If a woman says yes, it’s not rape. If a woman is drunk and says yes, and has no regrets later, it’s drunken sex. If a woman is drunk and says yes, but later has regrets, it’s date rape.

Does that make any sense?

That’s the question raised by Kim Voynar in Movie City News in discussing a controversial scene in the new Seth Rogan movie Observe and Report:

There’s been a bit of a brouhaha stirring over opening weekend about the alleged “date rape” scene in Observe and Report… Now, as the film is seen – or not seen – by a larger group of film writers, some are accusing the film of making comedy of date rape. But does it?

MaryAnn Johnason, writing for the Alliance of Women Film Journalists thinks it does:

Is date rape funny? That seems to be the big question of the day, because — yup — Seth Rogen’s character date-rapes Anna Faris’s character in Observe and Report …

[New York Magazine’s blog] Vulture finds the scene “explosively funny” — I do not — while also being “deeply uncomfortable,” which I think almost anyone would agree with. I think we’re sure to see much debate, even among feminists, about whether there’s anything redeeming in this particular example what appears to be, on the surface — and perhaps below the surface too — Hollywood’s casual misogyny.

On the other hand, Katey Rich of CinemaBlend.com declares that “Seth Rogen Is A Rapist, and That’s Okay.”

… [N]ow we’re faced with a mainstream comedy in which the main character, played by a beloved movie star, is totally, 100% a rapist. Women in Hollywood has already demanded that their readers boycott the movie, while Vulture argues that the scene isn’t even that bad given the other awful stuff Ronnie does over the course of film.

And this may be the moment where I have to hand in my feminist credentials and run away from the people with pitchforks, but here goes: I don’t think the scene is that bad. Rather, it works within the world and the tone of the movie overall, in which we are handed a main character– Ronnie Barnhardt, mall cop– and tested repeatedly as we watch him do a series of horrendous, ridiculous, and illegal things…

Voynar gets to the heart of the matter:

For me, the scene itself fell on the side of inebriated sex and not date rape, and I find the more vitriolic responses to it rather reactive and indicative of the larger issue of responsibility around sexual behavior and the urge to blame others for the negative consequences of our own choices…

There’s an inherent contradiction that a lot of feminists seem to prefer not to discuss at all: if we say that a woman who is inebriated by her own choice is therefore no longer responsible for the sexual choices she might make while in that state, is it fair to argue that the man she’s with, if he’s also inebriated, should be responsible for making that choice for her?

Would [they] be willing to argue that if a man has sex when he’s “too drunk” to make a sober decision, he no longer has responsibility for the consequences of that sex, such as pregnancy or spreading a STD? How can we seriously argue that a man who gets chooses to get too drunk and has unprotected sex IS responsible for the consequence of that choice … while arguing … that if a woman chooses to get herself too drunk to make a sober decision, the full responsibility for that choice must also fall on the man?

In other words, how can the fateful accusation of rape hinge on whether a woman who consents while drunk is happy or unhappy about that consent afterward? It shouldn’t. That does not mean that there is no such thing as date rape. A woman who consents to kissing or foreplay has not consented to sex, and there is no reason for a man to assume otherwise. Moreover, a woman who has been surreptitiously drugged cannot register either consent or protest, and any sexual acts performed on her are definitely rape.

However, a conscious woman, even when drunk, is a moral agent. Yes, means yes, and the fact that she has regrets later does not change that. Women can and should be held to the same standard as men. If men are expected to take responsibility for choices made while drunk, including sexual choices, then women should be expected to do the same.

Most people have heard of the human papilloma virus, HPV. It is the virus that causes genital warts in men and women. It’s gotten a lot of attention because it appears to be the cause of cervical cancer in women, cancer of female reproductive organs.

Many people have heard about Gardasil, the new vaccine designed to protect women against HPV, and therefore against cervical cancer. The vaccine appears to be very promising in women and studies are underway to determine if it is equally effective in men.

Few people are aware that HPV can infect the mouth through oral sex. A new study published in the March issue of the Journal of Infectious Disease (Oral Sexual Behaviors Associated with Prevalent Oral HPV Infection) is a preliminary study, but it suggests some very disturbing possibilities. Men who engaged in oral sex were more likely to have human papilloma virus infections of the mouth. More disturbing is that the study raises the possibility that oral HPV can be transmitted from person to person by open-mouthed kissing. Most disturbing of all, oral HPV may lead to oral cancer in the same way that cervical HPV leads to cervical cancer.

