Marcia Angell, former editor of the New England Journal of Medicine (NEJM) and author of “The Truth About Drug Companies,” wrote the lead article — to which many other academics, health writers and industry representatives responded.

Angell’s opening critique of the cozy relationship between the pharmaceutical industry and medical research institutions is devastating. Summarinzing an argument she made in her book — and in many prominent op-eds, interviews and in a NEJM editorial, “Is Academic Medicine for Sale?” — Angell outlines the steps through which big pharma influences, and in many cases controls, the entire process of medical research — from clinical trials of new drugs to continuing education of doctors.

By putting profit before public good, big pharma’s power distorts the medical mission of many universities:

Academic medical centers are charged with educating the next generation of doctors, conducting scientifically important research, and taking care of the sickest and neediest patients. That’s what justifies their tax-exempt status. In contrast, drug companies — like other investor-owned businesses — are charged with increasing the value of their shareholders’ stock. That is their fiduciary responsibility, and they would be remiss if they didn’t uphold it. All their other activities are means to that end. The companies are supposed to develop profitable drugs, not necessarily important or innovative ones, and paradoxically enough, the most profitable drugs are the least innovative. Nor do drug companies aim to educate doctors, except as a means to the primary end of selling drugs. Drug companies don’t have education budgets; they have marketing budgets from which their ostensibly educational activities are funded.

This profound difference in missions is often deliberately obscured — by drug companies because it’s good public relations to portray themselves as research and educational institutions, and by academics because it means they don’t have to face up to what’s really going on.

Angell’s most pointed criticism is not at the drug companies, however, who, apologists could argue, are just trying to do right by their investors. Rather, she is most bothered by the complicity of the academic institutions. Angell ultimately recommends three specific reforms:

First, members of medical school faculties who conduct clinical trials should not accept any payments from drug companies except research support, and that support should have no strings attached. In particular, drug companies should have no control over the design, interpretation, and publication of research results. Medical schools and teaching hospitals should rigorously enforce this rule and should not themselves enter into deals with companies whose products are being studied by members of their faculty.

Second, doctors should not accept gifts from drug companies, even small ones, and they should pay for their own meetings and continuing education. Other professions pay their own way, and there is no reason for the medical profession to be different in this regard.

Finally, academic medical centers that patent discoveries should put them in the public domain or license them inexpensively and non-exclusively.

Several of the respondents in the Boston Review pick up on one of Angell’s points and pursue it with more depth. In  ”The Case of H1N1,” Howard Brody, director of the Institute for the Medical Humanities at University of Texas and author of “Hooked: Ethics, the Medical Profession and the Pharmaceutical Industry,” explains how the pharmaceutical company Roche was able to obscure negative or neutral research on the drug Tamiflu while public health agencies around the world stockpiled large supplies. Later, the research in support of Tamiflu was found to be unconvincing.

David Bollier, author of “Viral Spiral: How the Commoners Built a Digital Republic of Their Own” and co-editor of Onthecommons.org, takes Angell’s recommendations a step further with his call to “Restore Medicine to the Commons“:

Understanding academic medicine as a commons helps us appreciate more clearly why it is so important to protect the non-market paradigm of research, education, and clinical care. In this mode, medicine harnesses the power of the scientific method through a transparent, ethical, merit-based process. It mobilizes community judgment and ethical scrutiny. It is insulated from the corrupting influences and self-dealing associated with an unregulated market economy.

Unfortunately, we have not been attentive to the value of academic medicine as a commons. We are suffering mightily as a result.

Suzanne Gordon, author of “When Chicken Soup Isn’t Enough: Stories of Nurses Standing Up for Themselves, Their Patients and Their Profession,” reminds us: “Don’t Forget Nurses.” She notes that nurse-practioners, who prescribe a great deal of medicine, have not been overlooked by the pharmaceutical industry, even if they are often forgotten in this type of discussion:

Today nurses no longer have to beg to get noticed. Like medical conferences, nursing conferences are now heavily supported by pharmaceutical and medical-equipment companies, which, like the corporations advertising on public television and radio, demand more and more of the spotlight. Nurses, like physicians, are flown to exotic spots and showered with so-called educational presentations. When I mentioned this phenomenon to a very respected nurse-academic, I expected her to share my concern. Her response: “It’s about time we got ours.”

Perhaps the most poignant — and funny — response comes from Adriane Fugh-Berman, associate professor of physiology and family medicine at Georgetown University Medical Center and director of Pharmedout.org. To show how continuing medical education (CME) is, in Angell’s words, “marketing masquerading as education,” Fugh-Berman creates a fictional scenario:

The gurgles and rumbles of an empty stomach are called, in medical-speak, borborygmi (it is one of the few onomatopoeic medical words). Let’s imagine that a company is developing a drug that prevents borborygmi. The first step would be to encourage people to take the disease state seriously. Marketing messages developed while the drug is still undergoing testing might include:

• While the occasional growling stomach is not a cause for concern, regular episodes could indicate the presence of CLASS (Chronic Loud Atypical Stomach Sounds).

• CLASS is not always benign. The distinction between normal stomach rumbling and a symptom of a serious disease can only be made by a physician.

• CLASS sufferers may limit their travel, work, and recreational activities out of embarrassment; some may become reclusive, fearing social stigmatization.

