Preventing Premature Births, How Much Should It Cost?

It cost $30 a month when local pharmacies made it as a gel – and it worked, for the last 8 years. It’s a treatment that helps women carry high-risk pregnancies to term. Now that K-V Pharmaceuticals has gotten it approved as an injectable drug by the FDA and patented it, they want to charge $1,500 per dose, or $6,000 per month. They say that’s ok because a typical 20 week course of Makena, the drug in question, would cost $30,000, while a premature baby would cost on average about $51,000 in the first year, and since after outcries they dropped their price to about $15,000 per 20-week course, that’s a big savings, assuming it works. They also claim government rebates and financial assistance to the needy will help those who can’t afford it get treatment (for something that was already available at a very reasonable price).

They’ve warned pharmacies they would face FDA enforcement if they continued to compound the drug – after pressure from professional medical societies and Senator Sherrod Brown of Ohio, the FDA stated it would not attempt to prosecute pharmacies unless there were safety concerns.

Naturally, the company invested money in the product in order to gain FDA approval – nearly a quarter of a billion dollars, according to an email statement to NPR. But according to Senator Brown, they could make billions of dollars in a single year off of their drug if they would price it similarly to the original generic drug, more than enough to pay for their investment and profit from the drug. And George Saade, president of the Society for Maternal Fetal Medicine, says that there is no measurable medical difference in the medications, only possible logistical benefits in having a product made by a company available everywhere, instead of compounded locally.

In Cutting Budgets, Who Feels the Cuts First?

The mentally ill are both men and women, and according to some statistics, women make up as many as 80% of the workers in health care. So when I heard a story about the cuts in states’ budgets that cause state psychiatric hospitals to be closed, which causes the mentally ill who go to hospitals to be kept in the ER for sometimes days waiting on a bed in a psychiatric hospital – it is troubling.

I once considered going to an ER and voluntarily committing myself for the 72 hour cooldown period. I was conscious enough to know which hospital had a psychiatric ward and to know I would rather spend some time in a less clinical facility. I received a reduced rate at the facility I chose, because they received state funding. Maybe those things would be different now. I would have left if I had had to pay for it all out of pocket – I didn’t have it. And if I had been turned away, sent to the emergency room, I don’t know how that would have affected my eventual recovery, into a stable life today. Years later I count that weekend as a turning point for me.

One ER doctor in the report I heard asked, if this was pneumonia, would we be okay with making them wait 30, 40, 60 hours to get a bed? To get adequate treatment? If we say we treat mental illness with parity, how do we explain this?

We recently deeply overestimated our commenters as a whole when Revena posted about an episode of Serenity about a man who survives a Reaver attack, then does his best to become a Reaver, and Mal’s explanation: that after having been traumatized, he must’ve felt the need to become like his abusers. Revena cited this bit from an email I’d written her.

In this ep, we have a guy who… what? Is suffering from Stockholm syndrome + 1? He’s seen horrific abuse, so he’s going to become like his abusers? Thank goodness that’s not how it works on non-fiction humans, or you can imagine the fallout from Bosnia, the Holocaust and tortured POWs – not to mention abused kids. I mean, we’d be extinct already with that amount of conscience-free sport abusers wreaking their havoc… It makes Mal look incredibly stupid (just observation and a moderate knowledge of history overcomes this idea) and it insults the vast majority of survivors of abuse and horror who absolutely did NOT go on to resemble their abusers in any way.

Apparently, a lot of our commenters think Mal makes good sense there, because we are having to delete comments right and left that seek to correct my confusion and explain that abused people become abusers. We’ve explained it all in the comments, but the new commenters don’t bother reading. They just can’t wait to share the fruits of their superior brainz with us confused people.

Except, no. I’ve actually done some reading on psychology. Hell, I’ve also looked at the people in the world and made some observations. If you think adults can suddenly snap and turn abusive, you’ve been watching too much TV without thinking critically, and that makes you not really what we’re looking for in a commenter. Here are some facts about psychology.