According to the study:

… [O]ral HPV infection was more strongly associated with the number of recent oral sex and open-mouthed kissing partners than with recent vaginal sex partners. In multivariate analysis, 6 [or more] recent oral sex or open-mouthed kissing partners … significantly elevated the odds of oral HPV infection developing …

To further evaluate the independent effect of open-mouthed kissing, a subset analysis was performed for the 59 college-aged men who reported no history of performing oral sex. Among these men, oral HPV infection was significantly more common among those with 10 [or more] lifetime and those with 5 [or more] recent open-mouthed kissing partners.

In other words, HPV infection was more common in men who had more oral sex partners, and more open-mouthed kissing partners. This suggests that, as expected, performing oral sex increases the risk of an oral HPV infection. The unexpected finding is that increased open-mouth kissing may also transmit the infection. That is supported by the fact that a few men who had never performed oral sex had oral HPV infections. It raises the possibility that they had contracted oral HPV from open-mouth kissing of partners who had performed oral sex on others.

What are the effects of oral HPV infection. In the short term, there appear to be few effects. In the long term, oral HPV infection is associated with the development of mouth and throat cancers. Tobacco use is another cause of mouth and throat cancer. It is unclear whether the two causes are independent or whether they interact.

The studies are preliminary, and involve only small groups, so the results must be interpreted with caution. Nonetheless, they are very worrisome. HPV genital infection is extremely common, particularly among young men and women. We know that genital HPV infection can cause cancer of the cervix in women. Similarly, HPV appears to cause at least some mouth and throat cancers. If a common genital infection can be easily transmitted to the mouth through oral sex, and then passed along through kissing, the potential for widespread infection and serious consequences is high.

Fortunately, the Gardasil vaccine appears to have great promise in preventing cervical cancer, and there is reason to believe that it could be effective in preventing oral cancers caused by HPV. Let us hope that is the case. Otherwise, we could be facing the grim prospect of an epidemic of cancer caused by oral sex, and spread by kissing.

As an obstetrician, I’ve observed thousand of women in labor. Their reactions run the gamut from extreme stoicism to blood curdling screaming and everything in between. Occasionally, though, there were women whose reactions were decidedly out of the ordinary.

There was the woman who, in the midst of active labor, felt the need to rip off her clothes and run naked and screaming down the hall. She was ultimately led back to her room and the door shut, so she was free to run around naked, in private. She was fine and the baby was fine. No one seemed the worse for wear except, perhaps, the expectant parents who were touring labor and delivery in preparation for their own birth experiences. When the naked, screaming patient caromed into their group, they were startled to say the least.

Another memorable occasion occurred during a blinding February snowstorm. A young woman, on reaching ten centimeters without pain medication was cheerfully told by the nurse that now it was time to push the baby out.

“Oh, no,” the woman cried, “I’m not doing that. I’m done and I’m leaving!”

Whereupon she lumbered out of bed, grabbed her heavy winter coat and headed for the elevators. I’m not sure where she thought she was going to go, or what she though was going to happen, since she was taking her baby and her labor with her. Fortunately, a security guard caught up with her as she was trying to get out the main entrance and gently led her back up to the labor and delivery floor. She had her baby uneventfully only 45 minutes later.

There was one patient, though, who stood out above all others, and whom I still remember vividly more than a decade after the fact. With every contraction, she slapped her husband across the face.

She was not my patient; she was a midwife patient. I always worked with certified nurse midwives and found them to be extraordinarily skilled and competent. I was available as back up in the event of a medical emergency. This time, unusually, I was called for emotional distress … of the midwife.

The midwife had spent the previous twelve hours with the patient and her husband and she looked traumatized. The patient, she said, was too difficult to handle. That was an unexpected admission from this midwife, who was very experienced with all manner of patient difficulties. No, the patient was not running around the room screaming; no, her husband was neither drunk nor abusive; no her family members were not carrying weapons. She was completely uncooperative, but the worst part is that she was beating up her husband.

Really? I found that hard to believe. Most women in labor don’t have the presence of mind to beat up anyone. Moreover, according to the midwife, she had a working epidural that was providing excellent pain relief. The patient could feel pressure with contractions, but did not seem uncomfortable. Nonetheless, she was demanding more medication in her epidural (she already had plenty), she was refusing to push the baby out (she was now 10 centimeters dilated), but most distressing, with every contraction, she slapped her husband across the face.

This I had to see. I slipped into the vestibule of the labor room and observed. Sure enough, with every contraction, her husband crept closer to “help” her, and she slapped him square across the face with the flat of her hand. He had big red welts on his cheeks to prove that it had been going on for sometime. In between contractions, she was being abusive to the anesthesiologist who was patiently trying to explain that it was not safe to put any more medication in her epidural. He tried to reason with her. She had adequate pain relief already; she was feeling only pressure, not pain, and he did not want to abolish all sensation or she would be unable to push the baby out. She didn’t care, she said. She had no intention of pushing this baby out anyway. We could operate on her if we wanted it to come out.

