Wear Your Rubbers

                                                       Wear Your Rubbers

                                                         by Marco M. Pardi

 “It is obvious that the best qualities in man must atrophy in a standing-room only environment.” Stewart L. Udall  The Quiet Crisis, 13, 1963

Those of us who grew up in Northern climes well remember that advice.  Slushy streets and sidewalks made short work of the best shoe water-proofing of the day, especially in the 1940’s and 1950’s.  It would be a few years before I would learn that one could put a rubber on something other than a foot.  And then, even having one tucked inside one’s wallet, where the  distorting ring was a kind of Round Badge of Courage, signaled unmistakable attainment of a status magnitudes above mere virgins still wrestling to get a grip on things. No matter that the decrepit, long sat upon sheath would crumble to the touch were it ever extracted from its “Sold only for the prevention of disease” pouch.

In the year of my birth, 1942, world population stood at 2.4 billion.  Then WWII deepened, the NAZI “Final Solution” came into full play, Korea and later SouthEast Asia erupted in war, famines hit Africa while tsunamis and hurricanes devastated Asia,  HIV swept the globe and China instituted a One Child policy. Still, by 2012 the world population exceeded 7 billion.  The projected world population for 2100 is over 11 billion.

In June of 1981 I left college teaching, promising myself I would never again waste my time in what was quickly becoming a service industry to the BMW/Yuppie generation. I turned full time to my ongoing consultant work, applying my skills from Virginia to South America.  In 1983, declining a move to Central America, I chose instead to take a position with the Centers for Disease Control (the “& Prevention” was not added until the Clinton presidency).  The position offered geographic and economic mobility and the opportunity to put my medical science background to use.

Each of my first four resident assignments was to a major U.S. Sunbelt city awash in cocaine and sexually transmitted diseases.  While “crack houses” proliferated, curb side service was readily available.  Oral sex went for as little as 50 cents to a dollar in some places.  And home made injectable methamphetamine (“poor man’s cocaine”) was growing in popularity.

In my first days of public health clinic duty, interviewing patients for their sex contacts within certain time parameters and administering medication I quickly learned two things: a large percentage of the population does not consider oral-genital contact to be “sex” (a fact not brought out during the later impeachment of Clinton); and, one does not ask a female if she has children, one asks how many children she has. During field work I saw many of these children, spread around the house with Grandma because Mom, whom they almost never saw, was “running the streets”.

I was fairly new in my first assignment when, during clinic duty, there was a great uproar among my fellow epidemiology staff.  Routine Neisseria gonorrhoeae lab tests done on a young woman a few days earlier had come back positive for Penicillinase Producing Neisseria gonorrhoeae – PPNG. Because PPNG was hitherto unknown in this particular jurisdiction, chaos ensued.  Locating information was shouted and every available “epi” was dispatched to find her.  Unsure of the urgency, I asked why everyone was running out to look for her.  “If her PPNG goes to PID (pelvic inflammatory disease) it could impair her ability to have children!” In a rare and not to be repeated moment of naivete, I said, “And this is bad?” Stunned silence.

Over time I came to understand the primary concern was not the health of the patient, it was the health of the program.  The STD programs in these high morbidity areas were immensely expensive. An STD patient who slips through the net and presents in a hospital with an ectopic pregnancy from untreated gonorrhea, or delivers a congenital syphilis baby is taken by many as evidence these programs couldn’t work, don’t work, and never will work, especially with “those people”. Federal and State funds are reassessed.

The standard intake protocol in one huge State began, in syphilis cases, with a record search.  Where previous infection had been recorded, or even remembered by a seemingly coherent patient, we had to write REINFECTION in bold across the top of the chart and on the forms submitted to State and Federal disease registries.

However, some bureaucrats, perhaps under the sway of the religious groups which had succeeded in putting a President in office, began vocalizing dismay over public money being spent, often several times, on the same people.  The State, seeing its funding in real danger, quickly changed the protocol, dropping the REINFECTION notice;  since no re-infections were being recorded, every case looked like a new infection.  That statistical profile was leaked to the press and the State found itself swimming in money to stem the “epidemic of venereal disease sweeping our fair land”.  The national news media interviewed us – at arm’s length.    

In another State, as HIV was morphing in the public mind from a “gay disease” to an amorphous but apparently equal opportunity disease we decided to survey the incidence.  Incoming clinic patients and contacts between 15 and 29 years of age were asked if they would submit to an HIV screening test.  Pre and post test counseling sessions were provided.  Among those who took the test in 1987-88 20% of males and 22% of females returned positive results.  We also found that, even though post test counseling for positives stressed the potentially fatal outcomes of unprotected sex, a majority of them returned to the clinic for treatment of newly acquired STDs.  This finding was reinforced as the number of HIV infected babies rose exponentially.  

What do these narrow samples indicate?  People have sex.  No matter the risk to themselves or others, people have sex.  In light of the consequences already mentioned, and the rapid rise in unwanted, premature, and  infected/impaired babies born, often to teen aged mothers (“babies born to babies”, as some social activists say) who cannot possibly afford the neonatal and/or long term care needed, it appears that Abstinence Only programs are not just naive or stupid, they are criminal.

Who are the primary drivers of these programs?  It is all too easy to point to the “religious” groups that foment loud and threatening protests outside abortion clinics, bombing of those clinics, and murder of the doctors therein. While many would deny such an indictment applies to themselves, one cannot expect to yell “Fire” in a movie theater and not take responsibility for the casualties pursuant to running for the exits.

