June 27, 2009

I learned about menorrhagia and other female reproductive oddities and abnormalities in the esoteric world of the fertility clinic. It is a strange environment, staffed by female nurses, counsellors, and secretaries, but headed entirely by male doctors. Mine was not even an exception to the general rule: this pattern remains common among fertility clinics everywhere except the Middle East, where the gender division is of a different kind.

A brief definition. (Don't squirm: it is relevant.) Menorrhagia is defined as regularly having abnormally heavy menstrual periods, with blood loss per cycle of more than 80 mL.

It is the nature of research to reflect its society, and medical research is no exception. Obviously such heavy cycles can be disruptive to a woman's activities. but at the extremes, menorrhagia can also impact severely on many women's health. It can cause anaemia, and itself be a symptom of underlying health problems. Treatment focuses upon reducing flow to a "normal" average, either through pharmacology or what is now day surgery (which most commonly involves some variant of freezing, burning, or otherwise destroying living endometrial tissue).

Yet in all the journals I found myself reading, only one study examined the actual rate of associated anaemia, finding that only 25% of women with menorrhagia also had anaemia. Every other comprehensive survey of menorrhagia was premised entirely upon quality of life issues.

Interestingly, no study I have yet found examines whether a tendency toward menorrhagia might have other advantages. None have looked at such factors as whether (in the absence of other medical conditions, such as fibroids) menorrhagic women are more or less likely to have specific complications in childbirth, birth weight of the neonate, or child development.

In our society, after checking for and treating any underlying medical conditions, women and physicians alike invariably come to a similar conclusion: if a woman presents with menorrhagia and finds it an obstacle in her daily life (presumably beyond the normal obstacle of menstruation, although how exactly would one measure that?), it is desirable to eliminate it. No other factors are relevant.

June 22, 2009

No matter which economics analysis I read, the consensus is the same: the economy has mostly bottomed out, and by the end of the next two quarters, we should start seeing a turnaround. It is a very solid consensus. That six-month just-beyond-the-horizon has held firm through the past two years.

Sometimes it seems almost as though there are two different recessions: the one measured by the economists, and the one experienced by the majority of people. Job figures stubbornly continue to refuse to do what they are supposed to do. California continues to pay its government workers in state scrip: which has immediately created a new form of underground economy on E-Bay. The official jobless rate in the United States is some 9-odd percent, but if you count in the workers forced to part-time hours and status who specifically want a full-time job, it jumps to over 20% -- and no one knows just how many are no longer even counted, who have fallen between the cracks entirely. Statistics are a strange species of beast.

I find it particularly darkly amusing that so many economists are pointing to the rising price of oil as an indicator that the current economic depression is coming to an end. Exxon, of course, has never ceased making profits throughout.

There is a very deep belief among economists that in a mature marketplace, basic consumption patterns don't change. At most, the rate of consumption only swings back and forth within those patterns. Within this belief structure, any lull in spending is only a marker of pent-up demand waiting to burst forth the moment the price drops to the appropriate level. Even Barack Obama has stated as fact that there had been 15 million cars sold annually in the United States before, and in time there would be again.

When Franklin Delano Roosevelt was elected during the Great Depression, he immediately began pumping stimulus money into the economy. Within two years, the economy was showing weak signs of recovery, so -- operating within exactly the same belief -- the stimulus money was withdrawn. As it turned out, those weak signs had been almost entirely due to federal stimulus money. When it was removed, the economy collapsed anew, even worse than before. It took a world war to bring us out of that one.

But what if demand for non-necessary goods is not an absolute?

When Seoul mayor (now president) Lee Myung-bak decided to tear up its city-centre elevated highway, a 1976 model of "successful industrialisation and modernisation," to uncover and restore Cheonggyecheon as a viable city-centre river, there was an immediate outcry that the remaining traffic system would no longer be able to handle the volume of Seoul traffic. To everyone's surprise, what ended up happening was that the downtown traffic volume actually decreased by 2.3%. It is not that fewer people are going downtown: the use of subways increased by 4.3%. Lee speculates that traffic is like a gas, expanding to fill the available space. When the space is less, the traffic is also less.

