She has been called “an angel in a white coat.” She is a doctor and the first black woman and youngest person elected to the board of the American Medical Association. She received a MacArthur Foundation “genius” grant. She’s been honored for her medical work on behalf of the poor by both Nelson Mandela and the Pope. The President has just appointed her to the job of Surgeon General

And around the web from the blogosphere to mainstream publications people are discussing … her weight!

There’s no quicker way to diminish the achievements of a powerful woman than to talk about her body. But don’t worry, it’s okay because prejudice against the overweight is the socially acceptable prejudice. It’s socially acceptable because it masquerades as a health issue although it is really a class, race and gender issue.

Let’s be completely clear on one point first. Those piously declaiming on Dr. Benjamin’s potential influence as a health role model are ignoring the scientific evidence. Decades of scientific evidence have already demonstrated that, contrary to the conventional wisdom, overweight people live longer than people of “ideal” body weight.

The hysteria about weight sweeping contemporary America is just that, hysteria. Of course morbid obesity is a serious health problem with potentially deadly consequences. However, simply being overweight is not only safe, but actually appears to be protective compared to “ideal” weight. That’s what the data really show.

Why is the conventional wisdom about weight completely unhinged from the actual scientific evidence? The answer, I believe, is prejudice. Weight has become a proxy for social class. And, as we all know, it’s always open season when it comes to criticizing the bodies of women, particularly black women.

When poor people were thin because they didn’t have enough to eat, being overweight was a sign of status. That’s changed now. Thin is a sign of wealth. Achieving and maintaining the favored body type requires access to healthy food and special diet foods. It also requires exercise equipment or membership in a gym or, most exclusive of all, a personal trainer. All these things cost money, so weight has come to be viewed, accurately, as a sign of economic class.

Much of this is perceived only on the unconscious level. Nonetheless, it leaves people feeling free to criticize those who are overweight, supposedly on “health” grounds, but in reality as a proxy for social class.

Let’s be brutally honest here: Regina Benjamin looks like the stereotypical fat, black welfare queen and therefore, a socially acceptable target for our class, race and gender prejudices.

The hypocrisy about health concerns is glaring. Did anyone dare to discuss C. Everett Koop’s weight when he was appointed Surgeon General? Has anyone declared President Obama unworthy of being a role model because he smokes? Of course not, but it socially acceptable to muse about the “suitability” of Regina Benjamin as Surgeon General because she is an overweight black woman.

I am so angry I could spit. An extraordinarily brilliant, compassionate, gifted individual has been nominated to take control of an important health organization in disarray and the mainstream media is talking about her body. Salon Magazine ran an article about it yesterday, and MSNBC has Arthur Caplan discussing the “bioethical” implications of Dr. Benjamin’s weight today. Have people lost their minds?

No, of course not. They’re just enjoying the socially acceptable occupation of criticizing black women’s bodies; there are so few politically correct forms of prejudice left that no one can refrain from indulging.

There are not many heartwarming stories about death, and even fewer about suicide. That small number is destined to grow with the addition of the true story of Sir Edward and Lady Downes, and elderly couple who chose to end their lives together as she faced imminent death from terminal cancer.

From The New York Times:

…[O]ne of Britain’s most distinguished orchestra conductors, Sir Edward Downes, [flew] to Switzerland last week with his wife and joined her in drinking a lethal cocktail of barbiturates provided by an assisted-suicide clinic.

Although friends who spoke to the British news media said Sir Edward was not known to have been terminally ill, they said he wanted to die with his ailing wife, who had been his partner for more than half a century.

According to their children:

Sir Edward, who was described in a statement issued earlier on Tuesday by [their son and daughter] as “almost blind and increasingly deaf,” was principal conductor of the BBC Philharmonic Orchestra … [and] a conductor of the Royal Opera House at Covent Garden in London, where he led 950 performances over more than 50 years.