I entered the main part of the room and introduced myself as the doctor on call, here to help her have her baby. The husband and the anesthesiologist looked relieved. I decided to tackle one problem at a time. I turned to the husband.

“I think,” I suggested gently, “that you might be getting a little too close to your wife when she has a contraction. Let’s pull up a chair and have you sit close enough to hold her hand, but no closer.”

“Really? You think so,” he looked dubious. “I want to help.”

“Oh, yes,” I replied. “I’m pretty sure that will be better. Let’s give it a try.”

Next I turned to the patient.

“You can’t have any more pain medication right now. You’ve reached the limit of safety.”

That was greeted with a stream of expletives, and a declaration.

“I don’t want to feel anything at all.”

“Sorry,” I said, “but that’s simply not possible. I’m sure you understand that the most important consideration is the safety of you and your baby.”

Apparently, she didn’t understand. She was defiant.

“The midwife says I have to push the baby out, but I’m not going to push. If you want this baby to come out, you can pull it out with forceps or something, or you can cut it out with a C-section.”

“No,” I said, “forceps and surgery are medical procedures, and they must be used only for medical reasons. We won’t be doing that unless there is a medical need.”

“Instead,” I continued, “I’m going to ask the anesthesiologist to let your epidural wear off a little bit. You might get uncomfortable, but the urge to push will return, and you’ll push the baby out.”

“Oh, no I won’t,” she threatened. “I won’t push and you’ll have to wait for hours.”

I made a dramatic show of looking at my watch.

“That’s okay,” I responded as sweetly as I could under the circumstances. “I’m here for the next 12 hours, so I’ve got plenty of time. The baby looks fine on the monitor, so there’s no rush. Take all the time you want.”

I headed for the door.

“You’re a bitch,” she screamed after me.

I turned.

“Yes, I guess I am.”

Her epidural began to wear off in 30 minutes. The pain began to come back and so did the urge to push. The nurse explained that the harder she pushed, the sooner it would be over, and it was in her interest for it to be over. The longer she waited to cooperate, the more intense the pain would become.

Once she began cooperating, she was able to push the baby out in 5 minutes.

Unfortunately, that did not improve her personality. She handed her son off to the nurse and when he was swaddled, directed that her husband should hold him. She subjected both him and me to a constant stream of verbal abuse while I was delivering the placenta and he was cooing at her new son.

When everything was done, I congratulated her, even though she was glaring at me. I mentioned that I would be calling Social Service to visit her before she went home because it looked like there might be some tension between her and her husband.

“Really?” She seemed genuinely shocked. “Can’t you see? We get along great.”

A visitor from outer space might be forgiven for concluding that the most important part of the human body is the foreskin. It is, after all, the only part of the body that has multiple organizations devoted to its preservation in the natural state. The visitor might get the impression that the choice of circumcision is a fateful choice with profound implications for the rest of life.

It would probably come as a shock to our visitor to learn that circumcision is just one in a series of issues that allow some parents to feel superior to other parents. In fact, the fetishization of the foreskin is just another example of maintaining that minor, irrelevant decisions are critical to parenting, while major decisions that have an impact on the community at large (such as vaccination) should be left entirely to parental discretion.

The language used by foreskin fetishists might lead the visitor to believe that circumcision is very dangerous. According to circumcision.org: “Based on a review of medical and psychological literature and our own research and experience, we conclude that circumcision causes serious, generally unrecognized harm and is not advisable.” Foreskin fetishists also employ inflammatory language to express their judgmentalism. Circumcision is “mutilation” and parents who choose to circumcise their sons are “mutilators”.

The foreskin fetishists are so obsessed with the foreskin that they actually dare to advance the misogynistic claim that male circumcision is analogous to female genital mutilation, in other words, that the foreskin is the analogue of the clitoris. The male analogue of clitoridectomy is is amputation of the penis. Comparing circumcision to clitoridectomy is like comparing ear piercing to having your ears cut off.

Anti-circ activists like to claim that there only risks and no benefits to circumcision, but that is not true. According to the American Academy of Pediatrics:

“Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data arenot sufficient to recommend routine neonatal circumcision. Inthe case of circumcision, in which there are potential benefitsand risks, yet the procedure is not essential to the child’s currentwell-being, parents should determine what is in the best interestof the child. To make an informed choice, parents of all maleinfants should be given accurate and unbiased information andbe provided the opportunity to discuss this decision. It is legitimatefor parents to take into account cultural, religious, and ethnictraditions, in addition to the medical factors, when making thisdecision…”

Circumcision is now known to have additional benefits in preventing the transmission of HIV. In fact, the World Health Organization has begun recommending routine circumcision for adult African males, in order to limit the spread of a disease that has devastated a continent.