(The analogy does not allow for Boyle's relationship between volume, pressure, and temperature, although it works well enough if the vessel is not assumed to be closed with a fixed amount of gas ... which, come to think of it, is also appropriate for the marketplace. The credit-based economic system is anything but a closed system. As a further real-world ironic comment on the ideal gas law, areas surrounding the stream are also cooler than other parts of Seoul by an average of 3.6°C.)

Instead of the "modern" city-centre elevated highway, Seoul now has a natural river-park environment running through the centre of the city, used by thousands of people every day. As eco-projects go, it doesn't have all that much of an impact on Seoul's environmental imprint as a whole, not by itself. However, it is a start ... and in the meantime, it has brought back into the open another layer of Seoul's soul.

June 20, 2009

Caught without child care, Australian senator Sarah Hanson-Young took her two-year-old daughter Kora to work with her on Thursday. She stayed with her daughter just outside the legislative chambers until the bells rang for a vote, at which point she brought her inside. Kora continued to play quietly until Senate president John Hogg ordered Hanson-Young to take the toddler outside.
We cannot allow children to be in here for a division.
- Australian Senate president John Hogg
This would have made her miss the vote on the bill introduced by her own leader, Bob Brown. Not surprisingly, Brown countermanded the order, suggesting that Hogg provide the necessary child minder. Hogg declined. A staff member from Brown's office arrived to take Kora out of the chamber -- at which point Kora started screaming.

Whether or not this turns out to be a publicity stunt -- as were so many of the early suffragette demonstrations -- it still illustrates a few interesting points.

In this episode of the continuing debate over whether the work and domestic spheres can continue to be rigidly divided, commentary ranges from the outraged (that there is no provision for breastfeeding mothers in Senate) to the differently outraged (that left-wing/Green mothers should expect the rules to change for them, or at all). While the first argument draws entirely upon demographics, the second pulls from a combination of occupational and even recreational "parallels" and slippery slope extrapolation. Leaving out all the "I don't have that so why should she?" taxpayer, and ad hominem comments, this is a representative sample: Comments against Hanson-Young's action outnumbered comments supporting her by nearly 3:1. Although more women than men supported Hanson-Young, the last two comments were very typical of many female commentators, some of whom self-identified as feminists. Yet I do wonder whether there is a point that is being missed by both sides.

Never mind whether or not there is actually any rule about children in the Australian chamber, as will be challenged on Monday. Never mind that the Australian parliament does have a crèche, but that the spaces are already full. Never mind even that strong adult involvement in a young child's development has been strongly linked to a higher intelligence quotient. These are questions that will be pursued by those researching factors deterring young female politicians -- at age 27, Hanson-Young remains the youngest person ever elected to the Australian Senate -- yet in all that research they will miss the essential point that the whole child care / flexible workplace issue is actually secondary: related, but a consequence rather than a cause.

What I find most ironic in all this is that not one politician and not one major news source suggested that in the absence of available child care, the father could equally well have been left in charge of the child. (He serves on the City of Mitcham council, and also ran for federal office in 2004 and 2006.) Yet at the same time, by emphasising so strongly the importance of her job while never mentioning his, all those involved imply just as strongly that his job is less important. Child care or no child care, the attitude remains that regardless of the job split, the primary responsibility for the child is naturally and self-evidently the mother's.

As in so many cases, the real story lies in what is not said.

The commentary suggests a deep parallel assumption that it is the mother's choice whether or not to have and prioritise children. If she chooses to have children and also to prioritise those children, then obviously she won't give her full attention to any high responsibility job: so it is inappropriate for her to seek one. At the same time, the male corollary always assumes that a young child is distracting at work: so others should deal with it.

