Andrew Sullivan's Blog, page 367

What Good Is Foreign Aid? Ctd

A reader with 20 years of development experience urges us to expand the terms of the debate:

The fact is, Bill Gates and William Easterly are both right – to a point. In health, aid has made enormous difference on many fronts, not least of all HIV. The rapid resurgence of drug-resistant TB is incredibly scary, and aid’s role is essential. That said, you can find lots of waste and programs that don’t improve things, at least for very long.

Still, the debate really misses the point. This is a rich time in the development world, where people are asking very hard questions about what works and doesn’t work, rather than merely defending aid money. There are, of course, the randomnistas using randomized controlled trials to test whether development projects have caused quantifiable change. And thinkers like Owen Barder are among many promoting complex, adaptive approaches to projects (based on the evolutionary idea that each community/organism succeeds by trial and error and making adaptations suitable for its circumstances) in reaction to linear, command-and-control,”best practices” (logframe) approaches of aid donors. Others are looking at whether just giving cash to poor people is effective, and under what circumstances. I‘m just scratching the surface, but the “Is aid good or bad?” debate is stale.

The Things We Carry

For the short documentary Pockets, director James Lees asked Londoners to reveal their cargo to the camera. Natalie Rose Obank praises the film’s style:

The sound edit … plays quite a nice part to the film. The music itself is quite light-hearted but noticeable. It creates an atmosphere for the audiences, just as to the setting of the work – where these people are, just out on a street. The background atmos track is plain and simple, this doesn’t distract the view from the main purpose of the film, which is what each person in the shot presents. In the edit, I noticed that throughout, the interviews don’t always show a full face, but focus on a particular feature of that person (if it’s important) sometimes it would jump cut from a standard documentary set up and then only show the side of a face. … [I]t almost gives the audience a surprise as the styles of shots change. It keeps the film interesting throughout and also promotes people’s individuality.

(Hat tip: Aeon Film)

What The Asian Powers Can Learn From WWI

Robert Farley sees one major lesson:

As the centenary of World War I approaches, several commentators have argued that the emerging multipolar power structure of East Asia is coming to resemble that of Europe prior to 1914. Setting aside the wisdom of the political comparison for a moment, there is one way in which the comparison is apt. Just as real knowledge of modern, high-intensity warfare was limited in 1914, the emerging great powers of Asia have little experience with the forms of warfare they are planning to use.

Although most of the European powers had experience with colonial wars, they did not have the space or time to work out the implications of the technologies that would eventually characterize World War I (the machine gun, the dreadnought, the submarine, and the airplane). The degree to which military commanders of 1914 were surprised by these technologies has been wildly overstated, but the armies and navies had not developed the tactic, hands-get-dirty experience of how to fight in a new technological environment.

It bears repeating that we have very little sense of what contemporary air and naval warfare between peer or near peer competitors will look like. This is true not only of land warfare (the US invasion of Iraq in 2003 is probably the best model we have, but isn’t very helpful) but also of naval and air warfare. And in particular, the emerging East Asian powers lack recent combat experience. China last fought a land war in 1980, a naval conflict in 1974. The Japanese military has not engaged in combat since 1945. The Indian military is in better shape because of its anti-guerrilla efforts and constant sparing with Pakistan, but still has little recent experience with major combat.

Ending Life Before Birth

Phoebe Day Danziger reflects on terminating a pregnancy because her unborn son had severe medical problems. She writes, “it was clear to me that what we were dealing with was choosing an end-of-life care plan for our son”:

Sometimes I wish I had chosen to continue the pregnancy for purely selfish reasons. Had we not aborted, our son’s birth would have been noted, his death would have been marked, and our deep and long-lasting grief would have been acknowledged and validated. Instead, we chose to give our baby what we felt was the most humane, comfortable, and loving end-of-life experience we felt we could facilitate, a cause that on its face is championed even in the most introductory ethics discussions among new medical students.

Because of the choice we made to end his life, our son never got the chance to gaze up at his parents, to see who it was that had been talking and singing to him all along. He never got the chance to fall asleep in our arms, bundled and cozy, pink lips and fuzzy hair like a duckling, smelling of milk and baby, the very best smell in the world. Neither, however, did he have to suffocate to death at birth, his small body gasping to fill his woefully hypoplastic lungs. He did not have to feel pain shooting throughout his abdomen, grossly distended with urinary ascites. He did not have to experience one minute away from the warmth and love of my body. We chose, instead, for him to be born straight into peace.

The Dish’s thread on late-term abortions is here. Drawing by Di Vinci from Wikipedia Commons.