Why do anti-circ activists fetishize the foreskin? They do so because it is a convenient way to assert superiority over parents who make different decisions. The anti-circ activists belong to a group of parents who believe that parenting can be reduced to a few decisions (trivial in reality) about birth, circumcision, diapers (cloth or disposable), whether your child sleeps in your bed, and how much and how you carry your baby around. Fortunately, or unfortunately, parenting is far more complicated. There are no fool proof prescriptions for successful parenting, and no simple ways to separate the “good” parents from the “bad”.

Rather than judge parenting by process (the decisions parents make), good parenting can only be judged by outcome. Did the choices that the parents made allow the child to reach his or her potential and become a happy and productive member of society? When parenting is judged by outcome, we are all in the same boat. No one really knows if they are doing the right thing until long after a particular decision is made. Therefore, no parent can feel superior to another parent. However, some parents really, really want to feel superior to everyone else. Hence the elevation of the foreskin to being one of the most important parts of the human body.

My first job after residency was in a neighborhood health center in the city. We provided care for a large, relatively discrete ethnic population. Most of my patients did not speak English, but I was never without one of our excellent translators. My patients came from a culture where children’s futures were considered paramount. They heeded any and all medical advice about pregnancy and birth.

There were down-sides to the job, of course. I admired many things about the culture of my patients, but there were some I found difficult to accept. The clearly inferior position of women and the way that many of my patients greeted the birth of a daughter with obvious and profound disappointment bothered me.

One spring Friday, I met Mrs. W. She had come to the US only 3 weeks before and believed herself to be about 8 months pregnant. She had two healthy girls and no history of medical problems. However, on exam, her uterus was larger than expected and I ordered an ultrasound to see if she was closer to her due date than she thought. The patient smiled brightly when the translator explained the ultrasound and the translator reported that Mrs. W was happy to have an ultrasound. She and her husband wanted to know if this was the son they both prayed for.

The ultrasound report arrived in my office midmorning on Tuesday. Mrs. W was carrying twins, 8 months along, and both girls. One of the twins appeared to have a heart problem of some kind, with clear evidence of serious illness. The twin was swollen (probable heart failure) and there was other evidence of severe compromise.

I was furious. The ultrasonographer should have called me immediately. The information was extremely time sensitive. The patient should have been evaluated promptly by me and a battery of specialists to determine whether the babies should be delivered early and to arrange special care for the ill twin. The office called Mrs. W and advised her to come to the hospital right away.

At the hospital I found that the situation was worse than I feared. The nurses could find only one heartbeat. I pulled out a portable ultrasound machine and did a quick scan. The ill baby was dead. She had died, and based on her appearance, almost certainly from congenital heart disease.

The second baby looked healthy and vigorous. The situation still remained precarious, because it was unlikely that a pregnancy with a dead twin would continue to term, and it was 8 weeks before the expected due date. A baby born that early would have a good chance of survival, but far from assured. Mrs. W was admitted to the hospital and given medication to speed maturation of the baby’s lungs in advance of the inevitable premature delivery.

Sure enough, despite intensive medical efforts to prevent delivery, Mrs. W ruptured her membranes approximately 1 week later in the middle of the night. My partner on call delivered the babies. Baby girl 1 was sent to the morgue. Baby girl 2 went directly to the neonatal intensive care unit. We were optimistic that the extra week of pregnancy, and the medication for lung maturation had improved her chances for an excellent outcome.

The parents did not express any disappointment that this baby was girl. Indeed, they seemed to have bonded to her fiercely, visiting her in the NICU at all hours and willing her to live. Baby girl W had a surprisingly rocky course. She required prolonged ventilator assistance to breathe, developed gastrointestinal problems and other complications of prematurity as well.

Gradually, the Baby W began to improve and after several weeks it became clear that she would survive. Almost 2 months after her mother was admitted, Baby W went home with her parents.

Several weeks later I arrived at my office to start a day of seeing patients. Before I crossed the threshold, I knew that something was wrong. The translators had red rimmed eyes. Our patient educator was crying.

I looked around the room. “What happened?” I asked, dreading the reply.

“Baby girl W died last night,” one of the women replied. “The director of the health center wants to talk to you about it.”

I was stunned. Premature babies are at much higher risk of sudden infant death, but she had seemed so healthy when she left the hospital. I sought out the director and we ducked into an empty exam room to talk. I was still in shock and she looked grim faced. What had happened? What had caused the baby’s death?