Taken all together, precisely because in most cases the primary responsibility to deal somehow (regardless of the manner of that dealing) stubbornly refuses to latch to the father, this leaves a woman precisely four options.
  1. She can choose to stay at home with her child, while her husband represents her financial interests at the workplace.
  2. She can choose a low-intensity job where hours will never be unpredictable. These jobs are also low earning, low power, and low promotion.
  3. She can choose not to have children until she is established in her work. However, delaying children can result in not having children at all (due to sharply decreased fertility with age) -- not to mention that the risk of birth defects radically increases with age.
  4. She can choose not to have children at all.
If we truly are to be the equal opportunity society we imagine ourselves to be, perhaps there ought to be a few other options in there?

June 17, 2009

The results of Iran's presidential election are in. Mir Hossein Mousavi is claiming ballot fraud and wants an investigation. If that doesn't work, he's planning on making a documentary about global warming.
- Jimmy Fallon

Demonstrations in the streets are a curious thing, especially when they appear to be in favour of a media-popular goal. We never can resist an underdog story where the right person wins in the end, especially when that end comes within a month (or before the next media event). For some odd reason, no matter who wins, elections themselves increasingly seem to elect the wrong person.

On June 12, Iran's populace went to the polls. According to the polling records, 85 percent of eligible voters voted. At the end of it, a victory that seemed neck and neck going into the polls was given clearly to incumbent Mahmoud Ahmadinejad, with 62 percent of the vote. The protests started within hours, and grew into street demonstrations within days. In those early days, the most common clips on the western media were variations of, "Well, no one I know voted for him."

With the exception of a few televised pictures, most of what we have heard since then has come from those Iranian commentators who speak English and live in the west. By way of comparison, speaking English in Iran would be roughly as common, among the same demographics, as non-Hispanics who speak Spanish in the United States. These, now, are speaking for their entire country. Most are speaking as though their own personal interest in returning Iran to westernised ways were representative of the whole. From every single one of them, we have heard that the recent demonstrations represent the popular will of the people.

Yet demonstrations, like anecdotal evidence, are not in themselves representative of the popular will. They are, however, representative of a significant contingent which is powerful enough to pull together a group with a common voice, which governments would be wise to take into account in their future choices.

As travel and communications become faster and easier, demonstrations have increasingly become a visual tool designed to manipulate the mass media and consequently world opinion. Again and again, reporters have discovered that demonstrations seem to arise magically the moment their cameras come out, to evaporate as quickly afterward. In the meantime, our television screens show us only the demonstration. Normal street activity just does not draw the same ratings.

Every demonstration, from the simplest group protest at city hall to a new grassroots political party to the kinds of demonstrations that brought Islamic Iran into being, requires a fair bit of background organisation from cellular leadership structures. Depending on the targeted medium, the targeted demographics, the means of accessible communication, and the era, the word may be passed through letters, tavern gossip, telegrams, small-scale home gatherings, e-mail, newspapers, licensed and unlicensed radio stations, or even a paper message passed hand to hand. Larger local mass media won't usually get involved unless they find a reason to support the cause: usually only after a tipping point has been reached.

Those in a position of established power value demonstrations only insofar as they bring previously hidden sentiments into the open, where they can be dealt with. Even in so-called free speech societies, opposition to policy is limited by access to government or private mass media outlets, by policies designed to result in disproportionate population representation (eg. district redrawing), by the implicit threat of lost income, or even by social shunning when not toeing the government line. In more repressive societies, it is quite common to crack down with riot gear, tear gas, and even bullets on demonstrations and other acts of rebellion, or even to preempt them entirely through government-sponsored home invasion and arrests which don't follow due process.

As stated by the losing candidate Mir Hossein Mousavi, the premise of the current demonstration in Iran is that the official result of the election is a "dangerous charade". His newspaper, Kalameh Sabz, reports that personal identification numbers were missing from more than 10 million votes, making the votes untraceable. This is an interesting claim, considering that detailed voting statistical information of this sort could not be available yet. In fact, other protesters have objected to the election results on the basis that detailed election data has not yet been made available.

Kalameh Sabz also reports that some polling stations closed prematurely: which happens in every single election in every part of the world, not exempting the United States. For that matter, in every single election, some polling stations open late, or fumble electoral procedure. No perfect system exists. If an electoral loser seeks grounds for an appeal, they will always be available to be found.

