The Sixth Estate

This post is part 2 of a series on science, politics, and the future. You can also check out Part 1: “Science Denialism and the Future of Humanity.”

More or less on a weekly basis, every serious news outlet delivers a new report about antibiotic resistance. This week’s pertains to a hospital in Windsor. Within my lifetime, there is a fairly decent chance of reaching a point at which universal resistance is so common that antibiotics are basically passé, and at that point, large portions of the Western healthcare system will basically need to be shut down.

I mention this not just because it’s an issue of direct concern in and of itself, but because it’s an important analogy to climate change. The threat posed by climate change is, in the long run, bigger. But the end of antibiotics — if it comes — will come first. The science is (even) more settled. The effects are (even) easier to predict. The solutions will not require wholesale retooling of our economies. Yet so far, Western governments and drug companies have watched the end coming with studied unconcern. Why?

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Jane Taber of the Globe & Mail has acquired from an anonymous sourcea new explanation for why Senator Mike Duffy has an Ontario health card and doesn’t pay resident taxes in PEI, even though he claims that his primary residence is in Cavendish and he is compensated to the tune of tens of thousands of dollars by the taxpayer for having said residence while working as a senator in Ottawa:

Mr. Duffy, at the time of his appointment in 2009, was concerned that if he began paying taxes in PEI and using its health-insurance program, he would be forced to seek treatment elsewhere, according to a source who spoke on condition of anonymity.

PEI has no cardiac care centre, so residents have to be treated in Saint John or Halifax.

Yikes. Okay, first of all, and this appears to have sailed right over Taber’s head, this is not an argument for registering for a PEI health card. It’s an argument for not moving to PEI in the first place. If you have a heart attack at “home” (read: your vacation cottage) in Cavendish, they’re not going to open up a special, super-secret cardiac unit kept only for off-island visitors because you happen to have an Ontario health card. If you’re worried about the fact that PEI has no cardiac care unit and you need cardiac care, then you don’t live there in the first place.

Which, as it happens, is exactly what Mr. Duffy stands accused of doing. So much for that particular excuse.

But what this again illustrates is that we’re no longer talking about an issue of merely failing to uphold a few technical rules. We’re talking about fraud here.

The only question is: fraud against whom? Against Ontario taxpayers, for using an Ontario health card when he is really a primary resident of PEI, or against federal taxpayers, for collecting expense fees for his PEI cottage when he is really a primary resident of Ontario?

Either way, I guess we now know why right-wingers are so paranoid that lazy, self-interested gits are ripping off the welfare system. That’s what they think is going on, because it’s exactly what they do when given the opportunity.

Since I’ve received several complaints via email and ended up tussling in the comments section with none other than one of Canada’s foremost feminist bloggers, I thought it might be useful to respond in detail to the complaints from a number of people who’ve suggested that Friday’s rant saying it was “time to reopen the abortion debate” was at the very least counterproductive, and also insulting in that women’s rights are not negotiable and I wouldn’t say that about other human rights.

First of all, in case it needs to be said (and apparently it does), on this issue I stand with women’s choice, with the Supreme Court of Canada, and with the Charter of Rights and Freedoms. I don’t say that women’s rights or any human rights are negotiable, that violations of those rights are tolerable, or that it’s an indication of a healthy society that there are free-wheeling public debates over whether these rights exist and should be respected.

Having said that, I have other things I have to balance that with. First, in a free society, freedom of expression means the freedom to say things that the rest of us find outrageous. I’m kind of surprised to find myself channelling the late Christopher Hitchens on this, especially since Hitchens wasn’t actually pro-choice, but my position on this is firm. There is no subject on which a person should not be free to express honestly held opinions. That includes whether women’s rights exist. It includes whether aboriginal rights exist, whether the Holocaust happened, and whether some humans are better than others because of “race” and genetics. All four of these positions I find outrageous, and for similar reasons.

Now, if an angry minority is free to express outrageous things, the rest of us must be prepared to respond to those outrages, in detail, with as much as strength, persuasiveness and resolve as may be necessary. Outrageous opinions will be answered. We will not be silent. And the result is debate. You may not want to call it debate because the word “debate” conjures up people engaged in a polite back-and-forth on an unsettled subject where everyone agrees that there’s a 50-50 chance of either side being right. I don’t suggest that kind of formal debate only. But what is going on is still a debate. I don’t know what else you’d call it.

