of any product), to review their internal documents, and to determine if they introduced a product to market that they knew could harm consumers.

Evidently I’ve been living under a rock, because I only recently learned about the latest internet craze, web sites for married people looking to have an affair with other married people. AshleyMadison.com, the premier site of its kind, garnered a massive amount of free publicity when its Super Bowl commercial was banned in 49 out of 50 states. The ad showed a woman out to dinner with her annoying husband; the voice-over asked: “Isn’t it time for AshleyMadison.com?” The article I read went on at length about what such websites tell us about how we view marriage. I came away, though, with an entirely different impression.

Can a married woman be so desperate that she is willing to pay to get someone else’s husband to sleep with her? Isn’t that kind of defeating the purpose of an affair?

I’ve never had an affair, nor do I intend to, but I was under the impression that an affair was supposed to be an unbearably romantic experience, especially when contrasted with the stale partner being cheated upon. Despite your best efforts, you cannot ignore the attraction and neither can he. Ultimately, after strenuous attempts at resisting, passion overwhelms. You never intended it to happen, but the heart has a mind of its own, right?

Apparently not. When you sign up with AshleyMadison.com (“Life is short. Have an affair.”) or LonelyCheatingWives.com or MarriedDateClub.com, you actually plan your affair with someone else who is planning an affair. Where’s the passion in that? It’s like sending yourself roses and pretending that someone cares. If it’s only about having sex with someone, anyone, why not saunter down the street naked? Someone is bound to proposition you, and you won’t even have to pay.

I can’t get over the fact that people are willing to pay for this, and it’s not cheap. Packages start at $49 and quickly escalate from there. For $249, AshleyMadison.com promises to refund your money if you don’t end up having an affair.

I’m confused, though. Wouldn’t it be simpler, and far more lucrative to become a call girl? When you sign up as a prostitute, someone else’s husband pays you to have sex with him, and, as a call girl, the sex is pretty much guaranteed.

Sites like AshleyMadison.com pretend that they are wicked, but I find them to be pathetic. Sure they invite you to break your marriage vows, hurt your spouse and humiliate your children, and I guess that is “wicked.” However, if you have to pay for the privilege you must be desperate.

If recent surveys are to be believed, almost 50% of married people cheat at some point, proving that people can manage to be selfish, self indulgent and heartless on their own. Does anyone really need help to pull that off? Does anyone really need paid help to make it happen?

Websites that promote infidelity represent themselves as sexy, sinful and fun. In reality, they are nothing more than the most pathetic form of lonely hearts club: unhappy cheaters, so desperate for human contact that they are willing to pay for it. AshleyMadison.com and similar sites aren’t sexy, they’re just sad.

Rihanna has inadvertently shined the spotlight on a taboo subject. No, not domestic violence; discussions about domestic violence have become commonplace. Rihanna has highlighted the problem that no one wants to talk about, the role of women in sustaining abusive relationships.

The sad secret of domestic violence is that it takes two people to sustain an abusive relationship, the abuser and the woman willing to be abused. Rihanna is now the poster child for these women. Rich, talented and beautiful, Rihanna has no objective reason for returning to Chris Brown, the man who battered her face, an important source of her livelihood. She’s going back because she has the psychological need to be hit again, and Chris Brown is going to oblige her. It is only a matter of time before another picture of a bloody and bruised Rihanna appears in People Magazine.

Next time, it will be Rihanna’s fault as well as Brown’s. Sure, it will be Brown who perpetrates the violence, but it will be Rihanna who deliberately has placed herself in harm’s way. Just like the motorist who hits a pedestrian bears some of the responsibility, the person who darted in front of the car at the last moment is equally to blame.

Harsh? You bet it’s harsh. The problem of domestic violence is a brutal problem with harsh realities at its root. It’s time that we acknowledge a central harsh reality: women who return to abusers do so because of their own psychological need for abuse. Until we are as willing to confront the woman’s role in domestic violence as honestly as we confront the man’s role, it will be difficult to make any progress in this already difficult area.

Rihanna’s case is particularly worth highlighting because it has none of the added motivations that are often involved in returning to an abuser. Many women in abusive relationships have children by the abuser, adding an additional emotional tie. Many women in abusive relationships cannot support themselves without the abuser, and therefore stay rather than live in poverty. Most importantly, many women are deathly afraid of their abuser, having no means to protect themselves if the abuser wishes to wreak vengeance.