Another basis for protest is that the results of this election came out within hours, despite having to count 39.2 million handwritten ballots. Iran's previous election results had taken longer. In and of itself, this seems odd: and yet other countries do manage full election results within a couple of hours. In particular, Canada offers a quirky example of what can happen when national results come out too quickly. A large majority of Canada's population lies within its two easternmost time zones. As the only fully federalist country which spans four (and 1/2) time zones, the results of federal elections were often clear well before west coast ballot boxes closed ... with every single one of the ballots having been handwritten and handcounted.

Some election results are said to have been called in without having been properly monitored. Again, this does often happen in some election districts. However, it would be appropriate for any investigation to determine how closely the questioned districts match those areas which seem to have vote discrepancies.

The next step is to look at the results themselves.

For a country with an established democratic process, the voting percentage seems very high. Even when significant change appears possible, as when Barack Obama was elected, only 63 percent of eligible voters turned up to vote (and that was the highest since 1960). Although regional results over 80 percent are typical primarily of small conservative communities which, by their nature, have a high vested interest in voting, broad results over 80 percent are usually typical only of brand-new democracies. Whatever Iran is, it is not a new democracy.

In Iran, as for that matter in the United States, rural communities are generally much more conservative than urban communities: which often develops into a deep rural-urban social schism. Friday's results show homogeneity across both rural and urban areas. This result bears looking into.

We can't take the previous polls as any kind of objective evidence. Even discounting vested interests, there are just too many other biasing factors.

We must also not forget our history. Ironically (but not at all illogically) for a rebel who had been arrested by the former shah, the Iranian government led by Mousavi was known for tolerating no dissent. We must not forget that Mousavi became a wealthy man under the existing Iranian establishment, that he had been political secretary of the Islamic Republican Party and chief editor of its official newspaper even before he was appointed prime minister, and that he never lost the full backing of Ruhollah Khomeini, the only supreme leader Iran as a whole has ever acknowledged. Mousavi's green is no less an Islamic colour than Ahmadinejad's black.

Make no mistake: this is not a democratic voice of freedom, but a power bid.

The net result seems to be that there may have been election irregularities beyond the usual human factor, and they may have been on both sides.The why is obvious, as is the how. What remains to be determined is the extent, the overall effect, and how strongly Iran's population feels about that effect. Of course, it is entirely possible that by then, the demonstrations will have preempted true analysis in favour of paradigm.

Are we willing to look into this glass and recognise a mirror?

Even among an audience used to laughing at Fallon's jokes, this one did not go over well. Audiences at such talk shows are prepared to be entertained and tend to be very vocal in their reactions: but this bit of political satire was greeted with something between an awkward silence, a collective hissing intake of breath, and a low mutter. I don't think I have ever heard such a reaction before on a late night show. In general, laughter greets jokes which are agreed with, boos those found inappropriate by the audience. But for this one, the implications are just too uncomfortable.

June 12, 2009

Comedians make inappropriate jokes all the time. This time, it was David Letterman who overstepped when his Top Ten list mocked Sarah Palin's family situation. Possibly due to a misunderstanding over which of Palin's daughters was at a particular baseball game, the 14-year-old or the 18-year-old, Letterman ended up using terminology which implies rape (due to sex with a minor, who cannot legally give consent).

While Jay Leno hosted The Tonight Show, the jokes were in line with the comfort level of a middle class who leaned toward right-wing policies, while carefully avoiding uncomfortable extremes. Watching Leno, one could understand entirely how California, a seemingly left-wing state, could vote down gay marriage, why indeed rejection was inevitable. Leno's take brought the primary night talk show choice to either middle class, soft right wing (with appeal to each coast), or working class right wing (with appeal to the midwest).

However, with Conan O'Brien's promotion to The Tonight Show, the after-11 viewing audience in the United States is now divided almost perfectly among gender and party lines. Republicans and older persons tend to be uncomfortable with Conan's style of humour. Especially by contrast, Letterman comes across as a comfortably edgier Mr. Rogers -- who has now overstepped the acceptable limits of that edginess.