Lady Downes, who British newspapers said was in the final stages of terminal cancer, was a former ballet dancer, choreographer and television producer who devoted her later years to working as her husband’s assistant.

“After 54 happy years together, they decided to end their own lives rather than continue to struggle with serious health problems,” the Downes children said in their statement.

What could be more natural or more romantic? An elderly couple who had an unusually long and happy life together faced only debility, decline and life apart. They viewed this prospect as insupportable and chose to take control of their destiny by ending their lives now instead of suffering longer. Their deaths were quiet and peaceful, just as they had planned

…[T]he children said, they watched, weeping, as their parents drank “a small quantity of clear liquid” before lying down on adjacent beds, holding hands.

“Within a couple of minutes they were asleep, and died within 10 minutes,” … the couple’s 41-year-old son, said in the interview after his return to Britain. “They wanted to be next to each other when they died…”

Of course Britain, like the United States, does not permit an elderly couple to control the timing and method of their own deaths, even when those deaths are inevitable. Sir Edward and Lady Downes were forced to leave their home and travel to Switzerland, where the organization Dignitas helped arrange the suicides.

Predictably, the news of the deaths has ignited controversy back home. The British Medical Association, in their wisdom, voted recently to deny the terminally ill the option of assisted suicide.

Not surprisingly, though, in a society that forces the terminally ill to live even if they are suffering, it is Sir Edward’s death that has sparked the most outrage. He may have been 85 years old, almost blind and losing his hearing, he was not terminally ill. He had lived a long time, longer than most men, and was satisfied with his length of life, but the British, like Americans, believe that death is far too serious a matter to be controlled by the person who is dying.

That’s the source of the outrage. It is certainly not about the deaths of this elderly couple for natural deaths at the very same moment would have provoked no concern. The outrage is directed at the temerity of Sir Edward and Lady Downes in arranging the time, place and manner of their deaths instead of taking their chances with cruel fate.

The concern is not for them, of course, but for us. As Rod Dreher writes on Beliefnet:

We shall very soon proceed from the “right” to die to the “duty” to die, when one is seen, or made to see oneself, as a burden on the living.

In other words, Sir Edward and Lady Downes’ continued suffering is a regrettable necessity to protect the rest of us. If they are allowed to die, the inevitable next step would be to force others to die. It’s the classic slippery slope argument. But as students of logic know, the slippery slope argument is an intellectual fallacy. The slippery slope is a fallacy because it denies the possibility that a middle ground can and does exist.

It does not follow logically that allowing people to control their own deaths will lead to forcing people to die. It is possible, but those who wield the slippery slope argument are obligated to prove a connection, and thus far, no one has done so.

Moreover, the slippery slope argument in this setting is incredibly cynical and selfish in the extreme. The underlying supposition is that any amount of suffering of any number of other people is allowed in order to prevent the chance that one of us may suffer inadvertently in the future. In other words, for Dreher, the Downes’ suffering is the price they have to pay to protect Dreher from a theoretical future where he might be forced to die.

But his fear of theoretical future suffering is not a justification for the very real and ongoing suffering of terminally ill and elderly people who are ready to die but are forced to live. I applaud Sir Edward and Lady Downes for having the strength of character and purpose to make their own most intimate decisions and carry them through. And I have deep respect and admiration for the intense love that makes surviving alone an unbearable prospect.

The blogosphere is abuzz with the news that Midwifery Professor Denis Walsh has declared that labor pain is good. According to the Daily Mail:

In an article for Evidence Based Midwifery, published by the Royal College of Midwives, Dr Walsh said the NHS was too quick to give in to requests for pain-killing injections.

He said: “A large number of women want to avoid pain, but more should be prepared to withstand it. Pain in labour is a purposeful, useful thing which has a number of benefits, such as preparing a mother for the responsibility of nurturing a newborn baby.”