None of these factors affect Rihanna. Her relationship with Chris Brown is casual and has not been going on for very long. They are not married, and they have no children. Rihanna is fully capable of supporting herself without Brown, and, more importantly, can afford to hire protection against Brown if that is necessary. So Rihanna is going back for one and only one reason: she wants to go back.

Based on publicly available information, it appears that Brown has a classic motivation for domestic violence. As a child, he witnessed his mother being beaten by his stepfather, and he was powerless to protect. Now, as the abuser, he is the powerful one, reliving the experience as the abuser, not the victim. Without serious effort and significant psychological counseling, it is difficult for such men to restrain themselves from abuse. The chances that this was his last episode of domestic violence are vanishingly small, regardless of what he says, promises or believes about himself.

The motivation for women who deliberately return to abusive relationships often centers on deep-seated insecurity. Simply put, as painful as it is both physically and psychologically, being a victim of domestic violence feels “right” and deserved. Such women do not believe, at the deepest levels of their being, that they have the right to be safe, healthy and cherished. They, too, need significant psychological help to reject the mindset that leads them to blame themselves for “provoking” the violence, and to reject the desire to forgive the abuser or believe his protestations of remorse. No doubt Brown is remorseful, but that does not mean that he won’t hit her again.

Only those close to Rihanna can encourage her to get the help she needs, and perhaps even they cannot get her to appraise her situation more realistically. Whatever happens to Rihanna, however, she has give parents a priceless opportunity to discuss domestic violence with their children, particularly their daughters.

Every girl should be taught, and must accept at the deepest part of her being, the conviction that she deserves to be healthy. No one, absolutely no one, ever has the right to hit her. There is no verbal or behavioral provocation so great that it merits physical punishment of adults, let alone adults in an emotional relationship.

Any girl who is treated abusively, either psychologically or physically, by a boyfriend should run in the opposite direction. He may appear remorseful, but it is important to understand that he will not change until he gets considerably psychological help, and maybe not even then. While it may be worthwhile standing behind a husband who makes a long term, good faith effort to control himself, there is simply no justification for standing by a boyfriend.

Rihanna is sending a message to young girls everywhere, but likely not the one that she thinks she is sending. She may believe that she is demonstrating the power of forgiveness, but, in reality, she is demonstrating the power of self-hatred. Parents should make sure that their daughters understand what Rihanna is doing, and that they should feel sorry for her, not admire her. There is never any justification for allowing a boyfriend to be abusive … never! The sooner our daughters learn that, the better.

Simply working in a hospital is an education in itself. You see people and things that are totally outside the realm of previous experience: drug abusers, criminals chained to their hospital beds, domestic violence. And every now and then, you see something that is just totally bizarre. The case of the toilet bowl baby falls into that category.

The story began when a young woman sought care at a local clinic one frigid mid-winter evening. The clinic was busy and the woman stood in line for quite some time before even reaching the triage nurse. She told the nurse that she was suffering from abdominal pain, and, oh, by the way, she thought she was 5 months pregnant. She hadn’t had any prenatal care, but she did remember when she had conceived. The clinic was busy, the woman didn’t look too sick, and the nurse told her she would have to wait.

After waiting over an hour, her abdominal pain was worse and she got back into line to speak to the nurse again. When she reached the head of the line, she told the nurse that the pain was worse, coming and going in regular intervals. The nurse pointed to the packed waiting room and told her she just had to wait.

The pain continued to intensify. The woman got back into line. Once again she was told to wait. Now she needed to use the bathroom, and asked the nurse where it was. The nurse never even looked up, but simply pointed to the corner of the room.

Shortly thereafter, the room echoed with screams coming from the bathroom. The nurses and security guard rushed to the Ladies Room. They found the young woman sitting on the toilet, having delivered a premature baby into the toilet bowl. The staff swung into action. They clamped and cut the cord, placed the patient on a stretcher and started an IV. They left the baby in the toilet since the woman had told them she was only 5 months pregnant, far too early for a baby to survive.