Baby girl W’s mother had found her lifeless in her crib the previous night. She called an ambulance, which brought the baby to another hospital closer to home than our hospital. The pediatricians at the other hospital tried to resuscitate Baby W but it was far too late. Compounding the tragedy, no one could communicate with Baby W’s parents because they did not speak English. They waited for a translator to arrive.

The pediatrician, who had no knowledge of the complicated history of Baby W, proceeded as if this were any other unexplained infant death. He sent the baby’s body to radiology for a full body X-ray. By the time the translator arrived, he knew why Baby W had died.

The director looked anguished.

“Baby W died of a skull fracture. The x-ray also showed that she had multiple broken ribs, and a broken leg. Baby W was beaten to death.”

I was dumbfounded. The director recognized my confusion.

“The father has already confessed. He killed the baby because he did not want another daughter.”

I went back to my office and told my staff. They were equally stunned, and over the next few days we agonized over whether any one of us could have seen this coming. Child abuse is not uncommon in any community, and we had all been trained to look for the warning signs, but none of use had seen any.

Sometimes tragedies leave us with valuable lessons, but sometimes they leave us with nothing but grief and pain. Even after 20 years, I still cannot make sense of what happened. Baby girl W’s life had been threatened by the death of her twin, by the negligence of the ultrasonographer, and by a whole host of additional complications of prematurity. We all worked so hard to save her, and then, unwittingly, we sent her home with the man who would kill her. Baby girl W’s life and death must mean something, but, I confess, I cannot conjure anything positive from her story of illness, struggle and the ultimate betrayal.

Who owns a man’s sperm? For most of human history, the answer was obvious. The man owns it, unless, of course, he deposits it in a woman. Then she owns it, and he can’t ask for it back.

In this age of burgeoning reproductive technology, the answer is no longer clear. Sperm deposited in a sperm bank by a man preparing for the ravages of chemotherapy or the potential ravages of war can be used by others beside him, and can even be used after his death. That situation presupposes a man who has expressed a wish to have children in the future and has taken specific actions (collecting his ejaculate, giving it to the sperm bank, and paying for its preservation).

However, it is also possible to harvest sperm directly from the testicles of a man who has never given consent to have his sperm taken, including a man who is recently dead. That’s exactly what a Texas woman, the mother of a young man, dead after a bar fight, is trying to do.

According to an article on MSNBC:

… Nikolas Colton Evans, 21, died Sunday at a Brackenridge hospital after being punched and falling outside an Austin bar March 27.

His mother, Marissa Evans, told the Austin American-Statesman newspaper …”I want him to live on. I want to keep a piece of him,” …

Court documents said the sperm had to be collected within 24 hours of Nikolas Evans being removed from life support unless the body was cooled to no more than 39.2 degrees.

[Travis County Probate Judge Guy] Herman ordered the county medical examiner’s office to continue storing the body at the proper temperature until the sperm could be collected…

While the judge’s sympathy for a distraught and grieving mother is admirable, his decision is wrong, both ethically and legally.

Parents do have the right to authorize the harvest and donation the organs of a child who has died, but sperm are not like other body cells. In and of themselves, they are useless to anyone else. Their value comes from the ability to use the sperm to conceive a baby, the biological child of the deceased. The ethical issues raised are complex.

Who owns a man’s sperm? Can he be made to father a child without his express action, involvement or consent? These are issues of basic reproductive rights.

The issue of reproductive rights has been adjudicated many times. No one has the right to force a man to become a parent without that man taking action to become a parent. The action can be something as simple and unintentional as having sex with a woman capable of conceiving. Although the man may not have the intention of becoming a parent, his action in having sex makes him ethically and legally obligated for any offspring that result.

Depositing sperm in a sperm bank, against the possibility of being rendered infertile in the future, or for use in infertility treatment, can also serve as taking action to become a parent, as long as the man gives consent for the implantation of that sperm in a specific individual, or makes legal arrangements in advance to cede control of the sperm in the event of his death.

Merely depositing the sperm is not enough. Women who have tried to use the sperm of a former partner, after separation or divorce, are not allowed to do so. Indeed, the courts have ruled that women cannot use embryos created with a partner’s sperm before separation or divorce in the absence the man’s specific consent. These rulings have established the principle that the action of donating sperm does not establish the fact that a man wishes to become a father with a particular woman at a particular time.

The restrictions on harvesting sperm, an invasive procedure, should be even higher. The Texas mother argues that her son always wanted to have children, but that is not enough. Donating sperm to a sperm bank implies that a man wants to have children, but those sperm cannot be used to create those children unless the man agrees to implantation in a specific woman at a specific time. Both ethically and legally we acknowledge that men have every right to change their mind. If we cannot deduce a desire to have children from the action of depositing sperm in a sperm bank, we certainly cannot deduce such a desire from vague claims of wanting to be a parent in the future.