Interestingly, these religious groups are able to claim tax exemption at the very same time they are crushing honest tax payers with the burden of their self anointed preferences.  American interstates are peppered with billboards asking the passing reader to call or come in for counseling and advice for unwanted pregnancies.  In fact, what awaits the girl who seeks such oh-so-friendly advice and help is a session of exposure to horrendously out of context medical procedures presented falsely as routine abortions, advice which includes outright lies such as “abortion leads to breast cancer”, and a litany of additional tactics specifically studied and designed to overcome any residual logic and decency in a highly vulnerable young woman. Tax payers pay by underwriting the social support networks, such as fire, police, and EMS services for these church based parasites. Tax payers pay by underwriting the huge consequences when the girl finds that “advice and support” ends at the door. Tax payers pay when religious groups own tax free income properties such as parking lots from which the groups derive an income while the city must make up the tax shortfall elsewhere. Tax payers pay, through taxes and through grossly inflated health care costs when girls who would otherwise have chosen abortion are forced, due to lack of access, to deliver in publically funded hospitals, often with astronomical costs for post-natal care.  One answer is: rescind the tax exempt status for those religious organizations and affiliates who campaign against abortion and/or contraception.  Or, send them the bills from the hospitals and the State Child Welfare agencies that must deal with the outcomes of their demands. When they won’t pay, file tax liens collectively on the organization and individually on its members.

What about the rest of the world?  Americans both pride themselves and grumble about foreign aid.  The fact is that no foreign aid is a simple hand out. Another fact is that foreign aid reflects the views and obligations of the Party in power.  People often point to birth rates in less developed countries as problematic.  What follows, for some, is a presumption that foreign aid just enables the problem.  In fact, during the years when Republicans (owing much of their political success to the grass-roots organizing of tax exempt religious groups) were in power large sums of foreign aid were approved and allocated to less developed countries for various reasons, including health care.  Yet, against all medical and socio-economic wisdom, Republicans imposed a gag rule on all federal personnel in positions to help people understand the relationship of over population to economic distress. Going further, those administrations canceled or withheld funds wherever multi-service health clinics were found to have even a desk devoted to Family Planning.  That’s Family Planning, not specifically abortion.  So a 5,000 sq. ft. facility providing primary care, immunization, dental, mental health, and other services lost all its funding if it had so much as 50 sq. ft. devoted to a desk with a single Family Planning counselor present.  Simple mention of efficacious means of contraception stopped funding for the entire health care facility.

Aside from a morbid dread/fascination with all things sexual, stemming from a distinctly minority view in one tiny region of the world over 2,000 years ago,  why would a scientifically savvy country such as the U.S. institute and enforce policies which obviously disable and harm less developed countries and exponentially exacerbate the entire variety of world problems which can be shown to share the one common denominator of over population?  In a word, Power.  Countries which are glutted with people are countries which are unable to sustain themselves, much less develop.  Countries which are unable to sustain themselves are ripe for exploitation, be it their natural resources or their labor.  The mega-giant trans-nationals, whether in energy, agriculture/aquaculture, or production of goods are easily able to forge agreements with corrupt governments which enable those governments to siphon off huge percentages of the income while devoting much of the rest to the development and support of police and militaries that are more commonly employed against their own people than they are in international defense.  The trans-nationals get what they want for a pittance, the governments get the means to ensure their own perpetuation, and the people go without the rudiments of sustainable life with only the hope that some of their children will survive to support them in their old age.

These same corporations provide much of the funding for political candidates, especially in the U.S., who will do all they can to ensure the world is filled with desperate low wage earners. The corporations funded Republican presidential administrations which returned the favor by appointing Supreme Court justices who ruled in favor of corporations over people (Citizens United).      

What about contraception in the U.S.?  With many States grabbing the spotlight by their attempts to whittle Roe v. Wade into practical non-existence, a parallel move at the Federal level has gone largely unremarked. This is the Federal law that enables pharmacists and owners of pharmacies to “act according to their conscience” when deciding to stock contraceptives or to fill legally obtained prescriptions for contraceptive measures.  This same law is being used as precedent by insurance companies refusing to provide contraception coverage while at the same time covering various “erectile dysfunction” pills, injections and procedures (inflatable implants). At first glance it is difficult to understand a business model which would prohibit a low cost outlay (contraception) in favor of a high cost outlay (pre-natal care and delivery).  That is, until we understand that insurance companies are part of the mega-corporations that benefit from a glut of future desperate workers.    

It is quite unlikely that evangelical folk, engaged in their semi-psychotic and glassy eyed raptures have any idea of how they are being played as dupes on the front lines for what they see as “Right to Life” and what corporations see as “Right to Exploitation”. Either way, the scientifically indefensible right to life positions or the exploitative practices of big business, the end result is the same: out of control over-population that will more likely than not bring down most of the planet’s biosphere with it.

Interestingly, those populations most commonly producing offspring who demonstrate understanding of these issues are the same populations whose reproductive numbers are rapidly dropping well below Replacement Reproduction Rate.  We are increasingly looking at a world of the powerful few and the ignorant many.  I use ignorant here in the sense of uninformed, not in the sense of being unable to benefit from information. And, it is significant that the very same groups I have indicted thus far are the same groups leading the efforts to discredit science education and public schools.

These seemingly disparate social sores are interconnected; the Hydra of Greek myth may have been a prescient metaphor. 

“The power of population is infinitely greater than the power in the earth to produce subsistence for man. Population, when unchecked, increases in a geometrical ratio.  Subsistence only increases in an arithmetical ratio. A slight acquaintance with numbers will show the immensity of the first power in comparison of the second.” Thomas Robert Malthus (1766-1834). An Essay on the Principle of Population, as it Affects the Future Improvement of Society, 1.1, 1798.