The ambulance crew arrived to transport the woman to the hospital. One of the EMTs retrieved the baby from the toilet and placed it in a metal bucket. It was a tiny, but perfectly formed little girl.

They arrived at the hospital well after midnight, and an obstetrics resident went down to the emergency room to examine the patient. Dr. A. had a medical student in tow. They met the patient in an ER cubicle, examined her, and delivered the placenta uneventfully. Dr. A. briefly took the baby off to the next cubicle for a teachable moment with the medical student.

Dr. A. demonstrated the signs of death to the medical student. The baby didn’t have a heartbeat, and wasn’t breathing. The baby had mottled skin and was cold to the touch. Dead. Dr. A. also pointed out that the woman had been wrong about when she conceived. By exam, the baby appeared to at 30 weeks gestation, 7 months along. Dr. A and the medical student returned the baby to the patient’s room and went out to prepare the paperwork.

The medical student, in the way of medical students everywhere, wanted to ask the patient a few more questions. Medical students generally ask massive numbers of questions, many of them irrelevant, because they haven’t yet learned how to focus their efforts. The medical student entered the cubicle and shortly thereafter rushed out to find Dr. A.

“The baby is alive,” he yelled to Dr. A.

Dr. A. looked up from the paperwork. “The baby is not alive,” Dr. A. said, mildly. “I just showed you that the baby is dead. Remember? She had no heartbeat, no respirations. She’s dead.”

The medical student looked frantic. “She’s alive! I’m sure she’s alive! You’ve got to come back!”

Wearily Dr. A. got up to humor the medical student. They went back into the cubicle.

The nurse, in an effort to tend to more than the patient’s medical condition, had carefully swaddled the baby in an infant blanket, putting a tiny stocking cap on her head. She encouraged the fearful mother to look at her baby. The mother was amazed; the baby was so beautiful. The nurse encouraged the mother to hold her baby, having learned that viewing and holding the baby were the first steps to coping with grief. The patient seemed so pleased with the baby that the nurse excused herself to get a camera to take a picture of them together. At least the mother would have this memento.

The mother was alone in the room, still holding the baby when Dr. A. and the medical student returned.

Squeak!

Dr. A. turned to the medical student, incredulous. “Did you hear that?”

Squeak! They heard it again. And it sounded like it was coming from the baby in the bed.

Squeak! Squeak!

Dr. A., now ashen, grabbed the baby from the mother’s arms and raced toward the nurses’ station.

“The baby has come back from the dead! Quick, call neonatology! The baby has come back from the dead!”

The neonatologist rushed down. Sure enough, the baby was alive.

Of course, she had never been dead at all. What was most amazing was that the baby had been kept alive by a series of misteps.

Because she fell into the toilet and was then placed in a metal bucket, the baby was very cold. Keeping her in the metal bucket during the ambulance ride through the frigid winter night had lowered her body temperature even further. Inadvertently, the EMTs had put the baby into a hypothermic state. Her body temperature was so low that her metabolism slowed considerably. Her heart rate dropped to very low levels and she rarely breathed.

Doctors sometimes deliberately induce hypothermia in infant about to undergo complex surgery, such as heart surgery. In that state, the baby is virtually hibernating; oxygen requirements drop dramatically, and there is a much lower chance of the baby suffering oxygen deprivation and brain damage as a result.

When doctors induce hypothermia, they must reverse it very slowly in order to minimize injury. Typically, they gently warm babies over a length of time. The ER nurse, in her effort to be compassionate, had inadvertently done just that. She had wrapped the baby and placed her in her mother’s arms, where she was slowly and gently warming.

When the neonatologist examined her, the baby’s body temperature was still far below normal, but she was very much alive, with a detectable heart rate and detectable breathing. They raced her to the neonatal intensive care unit, where they slowly and gently continued the process of warming.

The mother was joyfully stunned. She had a live baby!

Dr. A. and the medical student were shaken to the core. Each of them, for a brief moment, had imagined witnessing a real miracle, a return from death. Even after they realized what had happened, they could not shake the feeling that something truly extraordinary had occured.