The issue of control over sperm applies only to men, but there are analogous issues that apply to women. Now that eggs can be harvested from women, a parent, spouse or lover could request harvesting the eggs of a woman who is brain dead. Alternatively, a parent, spouse or lover could request that the brain dead woman be artificially inseminated and her body used not only to conceive a child, but also to support that child until birth.

The control of sperm (and eggs) is a matter of both bodily autonomy and reproductive rights. No one can be forced to become a parent unless he or she takes specific actions to conceive a child. There mere desire to have children in some indeterminate future does not meet that standard.

The Texas judge is wrong. The death of a child is a tragedy, but that does not allow the grieving parent to harvest the child’s reproductive cells in an effort to “keep a piece of him.”

From the Max Planck Institute comes news of a new study that sheds light on male-female interaction in the primate world.

… Cristina M. Gomes and Christophe Boesch show that female chimpanzees copulate more frequently with males who share meat with them on at least one occasion, compared with males who never share meat with them, indicating that sharing meat with females improves a males’ mating success. Although males were more likely to share meat with females who had sexual swelling (i.e. estrous females), excluding all sharing episodes with estrous females from the analysis, did not alter the results. This indicates that short term exchanges alone (i.e. within the estrous phase of the female) cannot account for the relationship between sharing meat and mating success.

The study does not explain why this exchange occurs. Are female chimps bestowing their sexual favors on males who bring them a highly prized food because those males are more likely to be good providers for a female raising young? Or do female chimps bestow their sexual favors on those who will pay for them, with meat being the favored currency? In other words, are female chimps looking for the best father for their children, or are they high priced call girls, willing to have sex with any john who can pay the extravagant price?

You might think that these issues would be of interest only to a small community of scientists who primate behavior. You’d be wrong. The Great Beyond, the blog of the prestigious journal Nature, believes that the way that the story has been reported in the mainstream media reveals a strong undercurrent of sexism.

Feminists avert your gaze. News that female chimps mate more frequently with male chimps that share their meat with them has prompted a slew of at best corny, at worst downright sexist, even lewd, headlines…

…Thank goodness for the Daily Mail, who confuse humans and chimps even in their headline, “Why food is the way to a woman’s heart (if you happen to be a male chimpanzee)”, to open their story with the brilliantly enlightened “As every Romeo knows, laying on a delicious dinner for two is one of the best seduction ploys.”

Seduction is also apparently what the chimps are up to according to Mongabay.com and the Independent.

And how about “Frisky chimps’ female meat market”? over at Blatherskite. Nice.

The Telegraph takes a leap that I’m not sure the author’s would have intended: “Buying a woman presents could help men get them into bed, a new study which shows that chimpanzees have sex for gifts suggests” is how their story begins.

Reuters have a go at linking the study with prostitution in their opening paragraph.

The long-term nature of the behavior, though, indicates that rather than being a form of chimp prostitution, the meat for sex exchange is a sign of something more prosaic. The male chimps don’t simply offer meat at the time that the females are sexually available (estrous); it is an ongoing behavior that persists even when the female chimps are unreceptive. The researchers believe that female chimps are looking for males who are the best providers. The ability to catch another animal is a sign of hunting prowess and a good hunter will be able to supply high quality food that will increase the chances of a healthy pregnancy and strong offspring.

According to Gomes, “Our results strongly suggest that wild chimpanzees exchange meat for sex, doing so on a long-term basis. Males who shared meat with females doubled their mating success, whereas females, who had difficulty obtaining meat on their own, increased their caloric intake, without suffering the energetic costs and potential risk of injury related to hunting.”

Feminists may not be mollified by the acknowledgement that the meat for sex exchange is not prostitution. Even the more mundane explanation lends credence to traditional notions of mate selection, and marriage interaction. The meat for sex exchange is the chimp form of the traditional marriage, where the men goes out into the wider world to do exciting things, and women stay home to raise the children.

One of the dirty little secrets of healthcare is that most preventive medicine does not save money. Sure, it saves lives, and it improves worker productivity, but it costs a lot more. That’s because those whose lives are saved live longer, thereby incurring increased Social Security benefits, and live to develop chronic diseases, thereby consuming increased Medicare resources. This unfortunate fact is revealed in an article on MSNBC:

Willard Manning, a professor of health economics and policy at the University of Chicago’s Harris School of Public Policy Studies, was lead author on a paper published two decades ago in the Journal of the American Medical Association that found that, taking into account tobacco taxes in effect at the time, smokers were not a financial burden to society.

“We were actually quite surprised by the finding because we were pretty sure that smokers were getting cross-subsidized by everybody else,” said Manning, who suspects the findings would be similar today. “But it was only when we put all the pieces together that we found it was pretty much a wash.”