Dr. Walsh recycles an entirely fabricated claim:

[Epidurals] also led to lower rates of breast-feeding. He added: “Emerging evidence showsthat normal labour and birth prime the bonding areas of the mother’s brain more than Caesarean or pain-free birth.”

The belief that pain in labor is beneficial has a long and sordid history. A large body of scientific literature shows that women’s pain (of any kind) is much less likely to be taken seriously than men’s pain.

The Girl Who Cried Pain: A Bias Against Women in the Treatment of Pain (Journal of Law, Medicine & Ethics, 29 (2001): 13–27) provides a disturbing description of the ways in which the pain of women is systematically devalued, disbelieved and undertreated.

…Women who seek help are less likely than men to be taken seriously when they report pain and are less likely to have their pain adequately treated…

The study by McCaffery and Ferrell of 362 nurses and their views about patients’ experiences of pain found that while most of the nurses (63 percent) agreed that men and women have the same perception of pain, 27 percent thought that men felt greater pain than women… The same study also found that almost half of the respondents (47 percent) thought that women were able to tolerate more pain than men …

These erroneous attitudes are particularly prevalent in regard to childbirth:

Bendelow found that “the perceived superiority of capacities of endurance is double-edged for women — the assumption that they may be able to ‘cope’ better may lead to the expectation that they can put up with more pain, that their pain does not need to be taken so seriously.” Crook and Tunks point to the influence of the psychoprophylaxis movement in the United States with its implicit assumption that it is good to experience childbirth without the aid of analgesia… [A]ccording to the authors, “these attitudes imply that we have a value system … that suggest women should be encouraged to keep a stiff upper lip.”

The authors believe that people discount women’s expressions of pain.

A deeper examination of why women are treated this way is explored by several feminist authors. They attribute it to a long history within our culture of regarding women’s reasoning capacity as limited and of viewing women’s opinions as “unreflective, emotional, or immature.” In particular, in relation to medical decision-making, women’s moral identity is “often not recognized…”

…These findings are consistent with studies reporting that female pain patients are less likely than their male counterparts to be taken seriously or are more likely to receive sedatives than opioids for the treatment of their pain.

It is not a coincidence that the philosophy of “natural” childbirth was promulgated by men steeped in the ethos that women’s pain was not worthy of serious consideration. Their claims that women can and should manage childbirth pain through psychological means, that women are “empowered” by pain or that the pain is “beneficial” are simply elaborate justifications for not acknowledging and not treating the pain of women.

Walsh’s claims are just the 21st Century version of the willingness to dismiss the pain of women. He has dressed up his claims in scientific jargon to make them more palatable to a more sophisticated audience, but there is no scientific basis for his claims. There’s NO scientific evidence that unmedicated childbirth is better, safer, healthier or superior in any way than childbirth with pain relief. And the claim about endorphins and bonding is entirely fabricated; it was made up by Michel Odent.

Walsh is merely the latest update in an endless string of men (and sometimes women) who discount, dismiss and disbelieve women’s suffering. The original reaction was to claim that pain was all in a woman’s head; the updated version is to claim that if she cared about her baby and herself she would gladly embrace the pain and be a better mother and woman for the experience.

Curiously, no one has been able to find a form of male pain that supposedly benefits men. I suspect that it is more than mere coincidence that the only pain that is supposedly beneficial is pain that only women can experience.

Many years ago I regularly received a free monthly publication called “Doctor, I’ve read …” Unlike much of what doctors receive for free, it was both interesting and extremely useful. It was a compendium of excerpts from newspapers and women’s magazines about women’s health. It alerted me to what my patients were reading so I would be prepared for the inevitable patient questions, and because I had read the same article, I could explain to the patient whether it was reliable or not.

I often thought that there should be a similar publication for patients, showing them how they could evaluate medical claims found in newspapers and magazines. Such information is even more important today when medical claims are widely disseminated on the web. There is a great deal of excellent medical information available on the web, but far more information is erroneous and even dangerous.