• Yes, abusive people virtually always have been victims of abuse.
• But remarkably, the vast majority of kids (estimated at 7 out of 8 [ETA: or 9 out of 10?], though more studies are needed) raised in abusive situations do not become abusers themselves. Why is that, do you suppose? This is where critical thinking is helpful.
• Statistically, the fact that abusive backgrounds usually don’t produce abusers is more telling than the fact that virtually all abusers come from abusive backgrounds. Think of it this way. If 88% of people who eat beef don’t get hives, but everyone who has hives eats beef, would you conclude that eating beef  is the sole cause of hives? I hope not. The typical child molester has up to 400 victims* in his or her lifetime (and this is just one type of abuser). Even using the 1 in 8 stat (for how many sexually abused kids become abusers themselves), one child molester should produce up to 50 new child molesters in every generation. And yet, if the amount of child molesters was multiplying that exponentially every generation, and we know child molestation’s nothing new in human experience, wouldn’t non-molesters be a serious minority by now?
• If abusive backgrounds usually don’t produce abusive adults, they cannot be the sole cause of how abusive personalities come into being. There have to be other factors, and no consensus has been reached as to what. The general theory in both law enforcement and counseling is that there are probably genetic factors and social factors as well as the upbringing to consider.

My personal theory is it’s not abuse that causes people to develop these personalities: it’s lack of consistent discipline which often accompanies an abusive upbringing. (Note: beating the shit out of a child does not equal discipline.)

But let’s move on to the bit you really should be able to work out for yourself without any textbook reading at all: once empathy is learned, it can’t be lost through sudden trauma. The idea that an adult who’s always been nice and wonderful (and not at all violently delusional) can suddenly snap and go on a killing spree is a myth spread by hack screenwriters. People without empathy can do a great job of mimicking someone who’s nice and wonderful for a very long time before something happens (what profilers call a “stressor”), and suddenly they can’t maintain the facade anymore. (This, by the way, would be the most logical explanation for what happens to our Reaver victim turned abuser, by the way – that he was never very high on the empathy scale, and what happened with the Reavers freed him of the need to keep maintaining his Mr. Good Neighbor facade.)

But the reason I say you should’ve known this yourself without any particular education is: do the math.

• Something like 1 in 4 women are sexually assaulted as adults.
• No one’s too sure about stats for men, but some not insignificant number of men have experienced sexual assault, usually during boyhood.
• In 2005 alone, 476,280 adults experienced domestic violence. Sorry, reported domestic violence. The actual number must be considerably higher. Most will have survived it.
• Lots of adults have really traumatic car accidents.
• Loads of people survive horrible random violence – drive-by-shootings, home invasions, etc. Or the loss of a loved one to violence.
• Loads of people have traumatic experiences from working in the military or law enforcement or other dangerous jobs.
• Hitler left more than 6 million extremely traumatized survivors.
• So did Bosnia.
• So will what’s happening in the Congo. (Hey Sylvia, I wonder if this could be the closest we’ll get to a real world approximation of what Reavers do to victims?)
• How many people get stalked? Forced to leave a job because of sexual harassment, or discrimination based on race, sexual orientation, etc.? How many people are being emotionally abused by partners, but not physically? These are traumatic, abusive experiences.

People who haven’t experienced some kind of emotional trauma as an adult are possibly more unusual than those who have (especially the older your sample group, since just being alive raises your odds). If anywhere near all these people snapped and became capable of willfully and remorselessly harming others, this world would be way more of a cess pit than it is. Because they wouldn’t just harm one or two people. Oh, no.

For goodness’ sake, people, when you come to this site and spout your mouth off, you are talking to a lot of abuse, assault and trauma survivors. If you don’t feel the need to educate yourself on what we’ve been through before telling us all about ourselves, then do not comment. If my reasoning doesn’t do it for you, then use your own Firefly based logic: you apparently think we’re all likely to rape you to death and then skin you for clothing, and if you’re lucky, we’ll do it in that order.

I’ve written before about Kerry Greenwood’s seventeen novel Phryne Fisher series, about the titular 1920’s flapper detective who is as fantastically perfect as James Bond, with almost as many installments. She wrote another detective series set in present-day Melbourne (which isn’t actually very present-day, since Jeff Kennet is still Premier…), starring Corinna Chapman. I must say, in the battle between the feminist in me and the historian in me, the historian won and I prefer the Phryne Fisher series, but man is Corinna an awesome feminist character.