Consider the situation. Right now, a vocal minority continues to insist that abortion be outlawed. A disturbingly large proportion of the Parliament agrees with them, including several ranking Cabinet ministers. A few days ago, some of these politicians tried to do an end run around the legislative system with an absurd request to the RCMP to begin prosecuting some late-term abortions as murders — even though late-term abortions are the ones which generally aren’t elective in Canada, but instead are done due to severe medical complications which have compromised the viability of the fetus, the survival of the mother, or even both, and therefore, one would think, would be the ones that even the anti-choice crowd might agree were ethically justifiable.

Under the circumstances, I think we’re kidding ourselves if we say that the debate about abortion is now over and shouldn’t be reopened. It may have been closed in the courts since 1988. It may be closed in the Parliament insofar as there is not (currently) any debate proceeding on legislation to regulate abortion. But it is obviously not closed and done with in the public sphere. It’s silly to pretend otherwise. Some of the people who criticized me here spend countless hours on their own blogs attacking anti-choice groups. Obviously as long as that battle still has to be fought, we cannot say that the debate is over.

Which is part of the reason that I’ve now become so convinced that the “debate is over now” line is problematic. Stephen Harper himself uses this line as an excuse for why he isn’t allowing his backbenchers to indulge in their anti-abortion fantasies too far — but, at the same time, he allows them to remain in his caucus and to produce an endless stream of absurd press releases demanding RCMP prosecutions, calling abortion doctors “fetus bullies,” and so on and so forth.

Now, some people found it offensive that I would imply that women’s rights are “debatable” when I would find it insulting and humiliating to make the same statements about, say, aboriginal rights. On the contrary: all rights are debatable. But at least for the moment, all constitutional rights are enforceable, and none of them are negotiable.

The reason I make this distinction, which may seem like just meaningless verbiage, is that when Stephen Harper says he will not support his MPs’ resolutions because it is “not the right to reopen the debate,” I find that response fantastically inadequate. Suppose, to turn this on its head, the MPs had proposed resolutions to strike Parliamentary committees to discuss whether the Holocaust happened, or whether people who aren’t of European descent aren’t fully human. Now suppose further that Harper responded to these resolutions by saying that he wouldn’t kick the MPs out of the caucus, but that it wasn’t the right time to “reopen the debate” about whether the Holocaust happened, or about whether aboriginal people are human beings.

I don’t think a single journalist, blogger, or fellow politician in the country would consider such a response to be appropriate. They would say that on such a fundamental issue as fundamental human equality and the reality of historical genocides, no responsible prime minister could allow a denialist to remain in the government. Moreover, every citizen should as a matter of basic education be able to explain, firmly and in some detail, why outrageous positions like Holocaust denial and white supremacy are absolutely untenable.

So it should be with constitutionally protected women’s rights. And yet it isn’t. Vellacott and his ilk remain in office, unfettered. Some of them may even be Cabinet ministers this time next year. Some of their fellow travellers certainly are Cabinet ministers, Jason Kenney among them. So you have a situation where people who are overtly opposed to respecting constitutionally protected women’s rights (like Jason Kenney) are currently in a power-sharing coalition with people who say that now is not the right time to have a debate over constitutionally protected women’s rights (like Harper himself).

Well, it’s time to yank that crutch out from under them. It would be nice not to have to debate fundamental human rights because everyone agreed on them. But that isn’t the case. And so long as it isn’t the case, clinging to the line that we shouldn’t “reopen the debate” is pointless. The debate wasn’t closed to begin with.

The recent request by several Conservative MPs, tireless anti-abortion crusader Maurice Vellacott among them, that the RCMP open murder investigations against physicians who have performed late-term abortions because the mother’s life was at stake has resulted in a predictable body of responses from across Canada. First, the leader of the Conservative Party, Stephen Harper, announced that his party would not “reopen the abortion debate.” (It will, however, continue to produce a stream of private members’ bills and public declarations that abortion is murder.) And then feminists responded by condemning what they see as an effort to reopen the abortion debate. My favourite Canadian feminist blog, Dammit Janet, even has a post label for it: “fuck the debate.”