“Skiing On Mass Graves”

Vladimir Troyansky explains why Circassians are none too happy about the Olympics this year:

The Circassians are an umbrella designation for many ethnic groups from the eastern coast of the Black Sea. In the first half of the nineteenth century, they waged a war against Russia’s expansion into the North Caucasus, which they lost. The Russian Empire annexed their territories, and then either ‘encouraged’ them to emigrate or simply expelled them outright. Nearly 90% of Circassians went into exile. Tsar Alexander II, known as the Liberator (of Russian peasants), proclaimed victory over the Circassian ‘rebels’ in 1864.

The date of 1864 makes 2014 the 150th anniversary of the Circassian expulsion. From the Sochi coast, ships loaded with Circassian refugees set sail for the Ottoman Empire. Circassians died in thousands on the journey, of hunger and disease. The triumphant parade of Russian troops, marking the end of the war, took place on May 21, 1864 in Krasnaya Polyana, site of the Sochi Winter Olympics.

Keating looks at the actions of the Circassian diaspora:

Today there are about 3 million to 5 million Circassians living abroad and about 700,000 in the Caucasus. The post-Soviet Russian government has been slow to recognize the extent of what happened to the group and has strongly resisted attempts to label it as genocide—the anti-Russian government of nearby Georgia did so in 2011— portraying Circassian nationalism as merely an outgrowth of the region’s Islamic radicalism. The global community commemorates Circassian Genocide Memorial Day every May 21.

However, the decision to hold the games in the symbolically important city of Sochi has focused new attention on the issue, with Circassian activists in New Jersey launching an international campaign against the “genocide Olympics.” The group has been protesting since Vancouver, and one of its pamphlets informs athletes that they’ll be “skiing on mass graves.” It’s possible that local activists may attempt to stage some sort of opposition at the games themselves, though the authorities have been coming down hard on protests of all kinds.

But the international protests haven’t gotten much attention:

[T]he only high-profile ally the Circassians have won is Doku Umarov, leader of the Islamist insurgence that has grown out of Chechnya’s shattered independence bid, and whose allies recently blew themselves up in the city of Volgograd. “They plan to stage the Olympic Games on the bones of the many, many Muslims who died and are buried on our territory along the Black Sea. We, the Mujahedeen, must not allow this to happen,” Umarov was quoted on his website as saying last summer.

The Circassians could do without such support, since they reject violence and activists’ long-term goal is to regain their homeland. It’s an ambitious aim, a kind of Caucasus Zionism, but the activists think it is feasible. “It might not be easy for the immigrants who are going to the Caucasus, that first generation, but their children are going to be fine. It’ll just be like when my parents came to the U.S.,” said Tamara Barsik, a Circassian-American who lives in New Jersey.

In the meantime, they’ll have to watch the Sochi Olympics on television, like everyone else.

(Photo: Circassians commemorate the banishment of the Circassians from Russia in Taksim, Istanbul. From Wikimedia Commons)

Going On A Trip And Never Coming Back, Ctd

Reacting to some criticism of 12-step programs, a reader writes movingly in support of AA and NA:

For both of my brothers and myself, 12-step recovery programs have literally been the difference between life and death. My younger brother had recently switched from heroin to crack cocaine by the time he entered the Fellowships of NA and AA; my entire family was quite sure that if a drug overdose didn’t kill him, some of the people to whom he owed money would see to it themselves. Eight years later, he has a wife, a lovely daughter, and a college degree, all thanks to working a 12-step program.

As for me, my drug of choice was alcohol.

I had chronic liver pains by age 26, and my hands shook so badly my mother thought I had Parkinson’s Disease. I needed at least 12 beers a day to feel normal, and a minimum of 24 to make myself forget that I just wanted to crawl into a hole and die. And even then I wasn’t miserable enough, and needed two more years of research into self-inflicted anguish before I’d reached as low of a bottom as I cared to discover. Seven years later, I am clean, sober, healthy, very successful in my chosen profession, and working a decent program.

Can I throw all of that away? Could I or my brothers or anyone else in a 12-step program pick up tomorrow? Absolutely. Drugs and alcohol are everywhere in this country, and plenty of people are eager to sell me my suicide on the installment plan. But relapse is a conscious choice by the individual, not a failing of the program. AA (my program) works 100 percent of the time for people who are 100-percent committed to the program, while they maintain that level of commitment. (The only exception being those who are “constitutionally incapable of being honest with themselves.” I interpret this to mean those with severe underlying mental ailments such as antisocial personality disorder. You certainly encounter them in the rooms of AA meetings, but you also find them everywhere else in society.)

The problem is that the disease never goes away; it is only in remission. It constantly informs an addict or alcoholic that he’s not really addicted, that his success in life proves it was only youthful excess or poor surroundings or bad luck or anyone’s fault other than his, that science can and will “cure” him like it has “cured” so many others. The disease speaks from the depths of the person’s own sickness, so the script may vary, but the objective never changes – to get the recovering addict alone and despairing, outside of their program, cutting themselves off from their friends in recovery and in a position where they’d rather resume the full course of their misery than stay in the half-measure misery of white-knuckle, program-less sobriety.