Corinna is a baker who runs her own shop, Earthly Delights. She’s also fat; an Australian size twenty. I have no idea how that translates in other regions, but that’s pretty big. Corinna knows she’s fat, and she’s entirely comfortable with it. And she’s fat because she’s fat in the same way that I have green eyes because I have green eyes – just one of those things that life hands you that you have no control over. She’s not fat because she has no willpower when it comes to food (or, perhaps worse – she comfort eats because of some ongoing unhappiness – Corinna is perfectly happy with her life) she’s just fat because she’s fat. Of course, she has a soft spot for certain things – namely, pastries and the gourmet chocolates friends make – but this comes across as a woman who enjoys her treats rather than one who comfort or binge eats. In fact, there’s a running point made along the lines of – would you really want to buy food from someone who looks like she never eats and therefore doesn’t even like her own cooking?

Conversely, two of her neighbours/employees, Kylie and Gossamar, are anorexics who indulge in the occasional binge and then starve themselves even more senselessly in the guilty aftermath. Corinna isn’t the least bit envious of their Kate-Moss-like figures; rather, she pities them and their obsession with conforming to unrealistic beauty standards.

Oh, and in the first book of what is so far a five-novel series, she attracts Daniel, a gorgeous man of Arab decent. Daniel adores Corinna for her intelligence, her passion, her drive, her empathy for the homeless junkie, Jason, whom she takes in and helps to turn his life around. No-one questions that a gorgeous man would adore a fat woman; it’s a case of, well, duh, didn’t you read the above line about intelligence, passion etc?

Like the Phyrne Fisher series, Corinna has an inner circle of friends and associates that features through all the books. I particularly liked her relationship with Jason as he first does a few odd jobs for her then, with her encouragement, finds a passion and flair for baking that sometimes surpasses Corinna’s own. (And she isn’t even envious; rather, proud that her apprentice/protege turned out so well. We so often see the gracious mentor when played between an older and younger men, but how many times have we see the over-the-hill female resentful of their talented protege’s rising star? And how many times have we seen a confident, content woman proud of their pupil’s talent, even when it surpasses their own?)

Anyway, as well as being a baker with a gorgeous lover and mentor to a junkie-turned-good, Corinna likes to solves mysteries in her life and the lives of those close to her. She doesn’t come across as competent as Phyrne, or as having such as well-stocked arsenal of witty comments, but to me, that made her a more realistic character. I could totally buy that Corinna had a knack for ferretting out information and piecing it all together without her needing to be impossibly perfect like Phryne.

As I said in my last article, Phryne Fisher comes across as something of a female James Bond, which in itself is a little refreshing seeing as so many fantastically perfect female characters are so passive, moping over men and such.  But her modern-day counterpart Corinna Chapman is far more realistic. She fails spectacularly at meeting our ridiculous standards of beauty, but is hardly lacking in friends or male interest; in fact, she’s far more content than her stick-thin employees. Corinna comes across as a very ordinary woman, albeit one with a strong sense of self-worth (something that’s hardly ordinary in fictional women) who has a big heart and a knack for solving mysteries – in other words, a woman that women and girls can aspire to be.  Yes, the historian in me preferred Phryne Fisher… but the feminst in me thinks Corinna Chapman rocks.

I was initially underwhelmed by Kerry Greenwood’s Cocaine Blues, the first in her seventeen novel series about 1920’s flapper detective Phryne Fisher. Phryne was gorgeous and witty, always saved the day and got the love interest (often more than one per book) while never looking unsightly, even with shredded clothing, knotted hair, etc. (If a movie were made, she’d be played by Megan Fox, and who never has a hair out of place, even after a car crash, being stranded at sea for several hours and so on.)

But by the third or fourth book, something occurred to me: Phryne is so fantastically perfect that she reminded me of another franchise featuring an impossibly gorgeous, witty hero who always saves the day and gets the love interest – who boys and men have been fantasising about being for the better part of fifty years.

James Bond.

Like Bond, Phyrne definitely enters the fantastical in the scope of her abilities – able to adapt to many a social situation, ferret out clues, work out whodunnits and catch the bad guy with the help of her motley crew of friends and assistants. (Mostly assistants because, you know, no-one is divine enough to be equal to Phryne in order to be considered ‘friend’.) And every man in the world (or at least Melbourne, Australia) finds her simply divine in much the same way almost every woman in the Bond universe finds him such. And like Bond – and unlike many impossibly unrealistic female characters – Phryne spends her days actively, doing cool things, not moping and pining over a man. (Cough Bella Swan cough.) Hell, even Phryne were to be knocked back by a man, she’d cut her losses and set her sights on another.