This puts us in what would be a hilarious position if the issue weren’t so important. Nobody, it seems, actually wants to have a debate about abortion right now. The Conservative backbench wants to jump straight to prosecutions. Stephen Harper is petrified of an abortion debate because he would probably have to choose between the Conservative base and the survival of his majority government. And many feminists don’t want to “reopen” the debate — I won’t say they’re scared of it, per se — because the Constitution is on their side, the courts have agreed, and that, as they say, is that.

Well I’ve had more than enough of this nonsense. I’m tired of Stephen Harper trying to have it both ways by saying he won’t “reopen the debate.” I’m tired of scurrilous backbenchers trying to score stealth victories by introducing bills that are actually pro-life pretexts so thinly veiled they wouldn’t fool a child. I’m tired of anti-abortion activists claiming that we are the totalitarian ones, and then, even as they mouth this piffle, trying to do an end run around the legislative process by calling on the RCMP to treat medically necessary abortions as murder cases. I am tired of the misogyny, and the hypocrisy, and the doublespeak, and the stupidity of it all.

So we are going to have this out. The abortion debate needs to be, as Harper puts it, “reopened.” And it should never be closed. It should never be closed for the same reason that debates are never closed on questions like whether slavery is wrong, whether the Holocaust happened, and whether the exploitation of children is evil. You can debate all of these things, which I strongly believe, and in a free democracy, it is right that you be allowed to debate all of these issues. This debate must never involve violence, and it must never involve outlawing free expression, and beyond that, it is pretty much a free-for-all, which is as it should be.

But fair warning: if you want to deny the Holocaust, or claim a right to exploit children, or demand that abortions be outlawed even to the extent of endangering women’s lives, I intend to see to it that your side loses, in as crushing and humiliating a fashion as possible. Those of us who stand on the side of basic human freedoms can never afford the complacency of thinking that debate is ever “closed.” We must always be prepared to test our arguments against those who would overturn our hard-won victories — and, yes, always be prepared to concede in the infinitely unlikely event that the other side raises a compelling argument. We will continue this fight wherever it may take us, as long as it takes, until the last dog dies.

Do note that “opening a debate” is in no sense the same thing as “passing a law.” We have just learned, as if we ever needed to, that the anti-abortion wing of the Conservative caucus is not interested in debating abortion, either. They want it banned, come hell or high water, and they’re prepared to do something as self-evidently ridiculous as calling on the judiciary to begin considering murder charges against abortion doctors in the absence of any direction to do so from either the legislative or executive branches of government. This is not reopening a debate: this is closing off debate through the rule of the police.

Harper is not interested in “opening an abortion debate” for more pragmatic reasons: he thinks it will cost him politically. This should not be a great concern to those who oppose Harper politically. Harper has for too long now been permitted to act as the spokesperson for a movement whose political priorities are dramatically at odds with his own. He should not be permitted to say that his position as prime minister is that debate is not permitted. He should be obliged — he should be compelled by public pressure, if necessary — to state his position on this matter. He worries about doing so because the consequence could be an irreparably divided Conservative Party. That is his problem, not ours.

But most important of all, it’s nonsense to talk about the danger of “reopening the abortion debate” because in the minds of some people the debate never ended. There are still anti-choice groups. They still run large protests in Ottawa. They still have a cabal of MPs on their side, some of them on the government benches, some of them on the opposition benches, and some of them in Cabinet. Some of the people in the Cabinet are men who believe God has told them to ban abortions.

Now, when those people claim it’s time to “reopen the debate,” what they seem to think is that free and open discussion somehow means that everyone who participates has a valid point. Uh-uh. You’re not getting off that easily. Anyone who claims that we should prosecute people for murder because they were trying to save one life where two might be lost is a morally compromised ignoramus. That includes you, Maurice Vellacott, Leon Benoit, and Wladyslaw Lizon. Don’t think that we will ever forget the stunt you tried to pull this month. We know what you are about. Do not expect us to stand in silence while you do this.

The National Post has given considerable space to a vicious attack on homeopathy which, in turn, gave rise to the publication of a spiel by a defender of homeopathy. I have to say, I’m disappointed. But the latter advocate makes her case just about as well as it can be made. Karen Wehrstein even has a high-powered medical research journal to back up her side: the impressive-sounding “International Journal of High Dilution Research.”