Expert witnesses for tobacco companies in their endless stream of litigation have seized on this fact.

Vanderbilt University economist Kip Viscusi studied the net costs of smoking-related spending and savings and found that for every pack of cigarettes smoked, the country reaps a net cost savings of 32 cents.

“It looks unpleasant or ghoulish to look at the cost savings as well as the cost increases and it’s not a good thing that smoking kills people,” Viscusi said in an interview. “But if you’re going to follow this health-cost train all the way, you have to take into account all the effects, not just the ones you like in terms of getting your bill passed.”

This dirty little secret calls into question the proposed financing of universal healthcare plans. The conventional wisdom about healthcare costs is that preventive medicine saves money. During the recent presidential election campaign, candidates relied on the assumed savings from preventive medicine to either control healthcare costs or to provide the money to extend healthcare coverage.

Smoking is a case in point. Although the calculations of the Centers for Disease Control (CDC) estimates that smokers cost the country $96 billion a year in direct health care costs, and an additional $97 billion a year in lost productivity, another less publicized calculation calls any cost savings into question. However, since smokers die approximately 10 years earlier than nonsmokers, each smoker forgoes 10 additional years of savings to Medicare, Social Security, and pensions.

According to The economics of tobacco: myths and realities published in the journal Tobacco Control in 2000:

Most societies devote a significant proportion of their health care resources to treating people made ill by smoking … It is certainly reasonable that a country should want to reduce smoking produced disease so that it could devote these resources to other health and social welfare needs.

It is also true, however, that non-smokers live longer than smokers, and thus that the health care costs of non-smokers during the “extra” years of their lives (compared to smokers) balance, at least to some extent, the higher costs smokers experience during each of their (fewer) years of life…

…[T]o appeal to the high medical costs of smoking as a fundamental reason to reduce smoking seems at least a bit disingenuous.

The cost of caring for the elderly in this country has been rising dramatically. According to a recent estimate by the Congressional Budget Office (CBO):

… the federal government will spend roughly three and one-third times more on the elderly this year than it did three decades ago (in constant dollars, excluding the effects of inflation). Since 1971, per capita spending on older people (in 2000 dollars) has risen at an annual rate of 2.4 percent a year, although over the past decade that rate of growth was 1.5 percent.

This year, spending on the elderly will account for more than one-third of the federal budget, up from about 22 percent in 1971 and 29 percent in 1990. That draw on the federal Treasury is projected to climb to nearly 43 percent by 2010 (according to CBO’s April 2000 baseline budget projections)…

Should people quit smoking? Of course they should. The cost to them and their families is very high, in terms of lives lost and productivity reduced. The cost to society, however, is not particularly high, and the premature deaths of smokers may actually represent a cost saving. So those who continue to smoke despite the myriad health warnings at least have one consolation. They may die early, but they’ll save the US government money.

Patients say the darndest things.

Sometimes, a doctor asks a routine question, one that she’s asked to others many times before, and gets a completely unanticipated answer. That’s why it’s important for any provider to ask questions as clearly and completely as possible, and clarify answers. Otherwise, the patient might be answering an entirely different question than the one you asked.

Occasionally that would happen to me when I saw gynecology patients in the emergency room. I asked every woman whether she was sexually active. Most answered either yes or no, but every now and then, I would ask, “Are you sexually active?” and the patient would say “No, I don’t move around much during sex.” or “Not active enough, if you asked my boyfriend.”

Questions asked and answered are important, but sometimes what is not asked is even more important. That’s why any provider should go through what is called a “review of systems” when taking a history. A review of systems means asking specific questions about most major aspects of body function. You can ask, “Do you have any medical problems?” and the patient will say no, but a review of systems often reveals a great deal of important information that may have been left out..

The typical case from my internship was a woman I was interviewing prior to her scheduled surgery. She insisted that she had no medical problems. I was in a rush and did not go through a review of systems. When I began her exam, I was surprised to find a large scar in the midline of her abdomen.

“What’s that from?” I asked.

“Oh, I forgot. That’s from my hysterectomy.”

“When did you have the hysterectomy?”

“Hmmm. Let’s see. That was last February. No, wait. I was supposed to have a hysterectomy last February, but they had to postpone it because of my heart attack.”

“Your heart attack?”

“Yes, I had a heart attack, but then they did angioplasty and I felt a lot better.”

“Angioplasty?”

“Yes. Then they rescheduled my hysterectomy, but I broke my leg …”

It is truly amazing what patients will forget to tell the doctor. A colleague admitted a woman who was 25 weeks pregnant to the hospital because she had a fever of 105. When giving her history, the patient insisted that she had no known medical problems. When the doctor examined her, she was shocked to find a very large incision extending from the base of the patient’s neck to the bottom of her breastbone.

