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.

Hundreds of newspapers and websites around the country have been buzzing with the news that sexually degrading song lyrics are linked to early sexual activity. The newspapers slavishly copied the press release issued by the American Journal of Preventive Medicine:

… Brian A. Primack, MD…, states, “This study demonstrates that, among this sample of young adolescents, high exposure to lyrics describing degrading sex in popular music was independently associated with higher levels of sexual behavior. In fact, exposure to lyrics describing degrading sex was one of the strongest associations with sexual activity…These results provide further support for the need for additional research and educational intervention in this area.”

Surveys were completed by 711 ninth-grade students at three large urban high schools. These participants were exposed to over 14 hours each week of lyrics describing degrading sex. About one third had previously been sexually active. Compared to those with the least exposure to lyrics describing degrading sex, those with the most exposure were more than twice as likely to have had sexual intercourse…

Similarly, among those who had not had sexual intercourse, those in the highest third of exposure to lyrics describing degrading sex were nearly twice as likely to have progressed along a noncoital sexual continuum compared to those in the lowest third…

There are a lot of problems with this study, but the primary problem is not visible to lay people: the press release was issued well in advance of the publication of the article. In fact, the article is not available until the April issue of the journal is published. Journalists can request an advance copy of the article, but judging by the newspaper articles, most simply copied the press release. That means that the public has no way to independently assess the validity of the study or to determine if the author’s conclusions are justified by the data in the paper.

On its face, the idea behind the study is perfectly reasonable. Early sexual activity among teens leads to significant public health problems like the epidemic of sexually transmitted diseases and teen pregnancy. Identifying factors that promote early sexual activity might be helpful in creating public education programs to prevent it. It is entirely possible that sexually suggestive media promote early sexual activity. Unfortunately, the methodology of this study renders its conclusions highly doubtful.

In the study, Exposure to Sexual Lyrics and Sexual Experience Among Urban Adolescents (no link available), the authors recruited over 700 high school students with varying amounts of pre-existing sexual experience. The authors “inferred” the amount of sexually suggestive lyrics to which each teen was exposed by a convoluted algorithm:

They asked each teen to identify his favorite music artist and how many hours per week the teen spent listening to all music. Then they assumed that the teen’s favorite artist was representative of all music that they heard during the week. Further, they assumed that proportion of that artist’s use of sexually degrading music across his entire repertoire was representative of the teen’s exposure to sexually degrading lyrics.

For example, if a teen reported listening to 21 hours of music a week, and his favorite artist used sexually degrading lyrics in 67% of his songs, it was assumed that the teen listened to 14 hours of sexually degrading lyrics per week. As the authors acknowledge, their method has tremendous potential for error:

 It is possible that an adolescent’s favorite artist does not represent total exposure, either because the adolescent lacks access to that artist’s music (for financial or other reasons) or because the adolescent listens to a wide variety of music…

 In truth, the authors had literally no idea how many hours each teen was exposed to sexually degrading lyrics.

Moreover, the choice of favorite artist who uses sexually degrading lyrics may reflect the teen’s personal values. Those who are sexually active may more likely to enjoy sexually degrading lyrics.

The authors present the results of the study:

Participants were exposed to an average of 31.0 hours of popular music per week (SD=21.1) and an estimated 14.7 hours each week of songs with lyrics describing degrading sex (SD=17.0). Thirty percent of the 711 participants had previously had sexual intercourse…

Compared to those in the lowest tertile, those with the most exposure to lyrics describing degrading sex had greater odds for having had sexual intercourse (OR_2.07; 95% CI_1.26, 3.41). Likewise, compared to those in the lowest tertile, those with the most exposure to lyrics describing degrading sex had greater odds for having progressed further down the noncoital sexual continuum (OR_1.88; 95% CI_1.23, 2.88).

In other words, high exposure to sexually degrading lyrics was associated with a doubling of sexual activity. That sounds impressive until you consider that there were many other factors that were also associated with doubling of sexual activity. Age greater than 15 and rebelliousness doubled the level of sexual activity, and being black more than doubled the level of sexual activity.

The authors suggest that the association between exposure to sexually degrading lyrics and increased sexual activity is important and might even indicate that increased exposure to sexually degrading lyrics leads to increased sexual activity. However, a fundamental rule of scientific analysis is that correlation does not equal causation. Just because something is associated with a change does not mean that it caused the change.

The authors’ data demonstrates the importance of this rule. While age greater than 15 was associated with double the level of sexual activity, it would be absurd to suggest that increased age causes increased sexual activity. Although black teens reported double the level of sexual activity compared to white teens, it would be absurd to propose that black race causes increased sexual activity. Similarly, it is an unjustified stretch to suggest that increased exposure to sexually degrading lyrics causes increased sexual activity.

The authors openly acknowledge that their method of calculating exposure for sexually degrading lyrics has potential for large error and that correlation does not equal causation, and that causation can go both ways, but then they throw caution to the wind:

In summary, adolescents are heavily exposed to lyrics describing degrading sex in popular music, and this exposure is associated with early sexual experience among them in an urban population of youth at high risk for risky sexual behavior. These results provide further support for the need for additional research and educational intervention in this area.