This particular little tempest was provoked by the printing of an article by University of Alberta professor Timothy Caulfield which, at least in its online version, appeared to label practitioners of homeopathy as “witch doctors.” This is of course quite wrong. Homeopathy is not an indigenous traditional medicine suddenly exposed to the harsh racist light of Western medicine. Homeopathy is a theory for medical treatment which has solid roots in the history of science. Just like phlogiston. And ether. And alchemy.

Unfortunately, as is so often the case, the back-and-forth style of argumentation that the media prefers is very unhelpful in actually educating its readership — which is presumably the primary objective when it comes to topics like medicine. Instead, whatever the good intentions of Dr. Caulfield, what we end up with are competing arguments from authority. Which authority do you prefer: the Ivory Tower academic from Alberta, or the executive director of the Canadian Consumers Centre for Homeopathy? How does someone without a background in medical research determine which authority is more persuasive? How does one account for the fact that both groups claim the weight of medical research is on their side? Judging from the comments at the Post, homeopathy is still an open question.

A question which the Post’s editorial board evidently doesn’t feel qualified to answer. But I thought I’d throw my hat in, too, since not merely the National Post but Health Canada currently endorses homeopathy as a suitable medical treatment for Canadians, I thought it would be helpful to see how well Caulfield’s position stands up to Wehrstein’s. So. Caulfield, or Health Canada?

My approach will be somewhat different than Caulfield’s or Wehrstein’s, though. Instead, today we’ll walk through the theory and practice behind two medications. The first one will be Oscillococcinum, a treatment for influenza which Wehrstein notes is “one of the world’s most popular over-the-counter flu medicines.” Oscillococcinum is a homeopathy remedy. It comes from natural sources and millions swear by it.

The second will be oseltamivir, better known by its brand name Tamiflu. Tamiflu is not a homeopathic remedy. It has been invented by “real” conventional medicine, aka white-labcoatted doctors, aka Big Pharma. It is produced by massive corporations and stockpiled by governments.

I’m sure you’ve guessed by now which one will be endorsed by Sixth Estate.

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Canadian nationalists can allow themselves a brief moment of unabashed exhilaration at the news that the British Columbia government is, finally, after many long and patient years, going after private surgeon Brian Day’s Cambie Surgery operation in Vancouver, B.C., for illegal billing of patients. It’s about damned time. The victory is not complete. The Medical Services Commission apparently will not be attempting to secure refunds for all the patients who paid illegally (which they presumably won’t mind too much), nor it will be attempting to fine Cambie Surgery to recoup the funding lost. But at least, apparently, public money will no longer flow to operations at clinics engaged in illegal double-billing.

And now for the heavier and more depressing part of this story. It’s an opportunity to go back into how “universal healthcare” works in this country, and I hope it will be useful to many Canadians (like me) who are passionately proud of our increasingly strained universal healthcare system, but not totally sure how it works on the ground level. (Aside, of course, from the fact that unlike Americans we don’t have to swipe a credit card on our way out of the hospital.)

This story begins with the major cuts to medicare that governments across the country put into place 20 years ago, during the early 1990s. One of the “victims” was Dr. Brian Day, a Vancouver surgeon. In 1996, apparently after his hours in a public operating room were cut, Day headed off into the private sector, creating the Cambie Surgery Centre where he offered patients a chance to queue-jump off the public sector waiting list — provided, of course, that they were willing to pay him a substantial amount of money.

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This uncritical promotional article in the Calgary Herald is worth a read:

Mozi-Q is a natural mosquito repellent created by Calgary-based Xerion Dispensary. The product, made from a plant-derived substance called staphysagria, is taken orally and is advertised not only as a bug repellent, but as a product that will also lessen the stinging and itching associated with insect bites.

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One of the most surreal medical institutions in our country is surely the College of Homeopaths of Ontario. This agency was set up by the provincial government in 2007 to accomplish a task roughly as useful to the future of humanity as the new Ether Studies Institute which Dalton McGuinty no doubt hopes to set up next, probably at York University. The College of Homeopaths has as its absurd goal the formalization and professionalization of a form of medicine which most sensible people realize isn’t real to begin with: homeopathy.