(I will never know why Philip Seymour Hoffman relapsed, but I’ve met people with even more time in recovery than he had who have relapsed and died – or, who almost relapsed, but said a prayer instead and returned to the rooms to talk about it. Was the program a failure if one of my friends chose to stick with it, and one decided to abandon it?)

If I speak of this in harsh terms, it’s because it hits close to home for me. Recovery programs are not social clubs or straw-man scapegoats for snake-oil salesmen touting miracle drugs and secularized rehab. Recovery programs are a triage ward where the successful do what the other survivors do and the failures stop doing those things; by four years in recovery I lost count of the number of acquaintances who’d gone back out and died out there, and I knew three friends who joined them in the morgue. This is the program that keeps me alive in those dark nights and reminds me there’s a dawn.

Another reader, an Episcopalian deacon who is also a recovering alcoholic, was struck by Sacha Scoblic’s statement, “AA is an incredible program and a true American achievement for the millions of addicts around the world who desperately needed help when absolutely no one else was offering it”:

Think about that – ”absolutely no one else was offering it.” I’m a Christian, and enough of a believer in the institutional church that I’m willing to don robes and a stole Sunday by Sunday and hold a chalice full of “the Blood of Christ, the cup of salvation” to the lips of adults and children who approach the altar for the gifts of grace. And yet I am a member of a church that offered “absolutely no help” to alcoholics in Bill Wilson’s day, and even today relegates me and my alcoholic companions to basement meetings. In fact, the (well-meaning) parish I serve is no better than a landlord to the AA group that meets weekly in the bowels of their building complex. They’re no better than the yacht club across town that lets its space for the morning meeting I attend. They’re a good landlord, but too often it stops there.

The Church doesn’t talk enough about addiction. We Episcopalians sometimes joke about our heritage as drinkers: for us, the light-bulb joke is about booze (it takes three Episcopalians: one to screw in the bulb, one to mix the martinis, and one to complain that the old light bulb is better … har har). We are better than this, and I hasten to add that I would not be sober without the support of a few good Episcopalians who say their prayers and befriend me with courage, love, and insight. I’m not bitter. But I often feel discouraged that churches can and should do more.

Anyone who claims the identity “Christian” – anyone who follows Jesus of Nazareth, who befriended people everyone else had abandoned – should do more. Let’s let my alcoholic friends know that there is life for them on the main floor of the church, too.

Previous Dish on Hoffman and 12-step programs here, here, here, here, and here.

(Photo of an AA “anniversary coin” marking 13 years of sobriety by Flickr user MTSOfan)

The Pantsuit Doesn’t Need To Be Vetted

Alyssa hates the scrutiny Hillary Clinton’s wardrobe choices receive:

The expectations are contradictory and impossible: women like Clinton are simultaneously supposed to not care about their appearance while looking impeccable at all times, not to care a whit about fashion but to have a sense of what clothes make their bodies look simultaneously attractive and appropriate to whatever occasion they’re dressing for.

If they hire stylists to make these decisions for them, freeing up their attention for, say, policy, they’re elitists. If they pick out their clothes themselves, they’re frivolous. If they try to be fashionable, they’re trying too hard, or failing to dress their ages. If they settle on a uniform, they’re dowdy and unimaginative. Sometimes, it seems like the only option that would satisfy everyone’s demands about her wardrobe is for Hillary Rodham Clinton presented herself as a disembodied floating head. But even then, we’d be stuck with a national conversation that’s now in its third decade: Hillary Rodham Clinton’s Hair, What Does It Mean?

(Photo: Wardrobe pieces are checked against stage lighting before the start of day two of the Democratic National Convention (DNC) at the Pepsi Center August 26, 2008 in Denver, Colorado. By Mark Wilson/Getty Images)

Immigration Reform Rises From The Dead? Ctd

A reader raises some fundamental questions about the debate:

I am from India and I did everything by the book to ensure I got my permanent resident card. I waited the requisite five years after getting my PR and today filled out my naturalization application. It is a very happy day for me, one I have looked forward to for a while.

Tell me the immigration system – with its huge backlog of applications and long wait times – is messed up, and I will agree wholeheartedly. But I fail to understand why amnesty for illegal immigrants is assumed to be a force for the good. Why should we reward people for breaking the law? And why is it so unacceptable to ask immigrants to learn English? Doesn’t it make it easier for immigrants to understand the laws and signboards in a new country? Generations of Chinese, Korean, Indian, Italian – and, well, you get the picture – immigrants have learned English before and acclimatized. What’s special about the circumstances of immigrants now that we have to set the bar so low for them?