But that’s not what the paper showed. We have no idea of the actual exposure of adolescents to sexual degrading lyrics. While exposure appears to be associated with early sexually experience, the three other factors that are associated with early sexual experience are clearly not causative. Even if there is a causative relationship, it is just as like to be that sexually active teens prefer sexually degrading lyrics, not that sexually degrading lyrics lead to increased sexual activity.

Finally, it was improper for the authors and the journal to send out press releases far in advance of publication of the paper. The press release is supposed to highlight the reasons to read the paper, not substitute for the paper itself. Deliberately sending out the press release in the absence of the paper deprives journalists and the public from the opportunity of actually evaluating the paper. It forces journalists to publicize the authors’ conclusions instead of their own conclusions. Maybe that was the point all along.

Are corporate murderers evil, stupid or both? How could any corporate executive deliberately release contaminated products into the market and expect to get away with it?

Yesterday, two corporate executives in North Carolina were each sentenced for 4 ½ years in prison for deliberately shipping syringes without bothering to sterilize them. Dushyant Patel, the owner of the company, has fled to India in an effort to avoid prosecution. Thus far 5 people have died, and more than 200 have been sickened, some sustaining injuries such as permanent brain damage.

Patel’s company AM2PAT, doing business as Sierra Pre-Filled, manufactured sterile syringes pre-filled with medication used to keep IV lines open. Pre-filled syringes for IV maintenance are ubiquitous in any hospital and are often used by patients at on long term therapy at home.

According to the Associated Press:

Court documents portray a disturbing recklessness that allowed syringes to ship before they were checked for signs of contamination. Reports detailing the testing were backdated to appear they passed procedure before shipping, and some test results were manipulated or fabricated in an attempt to deceive inspectors from the U.S. Food and Drug Administration, prosecutors said.

Patel’s company sold nearly $7 million worth of heparin and saline syringes in 2006-07. The plant in Angier, about 20 miles south of Raleigh, cut corners so it could maximize profit, including shipping products as quickly as possible without checking on safety …

In an effort to increase profits, the owner and executives of a company conspired to skip the sterilization of the syringes, and then altered the records to deceive inspectors from the FDA who were responsible for routine safety checks.

Not surprisingly, the unsterilized syringes were contaminated with bacteria. Specifically, the syringes were contaminated with Serratia marcescens. Serratia is a bacterium routinely found in soil and water. It can cause wound infections, blood infections (sepsis), and pneumonia, among other things.

Injecting the bacteria directly into a patient’s bloodstream dramatically increases the chance for serious, even deadly, infections. Moreover, all the people who received the injections were, by definition, already ill. That’s why they had an intravenous line in the first place. Shipping unsterilized syringes, ensuring that bacteria would be directly injected into the bloodstreams of people who were already debilitated by disease practically guaranteed that innocent people would die. Yet the owner and the executive of the company did it anyway.

The case is strikingly similar to the recent outbreak of salmonella traced back to one peanut processing plant. There, too, the owner, and possibly the executives of the company deliberately shipped out peanuts that they knew were contaminated with salmonella. Once again, it was virtually guaranteed that a substantial number of people would be sickened, and that some might die.

Leaving aside the moral dimensions (which are huge) for the moment, what were these business people thinking?

That nothing would happen? That’s simply not possible; they had to know that people inevitably would become seriously ill.

That no one would find out? That’s also impossible. Although lax FDA oversight allowed the companies to circumvent FDA regulations, once a pattern of disease appeared, the FDA would inevitably trace it back to the company of origin.

That they get away with it? They know that companies are destroyed and executives are imprisoned when people die as the result of the deliberate decision to introduce contaminated products into the marketplace.

Clearly these corporate executives are evil. They chose to deliberately infect people with serious diseases, simply to maximize profit. Yet, that does not seem like a sufficient explanation for the disasters that have unfolded. They must also be stupid. How else could anyone think they could kill people and get away with it?

 

Mention reproductive conflict and many people will nod knowingly. It is not unusual to find differences in the sexual needs of men and women. Conflict may arise over frequency of intercourse and length of foreplay, not to mention the differing proclivities of partners. Yet that’s nothing compared to the female praying mantis who celebrates successful mating by eating the head of her partner.

 

It may seem nonsensical that what represents sexual fulfillment for one partner leads to the death of the other. However, sexual fulfillment exists only in connection with reproductive success. Whatever behavior leads to greater reproductive success will be favored, regardless of the unfortunate impact on the sex that is victimized.

 

This is highlighted in an article in this month’s issue of Current Biology, Sperm Competition Favors Harmful Males in Seed Beetles. Co-author Goran Arnqvist, discussing the phenomenon of reproductive conflict says:

One especially tricky case involves species where the males have mating organs that are supplied with hooks, barbs, and flukes that cause internal injuries in females during mating. This is extremely common among insects, but it also occurs in many other animal groups. 