Homeopathy is a branch of medicine which advances the following claims. First, diseases are a result of distortions in the body’s invisible energy field, not viruses, or bacteria, or genetic mutations. Second, you can cure a disease by drinking a poison that causes the same symptoms as the disease — for instance, ground-up duck liver cures the flu. Third and finally, when you dilute these poisons in water, they get stronger — and the thinner they get, the stronger they get. As I’ve said before, this is like deciding that because your tea is too weak, you’re going to pour in a gallon of water.

Not just a gallon, though. To make a homeopathic preparation, you take one part toxin (duck liver, arsenic, caffeine, etc.), mix it with ten parts water, shake it up and down ten times, and repeat. This process is done anywhere from several dozen times to several thousand times (and each gets designated by a “X,” for instance, a 200X medicine). They needn’t bother. Once you dilute one part in 10 more than twenty-four times, there’s statistically very little chance there’s a single atom of a presence left. That’s not just basic chemistry; it’s basic math. Not a problem, homeopaths reply: water has quantum memory. What this means, and why it makes the thinned-down “medicine” ever stronger, even they cannot say.

Homeopathy doesn’t work. If it did work, it would be a Nobel Prize-worthy overturning of most of what we know about chemistry and physics, in addition to plain old common sense. So naturally, in Ontario, they’re creating a government-sponsored professional council to oversee it.

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The range of off-the-cuff commentary on the new health “deal” from the professional media is predictably pathetic. There’s the usual variety of pro-government shills nodding sagely and agreeing that Canadian healthcare is expensive and unsustainable, even though as far as First World countries go we’re solidly middle-of-the-road, and spend only a fraction of what the Americans do on a per capita basis.

One extreme I really didn’t expect, though I can’t say it surprises me, is the position that Jim Flaherty did us a favour by dictating his terms rather than negotiating an actual agreement with the provinces. That link goes to Don Martin, who apparently feels that a dictatorship is far superior to a federal democracy because it involves much less boring diplomacy. As I say, this hardly surprises me: since at least the end of April, when they endorsed this government en masse, the majority of the corporate media has been alternating between calling for authoritarianism and weakly fretting about how many eggs will have to be broken to make the new Canadian omelette.

Update: In the “maybe they’re just stupid” department, the Globe & Mail throws its hat into the ring by suggesting that we could develop an “efficient” system and drop our wait times down to German or Dutch levels if only we made physicians work overtime and handle “minor” questions over the phone. This statement cannot possibly have been made by anybody who actually personally knows a practicing physician. In any case, the reason Germany and the Netherlands have less problems getting access to doctors is because they have 1.5 times as many doctors per capita as we do. As I have repeatedly stated, and will keep on stating, you can’t make resources more efficient if they don’t exist in the first place.

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The Fraser Institute has released its regular survey of healthcare wait lists in Canada, and it says the results aren’t good: wait lists are too long, an average of 19 weeks, which they say is “the longest total wait time recorded since the Fraser Institute began measuring wait times.” And yes, for the most part, 19 weeks (read: over 4 months) is indeed a long time to wait for surgery.

First, as always, you must consider the source of this report. Not just the Fraser Institute, but who funds it. I have already explored the rather sordid fundraising techniques used by this supposedly independent think tank, which have extended to soliciting money from the tobacco industry to oppose tobacco taxes and spread spurious claims that secondhand smoke is not harmful. This report does not identify a sponsor, but there usually is one. For instance, the annual survey of evil mining regulations is paid for a mining trade association. So, does anybody fund the healthcare survey? The Fraser Institute certainly takes in money from drug companies and private clinics, both of whom would benefit considerably from the privatization of healthcare.

Oddly enough, the report makes a great deal of the fact that 19 weeks is a “new high,” but you have to dig very deep into the appendices to discover that in most provinces, the real spike in specialist-to-treatment wait times occurred during the 1990s, and then wait times plateaued or even declined over the past 8 years or so, presumably a result of the Liberal government’s healthcare accord. (The one that the Harper regime will almost certainly not be renewing in 2013.) So public spending actually did improve matters, which I know is anathema to the hacks at the Fraser Institute.

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