Unfortunately, there is no magazine like that, but there are publications for lay people explaining how to evaluate scientific claims. One of the best is Risk in Perspective: A Consumer Guide to Taking Charge of Health Information prepared by the Harvard Center for Risk Analysis. Although it’s geared specifically toward risk, it has valuable information about any health claims.

It’s worth reading in full, especially because the cartoons are very funny. The text is serious, though.

Health information can be based on untested claims, anecdotes, case reports, surveys, and scientific studies. Scientific studies, which take samples and apply the results to the whole population, often provide the best clues about health. Nonetheless, many studies are needed to be confident about an answer. The following are some factors that might help you judge information:

Less reliable (less certain)	More reliable (more certain)
One or a few observations	Many observations
Anecdote or case report	Scientific study
Unpublished	Published and peer reviewed
Not repeated	Reproduced results
Nonhuman subjects	Human subjects
Results not related to hypothesis	Results about tested hypothesis
No limitations mentioned	Limitations discussed
Not compared to previous results	Relationship to previous studies discussed

If you read these guidelines, it is not difficult to understand that most of the “alternative” health literature falls into the category of less reliable, and is almost always superseded by scientific evidence that is more reliable.

So, for example, anecdotes, the mainstay of vaccine rejectionists, are not reliable since they tell us nothing about what happens to most people. Those ubiquitous “clinical studies” not published in peer review scientific journals, often used for touting herbs and “natural” remedies, are not reliable compared to information that has been published in a peer reviewed journal. Bits of information scavenged from a variety of studies that were unrelated to the claim being discussed, a favorite of “natural” childbirth advocates, are far less reliable than actual studies of the specific claim.

The first step in evaluating any claim is to ask some basic questions. Is the claim based on a few observations or a scientific study? Was the study published in a peer reviewed scientific journal? Have the results been repeated by anyone else? Do the authors discuss the limitations of their own study? How do the results of this study compare with other, similar studies?

If the claim is supported only by anecdote, has not been reported in the scientific literature, has not been repeated by others, and it inconsistent with existing scientific literature, the claim deserves the deepest skepticism.

Lobbyists for private package delivery services have been wining and dining members of Congress in an effort to undermine support for the US Postal Service.

“It’s an outrage, actually,” declares their spokeswoman Louise Harry. “The US Postal Service is practicing socialized mail delivery.”

A Republican Congressman agrees: “Because of its monstrous size, the Postal Service has an unfair competitive advantage. They can deliver mail from one coast to the other for less than 50¢ per letter. There’s no way that private enterprise can compete with that.”

A Republican Senator concurs and warns, “Socialized mail is just the first step to destroy America as we know it. No one can deny that the US Postal Service has taken choice away from consumers. Can you choose any stamp you want? Oh, no. Every American is forced to use only government-approved stamps to send their letters. It’s an outrage!”

In an effort to fight what it perceives as an unfair competitive disadvantage, private delivery services are rolling out a new program of mail insurance, ChoiceMail. For a flat monthly fee, private delivery services will provide all the mail service you need, subject to a few minor restrictions.

“As the name indicates, we feel that the most important component is choice,” explains Louise Harry. “The consumer will be free to affix any stamp of his choosing, and we will deliver that letter!”

We were able to obtain a copy of the ChoiceMail contract to share with our readers. For a flat monthly fee, ChoiceMail provides unlimited delivery from coast to coast, and you are not required to use only government-approved stamps. You can use any stamp of your choosing. We asked Ms. Harry about the restrictions.

“Yes, ChoiceMail does reserve the right to determine whether your letter needs to go to the address on the label. We’ve found that a consumer may think that a letter should go to Aunt Irma in Oregon, but cross country mail service is expensive. It’s more cost efficient to send the letter to Uncle Ed who lives in the consumer’s own state. If the news is important, he can call Aunt Edna to tell her.”