And the baby? The baby did great. Once she was warmed up, she had a relatively unremarkable course. She never needed a ventilator and experienced nothing more than minor pitfalls of prematurity. She was discharge from the hospital when she weighed 5 pounds, only 6 weeks after she had arrived in a metal bucket. She has continued to do well, without any lasting effects from her experience as the toilet bowl baby.

Every now and then a scholarly paper comes along that is truly ground breaking. The brilliance of the paper is manifest in the synthesis of trends that we have all observed but never connected to each other.

Mary Eberstadt’s piece in the current issue of policy review, Is Food the New Sex?, is such a paper. It is a brilliant exposition on seemingly unrelated phenomena; at the same time that sexual license is embraced and even glorified, eating has become encumbered with ever more rules. Or as Eberstadt explains: our society has gone from sexually puritanical and licentious about food, to sexually licentious and puritanical about food.

Mary Eberstadt believes that the two phenomena are connected. She offers the following example that will be familiar to all:

…[L]et us imagine some broad features of the world seen through two different sets of eyes: a hypothetical 30-year-old housewife from 1958 named Betty, and her hypothetical granddaughter Jennifer, of the same age, today.

Betty is the stereotypical late 1950’s housewife. She cooks from cans, jars, and even serves frozen dinners. The only fresh vegetable that she serves is baked potato. Betty also has stereotypical moral views. Sex is appropriate only within marriage, and she believes strongly in the religious and social sanctions that penalize those who digress from that value.

The contrast with her granddaughter is remarkable:

…Jennifer pays far more attention to food, and feels far more strongly in her convictions about it, than anyone she knows from Betty’s time.

… Jennifer is adamantly opposed to eating red meat or endangered fish… She also buys “organic” in the belief that it is better both for her and for the animals raised in that way, even though the products are markedly more expensive than those from the local grocery store…

Most important of all, however, is the difference in moral attitude separating Betty and Jennifer on the matter of food. Jennifer feels that there is a right and wrong about these options that transcends her exercise of choice as a consumer. She does not exactly condemn those who believe otherwise, but she doesn’t understand why they do, either. And she certainly thinks the world would be a better place if more people evaluated their food choices as she does. She even proselytizes on occasion when she can.

Jennifer’s view of sex is also radically different from that of her grandmother:

Jennifer, unlike Betty, thinks that falling in love creates its own demands and generally trumps other considerations — unless perhaps children are involved (and sometimes, on a case-by-case basis, then too). A consistent thinker in this respect, she also accepts the consequences of her libertarian convictions about sex. She is … agnostic on the question of whether any particular parental arrangements seem best for children…

Most important, once again, is the difference in moral attitude between the two women on this subject of sex. Betty feels that there is a right and wrong about sexual choices that transcends any individual act, and Jennifer — exceptions noted — does not…

Simply put, Betty feels that there “rules” that should apply to sex, and people should be forced to conform to those rules, for their own good and for the good of society. Jennifer thinks that sex is a matter of personal preferences.

Betty thinks that the choice of what to eat is nothing more than personal preference. Jennifer is sure that there are “rules” that apply to eating, and that people should be forced to conform to those rules, for their own good and for the good of society.

What has happened?

Who can doubt that the two trends are related? Unable or unwilling (or both) to impose rules on sex at a time when it is easier to pursue it than ever before, yet equally unwilling to dispense altogether with a universal moral code that he would have bind society against the problems created by exactly that pursuit, modern man (and woman) has apparently performed his own act of transubstantiation. He has taken longstanding morality about sex, and substituted it onto food. The all-you-can-eat buffet is now stigmatized; the sexual smorgasbord is not.

Are human beings wedded to the notion that at least some appetites must be restricted? Have we transferred our “rules” and moral opprobrium about sex to “rules” and moral opprobrium about food?

It certainly seems that way. The same society that tolerates and even praises sexual licentiousness, despite strong evidence that it leads to serious health problems, is busily legislating against trans fats in restaurants, despite limited evidence that it will have any effect at all. The same people who howl “judgmentalism” at anyone who dares suggest that casual sexual encounters have dangerous consequences are enthusiastically insisting that their judgments about food should be forced on society as a whole.

Is the sad truth that we have made no progress at all? In the end, it is hard to avoid the conclusions that we have simply substituted opprobrium for one appetite with another appetite, replacing “rules” and views about sex with “rules” and views about food.