Despite Letterman's apology and Palin's acceptance of that apology, many continue to protest his show on the basis of that joke. Many continue to demand that Letterman be fired. Such is the vehemence of the reaction that the Wikipedia page dealing with Letterman is currently under an almost unheard of full editing block.

Letterman's current contract is on its final months. Before this whole thing blew up in his face, he had been expected to sign an extension this month which would last until 2012. Now -- firing probably is not a financially reasonable decision, and unless advertisers are pulling out, it seems unlikely that it would be. What I do know is that the resolution of this issue, say, a few months down the road, will demonstrate the current level of real power of the Republican hard right.

June 05, 2009

As soon as the media released the detail that David Carradine was found hanging naked in a closet, I knew what had happened. Like masturbation itself, it is one of those sexual practices which is far, far more common than most people believe: mostly because so many of us learn sexuality in secret, and in the determined quest for childhood innocence most parents are determined to keep it so, struggling against frankness in all sexual talk, be it at school or at home.

It begins with the choking game, which children practice secretly at school and in their bedrooms. Beginning around the age of 10, this game of inducing unconsciousness in oneself or in another has become as much a part of childhood oral lore as how to play tag. It goes under many names which are also indications of the reasons for doing it: Natural High, Space Monkey, Rocket Ride, Trip to Heaven.

As with anything which cuts off oxygen supply to the brain, brain damage or death are possible outcomes. Accidental deaths as a result of the choking game seem to peak around age 13; however, deaths officially classified as suicide due to hanging or suffocation continue to rise through age 19, even in environments where guns (for boys) and pills (for girls) are much more common means of attempting suicide. Over 80% of those known to have died from the choking game were male. Over 90% of their families never knew their children were playing the "game".

In adulthood, the choking game becomes autoerotic asphyxiation, its purpose now clearly sexual. The aim is to induce erotic stimulation and finally orgasm through oxygen depletion. It is well known that oxygen deprivation does lead to a drug-like effect. Either this, or the associated masochistic bondage, may act as arousal stimuli in some people. However, oxygen deprivation in itself, without the learned association with either a hypoxic state of altered consciousness (asphyxiophilia) or bondage, has no erotic effect.

Autoerotic asphyxiation is not a modern phenomenon. The first recorded case is that of the composer Frantisek Kotzwara, in 1791. Not coincidentally, the 18th century was also when public hangings started to predominate over other forms of public execution (and would continue to do so until 1865, when public hangings were discontinued); and thus when the public started to notice that many who had been hanged also had erections. Some had even ejaculated. So common is this phenomenon that most professional hangmen would note its presence or absence in their records.

As opposed to the medieval short drop, which usually caused death by suffocation, the standard drop was much more likely to break the neck. This made death from hanging much more rapid. It is the rapidity of death which is associated with the death erection.

Technically this erection is a priapism, and has nothing to do with sexuality. The existence of a priapism tells forensic investigators that death was sudden and probably violent. It is thought that damage to the spinal cord may be linked to the effect, since spinal cord injuries are also associated with priapisms.

However, what was absorbed by the popular lore was that oxygen deprivation was clearly linked with erotic sensation.

Obviously these practices are most dangerous when done alone. Very few injuries are reported when performing even the most extreme acts of RACK edgeplay with a partner familiar with safety practices and safe words. Performed alone, the chance of something going wrong goes up exponentially. After all, the aim is to cut off oxygen to the point of inducing unconsciousness.

Too many of us never discover the existence of either the choking game or autoerotic asphyxia until it claims the life of someone dear to us. Will the media be able to convey the educational message without descending into sensationalism?

June 03, 2009

So pervasive is the current trend toward labelling any unwanted behaviour as deviant and then finding a drug to "fix" it, one has no fears for the future of pharmacology.

This is not a new thing. Without going into a whole history of mankind, one needs only look to the Victorian age and what was labelled hysteria, as well as some of the treatments prescribed for hysteria before Sigmund Freud's relatively gentle psychoanalysis.