And there are things about Fisher and her world which I like more than Bond and his. Fisher’s inner circle – her staff, adopted daughters and assistant/friend Dot, along with another few characters, features consistently through the series, creating a sense of loyalty on Fisher’s part that I never got from what Bond movies I saw. Phryne might have, with the exception of one, forgotten about the last book’s lover by the next book, but she is always very loyal and considerate towards a circle of characters that appear consistently throughout the books.

The series also has something of a feminist theme. There is one point where Phryne laments the fact that, short of proving her husband physically abused her (and by the standards of the 1920’s, too) a woman in an unhappy marriage has no choice but to stay. In another, a one-shot character points out that girls aren’t raised to believe that they can be ‘everyday heroes’ like boys can (firefighter, police officer), so have to aspire to legendary, martyr-like heroes – Anne Askew, Joan of Arc. Here, I felt, Greenwood walked that fine line that occurs from writing a political commentary in a historical series as a contemporary writer… and she pulled it off rather well.

And I liked the back-story they give Phryne that James Bond has never been given. Over the series, we discover that she grew up in Australia in poverty, and it was only the massive losses of WWI that saw the Fishers rise to a state of British nobility. For this reason, she has a deep empathy for those in poverty – particularly those who are clearly willing to work hard but are oppressed by a system that hugely favours employers over employees – and some points I found quite touching, such as when she donates to a girl’s orphanage what she knows to her is a pittance but to them means untold treats.

So to me, Phyrne Fisher reads like a fantasy of what women would love to be – beautiful, poised, rich, intelligent, witty, always saving the day and ending up with the person she had her sights set on. But she is, on reflection, no more than what James Bond is to a lot of men. And while I wouldn’t want any girl or woman I know to seriously admire her, there are far worse women – real and imaginary – for them to be fantasising about being.

Enjoyed this article? Come back next Tuesday (Wednesday in Australia) for my critique of Greenwood’s Corinna Chapman series.

Jimmy Carter says much of the discrimination and abuse suffered by women around the world is attributable to a belief “that women are inferior in the eyes of God.” Carter called mistreatment of women “the most serious and all pervasive and damaging human rights abuse on Earth.”

I heard a spot on the national news on my local NPR station quoting a couple of comments from former president Jimmy Carter that caught my interest. When I searched for the speech, I found that Pres. Carter is considered a prominent feminist (at least, he is called that online in some places) and frequently makes similar points during some high prestige speeches. I respect someone who uses their bully pulpit to tell the Parliament of World Religions:

This view that the Almighty considers women to be inferior to men is not restricted to one religion or tradition. Its influence does not stop at the walls of the church, mosque, synagogue, or temple. Women are prevented from playing a full and equal role in many faiths, creating an environment in which violations against women are justified.

The truth is that male religious leaders have had – and still have – an option to interpret holy teachings either to exalt or subjugate women. They have, for their own selfish ends, overwhelmingly chosen the latter.

This.

Pres. Carter describes his experiences in the Southern Baptist denomination, which match exactly what I experienced growing up in several other denominations and nondenominational churches. He quotes and summarizes the Bible, and talks about how you can argue the interpretation and the examples either way, and ultimately it comes down to how you want to interpret it – and the fact that it is interpreted in a way that justifies and perpetuates harm to women is a matter of laziness and selfishness and fear, just as the interpretations that justify and cause harm to children, LGBT oriented people, etc. And while Pres. Carter in his speech to the Parliament of World Religions speaks at length about Christianity and touches only briefly on other religions (apparently because his knowledge and experience is on Christianity), he makes it clear he feels all the major religious traditions contribute to the problem, and can contribute to the solution if desired.

He says, “Having served as local, state, national, and world leaders, we understand why many public officials can be reluctant to question ancient religious and traditional premises – an arena of great power and sensitivity.” My natural cynicism about those with power and what they really want says many may not really care one way or the other, or may wish for little more than stability so they can maintain their power – but I think the point is an interesting one nonetheless, coming as it does from someone who has had that power, and still has a lot of power, and chooses to use it this way.