“What’s this from?” the doctor asked.

“Oh, that. That’s from my heart transplant.”

The doctor was incredulous. “Your HEART transplant.? Don’t you think that’s a medical problem?”

“Sure,” said the patient, “you asked me if I have any medical problems, but I don’t any more. The heart transplant fixed them all.”

Not surprisingly, the heart transplant was a relevant piece of information. The patient was taking immunosuppressive drugs that left her vulnerable to serious infection. Knowing that, the doctor started her on broad spectrum antibiotics, and she recovered quickly. Sometimes, what you don’t say it just as important as what you do say.

Everyone should keep a list of their past medical history, past surgeries, current medical problems and current medications. Be sure to share that information with your providers at the beginning of any consultation. The recommendation that your doctor offers is only as good as the information that she has available. Ensuring that your doctor has accurate and comprehensive information about you and your health is the first step toward getting the best possible care.

Telephone triage is a skill that every doctor must acquire. Many patients initially present over the telephone, and it is important to be able to tell the difference between those who need to be seen right away, those who can wait for an appointment, and those who don’t have to be seen at all. Office staff usually handles the calls on weekdays, but on nights and weekends, the doctor on call takes them herself.

Most calls are about distressing symptoms, but occasionally there are calls due to simple curiosity (“I have a sunburn; do you think my baby is hot?”), and even less commonly, some women call simply because they are lonely or depressed. Every now and then, there are calls that defy categorization. Such was a call that blindsided me on a blustery Saturday afternoon in early spring. I was the chief resident, and therefore, took all the OB and GYN calls that came directly to the hospital. I was sitting in the Emergency Room where I was already caring for a patient having a miscarriage.

The caller sounded like a self possessed woman in middle age.

“I’m calling,” she announced, “because I need some information.”

“Okay,” I said. “How can I help you?”

“My son got his girlfriend pregnant,” she continued, “and I think she had an abortion. I have reason to believe that she had it done at your hospital.”

“That may be,” I replied. “But I cannot share that information with you.”

Every hospital has strict privacy requirements. Although this was in the days before the strengthened provisions of HIPAA (the Health Insurance Portability and Accountability Act), no hospital or provider could share medical information about a patient unless authorized to do so by that patient.

“Let me tell you her name,” the caller coaxed, “and you can tell me if you took care of her.”

“It doesn’t matter if you tell me her name, or whether I took care of her,” I answered. “I simply cannot tell you.”

“Don’t I have any rights?” she demanded. “After all, that could have been my grandchild.”

I tried to explain that her relationship to the baby or to the mother did not matter.

“Just look in the computer,” she begged, “and tell me if she was at the hospital. You don’t have to tell me what treatment she had.”

I explained that I was not allowed to do that either. The woman on the other end of the line now sounded agitated.

“You don’t understand,” she insisted, “I have a very special reason why I need to know.”

I tried to explain yet again. “There is no reason that would allow me to give you the information that you want. It is literally against the law for me to disclose that information.”

“Please,” she pleaded. “You have to help me. The baby needs me.”

“Excuse me,” I was startled. “Did you say the baby needs you?”

The caller exhaled a sigh of relief at finally being understood. “Yes, the baby is calling me. Every time I try to go to sleep, I hear the baby calling me: ‘Grandma, Graaaandmaaa, help me, help me, I’m stuck in this bottle.'”

“What?!”

“Yes, I hear the baby’s voice every time I close my eyes. I know he’s trapped in the basement of a hospital, maybe your hospital. I have to come get him. You have to help me.”

“Oh,” I said, “I see.” And now I did. “That must be very upsetting to you.”

“It is,” she sounded very tired. “I can’t sleep, I can’t eat, I have to rescue the baby.”

“You must be very uncomfortable and upset,” I agreed.

“Can you help me?” she sounded desperate.

“I can’t tell you about your son’s girlfriend,” I acknowledged, “but there is a very nice doctor here with me in the emergency room and I think he might be able to help you feel better.”

“You do?”

“Yes, I do. I’m going to let him know what you told me, and tell him that you are coming to see him right now. I’m certain that he can help you feel better.”

“Will he take me to the baby? The baby is calling me,” she repeated.

“He won’t be able to take you to the baby, but he will be able to help you with the voice that you hear,” I responded truthfully. “Will you promise me that you will come in right now?”

“Yes. Yes, I’ll come in. Let me get dressed and I’ll be there in an hour or so,” she agreed.

And that’s just what happened. Within an hour or two, she was visiting with the psychiatrist on call. He couldn’t help her find the baby in the bottle, but he was able to help her make the voice stop calling.