Ms. Harry emphasizes that ChoiceMail can offer unlimited choice for a flat monthly fee because they do their utmost to control costs. As Ms. Harry explains:

“You might think that you want to send a letter to your old high school friend Billy to tell him about your new baby, but that’s wasteful. After all, you’ll see Billy at the high school reunion next year and you can tell him then. That’s why we check every letter and send only the ones that we feel need to be sent.”

Ms. Harry is particularly proud of ChoiceMail’s most innovative form of cost cutting, charging the mail recipient:

“Sure, Grandma Sue wants you to send a birthday card. It costs her nothing to receive that card, and she benefits from every card she gets. Why should we pay for the consumer to send a card to Grandma Sue? Let Grandma Sue eat the cost if she thinks getting a birthday card is so important.”

Ms. Harry concludes:

“The most important thing is choice. The US Postal Service is socialized mail and it restricts consumers’ choice to government-approved stamps. ChoiceMail allows consumers unlimited choice of stamps. Sure, we might not deliver your letter to the person you specify in the address or we might decide that it doesn’t need to be delivered at all. But you’ll rest easy knowing that you have sent your mail by private enterprise, the patriotic way, the American way.”

This post originally appeared in March 2009.

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.

Consider:

A young rural father was recently arrested and charged with felony child endangerment for smoking in the presence of his infant son. Police called to the home to investigate a domestic disturbance observed the father smoking cigarettes although a 6 week old infant was present in the same room.

Officers responding to the home reported that the smoking was a chronic problem. One noted that the home positively “reeked” of stale smoke indicating an long term, ongoing habit.

Parental smoking is known to increase risk of infant wheezing, respiratory disease and even death. As the police chief pointed out, “increasing the risk of infant death is clear evidence of felony child neglect. Our officers had no choice but arrest the father and file charges.”

If convicted, the father faces up to 5 years in prison.

This incident never happened, but it ought to happen all the time if the case of Stacey Anvarinia, the woman arrested for breastfeeding while drunk, is a precedent. I was quoted in a recent Associated Press article about this case, expressing outrage that a young woman was arrested for a made-up crime. The reaction to my comments indicate that many people feel that Ms. Anvarinia got what she deserved.

Why then would the same people would probably recoil in horror at the idea of arresting men who smoke in the presence of their infants? Fundamentally, it is the result of the American inability to understand relative risk.

Most Americans unthinkingly accept all sorts of risks that are familiar, while simultanously expressing outsize alarm at risks that are trivial in comparison. We like to pretend that we would never expose our infants to risk, but simply putting them into a car to drive to the store represents a risk far larger than the risk posed by breastfeeding while drunk (which is merely theoretical) or the risk of smoking in the presence of an infant (which is an all too real risk of illness and death).

Simply put, some risks, though large, are judged to be acceptable, while others, trivially small or non-existant, excite outrage. Those who throwing proverbial stones at Ms. Anvarinia for breastfeeding while drunk are living in glass houses. Many routinely expose their own infants to the far greater risk of travelling in a car.

Unfortunately, there’s an element of discrimination, too. The risk that smoking poses to an infant is far greater than any theoretical risk of breastfeeding while drunk. Yet I suspect that people would react with outrage at the idea of a smoker being arrested for smoking in the presence of his or her infant. Smoking is socially acceptable, while breastfeeding, for all its known benefits, is still considered slightly strange and suspect.

We need to be honest with ourselves about our own prejudices. When it comes to children and risk, we cannot pretend that we are unwilling to accept risk, because the reality is that we consider some risks, even large risks, acceptable. Moreover, we treat some risks as acceptable because they are socially acceptable. Smoking in the presence of an infant is more dangerous than breastfeeding while drunk. Unless we are willing to arrest and charge parents who smoke in the presence of their infants, we should stop self-righteously condemning Ms. Anvarinia.

I’ll be traveling intermittently for another week, and will occasionally repeat an old column. This article originally appeared on my Open Salon blog in March 2009.

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?”