Today, virtually every behaviour that does not fit into quiet acceptance is suspect. Too rambunctious is labelled attention deficit and hyperactivity disorder (ADHD). Too teary, depression. Too energetic, mania. Too rebellious, oppositional defiant disorder. Attention ought to be paid to context for diagnosis, but the DSM-IV makes no mention of context, only of approximate frequency of specific types of behaviour with the proviso that it be "detrimental" to a person's social, physical, or academic development.

(Nothing said, here, about what exactly "detrimental" means. After all, "detrimental" can as easily refer to a teacher's frustration as to a student's disability. Does the rumbunctiousness actually get in the way of learning? or is it that the student is bored? or that the teacher prefers not to expend the extra effort?)

Few physicians and fewer patients even pay that much attention. If it gets in the way, medicate it.

Methylphenidate (Ritalin) is the most commonly prescribed psychostimulant, used most often but not exclusively to treat ADD and ADHD. Its pharmacological effects are very similar to those of cocaine, and several different research approaches suggest that long term use of Ritalin may include a heightened susceptibility to amphetamines such as cocaine. Whether former Ritalin users are also more likely to be smokers has not yet been studied, but a very high percentage of cocaine addicts were formerly on Ritalin and also smoked.

How many diseases are slanted so strongly toward a single country? Numbers are difficult to obtain, but some studies estimate that 8 million American adults have ADHD. Similarly, between 3-5% of children globally are estimated to have ADHD, but the diagnosis in most European countries is 1% or less; and in most other parts of the world the percentage is even lower. Until 2000, nearly 90% of Ritalin was used in the United States; even today the percentage is still over 80%. Most of those diagnoses and prescriptions were based almost entirely upon the testimony of teachers. Only 20% of children diagnosed with ADHD show any signs of hyperactive behaviour in the physician's office. Some United States schools even receive extra funding for every child diagnosed with ADHD.

How many of those diagnosed with ADD are perfectly capable of spending non-medicated hours at a videogame? One adult I knew who was considered disabled with ADD for government purposes ran a small gaming business on the side, and had no trouble participating in table games that lasted for hours at a time. Back when I was GM to a tabletop roleplaying group, two teens in my group had been diagnosed with ADD, and in one it was strong enough to be very noticeable. Yet as soon as I was able to catch his attention enough for him to start caring, he could maintain complete focus, again for hours. What made the difference was not a pharmaceutical addition, but an attitude shift: what I had to offer was interesting. Full behaviour shifts were beyond me: I was not his parent, after all.

My experience is not alone. Several studies have found that over periods of three years or more, behavioural modification is just as effective a treatment for ADHD as medication, with none of the side effects. Most interestingly, a 2008 review of Ritalin found that while teachers and parents reported improved behaviour, the children's academic performance was absolutely unchanged. Whatever it is that Ritalin is changing, it apparently is not something that was "detrimental" to academic performance.

So many artists find that, once they were diagnosed for depression and medicated, some essential spark is missing. Maybe there was a reason so many artists suffered from depression or bipolar syndrome (and so many fought with their parents besides). Maybe art requires plumbing the depths as well as the heights. Powerful art speaks in emotion, of emotion, to emotion. Medication erodes emotion.

Antidepressants were the most frequently prescribed medication in N. America, and there much more frequently than anywhere else in the world, even before the current economic crisis. Now, I suspect that new prescriptions are going through the roof. But -- it is normal to feel depressed when your job or your house are at risk. If you have spent the past several years in job turmoil with absolutely no job security, a few "unexplained" tears are normal. Until recently, many jobs were assumed to be secure. How can you not grieve for their loss?

Grieving is not a process that ends overnight, or is expected to. Long illnesses turn families upside down. Why would we expect anything different during long periods of job insecurity or loss? Our jobs define us. Without the once-secure job we used to have, who are we? How can anyone expect to rediscover themself in a mere matter of days?

It is admittedly much easier to medicate, much more difficult to learn and apply coping techniques and alter behaviour. It does not get easier as one grows older. Consider, however, that the trade-off for the extra effort is your own independence: of body, of thought, of spirit. What is it worth to you?