I am not being facetious or Fox News-y. I apologize if I come across like that. But these are genuine questions that I would really like to see discussed.

Mental Health Break

The latest entry for the dogs vs cats debate:

Why CVS Is Quitting Tobacco

Daniel Gross applauds CVS for its decision to stop selling tobacco products by October 1:

Yes, CVS is a massive operator of bricks-and-mortar stores that contain pharmacies and sell cosmetics and other items. But that’s not all CVS does. Not by a long shot. In fact, the corporate parent is known as CVS Caremark. Why? In 2007, CVS merged with Caremark RX, a huge pharmacy benefits manager (PBM). PMBs, as their name implies, manage the prescription drug components of Medicare and other public and private insurance programs. And that’s a huge and growing business.

Jonathan Cohn points out that CVS is abandoning one industry in favor of another:

For the past few years, pharmacy chains have been providing the care that more traditional medical practices cannot.

In the next few years, the chains hope to provide a lot more of it. On a conference call Wednesday morning, Troyen Brennan, MD, chief medical officer for CVS, said the company already has 800 clinics in operation and plans to expand to 1500. That seems roughly consistent with the national trend. A recent study from Accenture suggested the number of clinics would double between 2012 and 2015.

This growth is what prompted CVS to stop tobacco sales, according to company officials: “We are retooling ourselves as a company,” Brennan said. “How can you continue to sell tobacco when you are part of the health care system?”

Kliff agrees:

CVS has increasingly moved beyond its traditional role as a pharmacy in recent years, expanding its reach as a health-care provider. Its MinuteClinics services have allowed the company to increasingly enter into contracts with hospitals and health plans, often providing primary care services on the weekends and evenings, when doctors’ offices tend to be closed.

CVS chief medical officer Troyen A. Brennan estimates that the company has between 30 and 40 partnerships with health-care systems across the country and is in talks with a similar number about starting additional arrangements. He said the decision to halt tobacco sales will make it easier to strike such deals, particularly those that include financial rewards for CVS if they can help patients stop smoking and reduce their medical bills.

Olga Khazan looks at how this decision might affect CVS’s competitors:

CVS is far from the only player in the retail-clinic space: Walgreens, Target, and Walmart all have their own versions. And as more and more big-box stores become homes for primary care, they may face identity crises because they sell the vice-oriented products that make consumers feel good alongside the services that make them well. Even as CVS stops offering cigarettes within 20 feet of a physician assistant’s practice, its competitors might continue to do so. And beyond tobacco, Walmart might encounter PR issues over the fact that it sells, say, Jack Daniels and cirrhosis treatments under one roof, or shot guns and wound care. Some states have even considered legislation that would prevent retail clinics from operating in stores that sell tobacco or alcohol.

Yglesias wonders if the pharmacy chain will remove other unhealthy items from its shelves:

[T]he cigarettes issue seems to me to mostly raise the question of how far CVS can really go down this road. After all, I was in CVS just yesterday to buy myself some Diet Coke. The Diet Coke sits next to the sugary sodas. And they’re across the aisle from the potato chips. Up front where you cash out there are lots of M&M’s and Snickers bars.

There is, to be sure, also some medicine for sale in your typical “drugstore.” But junk food is a massive product line. I’m not sure how junk food sales compare to tobacco sales, but much more square footage of the stores is dedicated to chips and sodas than to smokes. To really make the pivot CVS is talking about, it seems to me they’d have to change their business pretty drastically.

Jonathan Weil notes that the company will lose money on the move but clearly believes it’s worth it:

In dollar terms the move is a blip. CVS said the decision would cut annual revenue by about $2 billion, which is less than 2 percent of its $123 billion of 2012 sales. The socially responsible investing crowd will be thrilled. President Barack Obama praised the move. A certain majority owner of Bloomberg LP no doubt will be pleased, too. Walgreen Co.’s directors had better be ready to answer questions about why their company hasn’t decided to stop selling cigarettes, too.

Kilgore considers the broader cultural shift against tobacco:

The relatively mild backlash to the cumulative wave of anti-smoking laws, ordinances and private bans (would anyone light a cigarette in someone else’s home without explicit encouragement?), not to mention sanctioned discrimination by health insurers and employers and heavy legal settlements against the tobacco industry, probably means actual Prohibition will at some point become feasible. And the trouble to which tobacco addicts must increasingly go to indulge their habits—even as cannabis smoking becomes more acceptable—has to be having an impact on anyone wanting to live a normal life.

The CVS ban, particularly if it leads to similar bans by competitors, is another step towards the day when purchasing of tobacco products will happen in the equivalent of “head shops” where it’s available at all. And popular culture will follow, at least after Mad Men’s final season concludes.