According to the press release announcing publication of the article:

Goran relates that the males’ mating organ is rather similar to a medieval spiked club and that it causes severe wounds in females during mating. But since it is never a good idea for a male merely to injure a female, the researchers have assumed that these structures serve another purpose and that the injury is an unfortunate side effect.

“Females’ injuries as such do not benefit the male she mated with. It has been suggested rather that the injuries are a side effect of other benefits the males reap from the barbs. Now, for the first time, we are able to show that this is the case,” says Göran Arnqvist.

Longer barbs cause more injuries to the female, but they also increase the likelihood of male reproductive success. When females mate with two males, the male with the longer barbs is more likely to fertilize the eggs. As in other cases of sexual conflict, the interests of the male and female are different, and it is reproductive success that ultimately determines whose needs are more important.

 

In the past, Goran and colleagues have proposed that a coevolutionary arms race takes place between males and females. Since reproductive success is maximized by an injurious mating organ, it is favored despite injuries to the female. In reponse, female seed beetles evolve reproductive ducts with more connective tissue, minimizing the risk of injury even as the male reproductive organ evolves to maximize it.

 

That makes a certain amount of sense, but, obviously, there are some injuries that cannot be overcome regardless of evolution. The male praying mantis cannot survive long without its head and no amount of evolutionary adaptation can change that. Therefore, there must be a very strong boost to reproductive success than arises from the female eating the male’s head during mating, and indeed there is.

 

The male praying mantis can complete mating after being decapitated. In fact, biting off the male’s head actually appears to improve sexual performance. Decapitating a  male praying mantis causes it to reflexively assume the mating position.

 

Second, the male’s head is an excellent source of protein and nutrients. Ingesting her partner’s head allows the female praying mantis to produce higher quality eggs, and thereby increases the reproductive success of the species.

 

While reproductive conflict may be responsible for unhappiness among human beings, it appears to have significant advantages among animals. The next time any man complains about not “getting enough” he should pause to consider that it could be far worse. Instead of getting his head bitten off figuratively, his partner could make biting off his head the literal consequence of sexual satisfaction.

Let’s be honest. Thin people feel superior to people who are overweight. The prejudice is so deep seated that it has affected the practice of medicine. Rarely a week goes by without some scientific paper claiming to link obesity with various dreadful health problems; yet most are shoddy and poorly done, and almost all are debunked.

Why do thin people feel superior? The causes are economic and philosophical. Simply put, being overweight is associated with being poor. In addition, Americans have a deeply embedded strain of Puritanism that holds that those who have misfortunes somehow deserve them.

Many American predilections are grounded in economic status, and weight is no different. When poor people were thin because they didn’t have enough to eat, being overweight was a sign of status. Similarly, when poor people were tanned because of working outside, white skin was a sign of status. When poor women couldn’t afford anesthesia for childbirth, access to chloroform was a sign of status.

That’s changed now. Thin is a sign of wealth, a tan in midwinter (from a tropical vacation) is a sign of wealth, and preference for “natural” childbirth is also closely associated with upper income levels.

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 thin people feeling superior to those who are overweight, because, economically, they often are superior. Weight has become a proxy for social class.

America was founded by Puritans and Puritanism is a strong strain in our thinking, hence the otherwise irrational impulse to regulate the private behavior of others, particularly others who are poor. Americans take almost fiendish delight in pointing out the “deserved” consequences of smoking, over eating, and marijuana use. They have stigmatized those behaviors in every possible way.

In my town, smoking is banned everywhere, including out of doors. Many cities are busily promulgating laws to regulate the composition of food served in restaurants. Users of marijuana, even those using it for medicinal purposes, are routinely prosecuted and may be jailed.

It is not a coincidence that smoking, over eating, and recreational marijuana use are more common among the poor. That is what leads, in part, to the zeal for stigmatizing, banning and punishing such behavior. Smoke a cigarette and you are forced outside into the cold; put transfats into your restaurant fare and you may face a fine from your city or town. Smoke marijuana and you may go to jail. On the other hand, steal $50 billion and force people into financial ruin and suicide, and you get house arrest in your Manhattan co-op while awaiting your trial.

Being poor is, in and of itself, almost always viewed as the “fault” of the people who are poor. This is an echo of the Calvinist belief in predestination, a convenient belief that those who prosper in this life do so because they are destined for an even better life after death. Therefore, overweight is routinely viewed as a visible sign of personal sloth, and worthy of serious negative consequences. The health problems of the overweight are simply just punishment for their inability to exert self-control.

There are literally hundreds of studies that claim to show that overweight is a major killer. Except that it’s not. The science is shoddy because the outcomes are predetermined by prejudice.

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.

Walk down the hallways of any hospital and look into the rooms. Very few people are there because of weight related health problems. We know this to be true in our own lives. All of us know many people who are overweight, but they are hardly dropping dead on a regular basis.

Thin is in, because it is viewed as a sign of economic status, and an indication of personal rectitude. The prejudice against the overweight is not justified by the scientific data, nor by the fact that weight is now a proxy for wealth. Like any prejudice, it is not justified at all.