• CLASS can lead to overeating and obesity because sufferers may eat constantly to prevent audible stomach rumbling.

A pharmaceutical company may then begin to recruit physicians to act as mouthpieces for specific marketing messages …

Fugh-Berman continues the story all the way to the point where other companies are attempting to create “me-too” drugs that piggy-back on the original company’s success.

Angell, in her response to the responders, notes that Fugh Berman’s scenario “would be hilarious if it were an exaggeration, but it’s not. Drug companies frequently engage in such campaigns to prepare the way for a new drug or a new use for an old one. One example was the creation of an epidemic of ’social anxiety disorder,’ formerly known as shyness, and the marketing of Paxil to treat it.”

*In related news, Harvard Medical School just last week announced new restrictions on relationships between its 11,000 faculty members and pharmaceutical and medical device makers. Here’s a summary of the changes.

_ _ _ _ _ _ _ _ _ _

Plus: Drugs, of course, can’t solve everything. Writing in The New Yorker, Atul Gawande explores (in a very humanizing and moving way) how our healthcare system, which can do a great job of prolonging life, is often at a loss when it comes to care for the dying.

“People have concerns besides simply prolonging their lives. Surveys of patients with terminal illness find that their top priorities include, in addition to avoiding suffering, being with family, having the touch of others, being mentally aware, and not becoming a burden to others,” writes Gawande. “Our system of technological medical care has utterly failed to meet these needs, and the cost of this failure is measured in far more than dollars.”

More than 30 years later, Chodorow’s call appears as challenging as ever — at least in the United States, where parental leave is still unpaid (putting us behind 177 nations, including Haiti and Afghanistan, that provide all women, and in some cases men, income and time off after the birth of a child) and only 12 weeks long, which discourages even willing men from taking over child-rearing duties.

Four years before the publication of Chodorow’s landmark text, however, Sweden had already become the first country to replace maternal leave with parental leave, and Sweden has continued to break new ground by spurring a revolution in male attitudes toward and male participation in childcare. Katrin Bennhold of The New York Times writes:

85 percent of Swedish fathers take parental leave. Those who don’t face questions from family, friends and colleagues. As other countries still tinker with maternity leave and women’s rights, Sweden may be a glimpse of the future.

In this land of Viking lore, men are at the heart of the gender-equality debate. The ponytailed center-right finance minister calls himself a feminist, ads for cleaning products rarely feature women as homemakers, and preschools vet books for gender stereotypes in animal characters. For nearly four decades, governments of all political hues have legislated to give women equal rights at work — and men equal rights at home.

Swedish mothers still take more time off with children — almost four times as much. And some who thought they wanted their men to help raise baby now find themselves coveting more time at home.

But laws reserving at least two months of the generously paid, 13-month parental leave exclusively for fathers — a quota that could well double after the September election — have set off profound social change.

Bennhold goes on to describe the positive effects of this change, such as a lowering of divorce rates and an increase in shared custody when a divorce does occur. It has undeniably transformed what it means to be a man.

Birgitta Ohlsson, European affairs minister, puts it in the terms of an old feminist maxim: “Now men can have it all — a successful career and being a responsible daddy. It’s a new kind of manly. It’s more wholesome.”

For more on how father’s leave in Sweden came to be so popular, read this side piece on politician Bengt Westerberg, who in the 1990s “championed the introduction of the first dedicated father month — 30 days of paid parental leave that could not be transferred to the mother — to encourage reluctant men like himself to do their bit and overhaul Swedish society in the process.”

Despite the fact that Sweden and other countries are far ahead of the United States when it comes to supporting fair and equitable childcare, it’s important to remember that progressives in the United States have been fighting for some form of paid parental leave for almost 100 years.

Yes, 100 years. As Sharon Lerner reminds us in the Washington Post:

As far back as 1919, when the Model T was switching from a crank to an electric starter, the U.S. government came close to signing on to an International Labor Organization agreement, supported by 33 countries, that said women workers should receive cash benefits in addition to job-protected leave for 12 weeks in the period surrounding childbirth. That same year, Julia Lathrop, the chief of the Labor Department’s children’s bureau, issued a report on international maternity leave policy in which she decried the United States as “one of the few great countries which as yet have no system of State or national assistance in maternity.” She had recently returned from Europe, where Germany and France had paid-leave laws that had been in place for decades.

The entire article is a very enlightening history lesson — revealing the twisted politics that have held back justice and common sense for far too long. For more on that subject, check out Lerner’s new book, “The War on Moms: On Life in a Family-Unfriendly Nation.”

The research institute notes that insurance companies not only would have to “jump through numerous, unprecedented hoops to estimate the cost of abortion coverage and ensure that the abortion payments never mix with other funds,” but “they also are likely to face extensive public scrutiny and protest around their action.”

All told, according to an analysis by George Washington University’s Sara Rosenbaum, “the more logical response” for private insurers marketing plans within the exchanges — and eventually in the broader market as well — “would be not to sell products that cover abortion services.”

Plus: Drawing from its Congressional record, NARAL flags Republicans who have voted against reproductive rights and who also warned HRC would lead to government intrusion on private medical decisions.

Lasting Consequences: Katha Pollitt talks with Carol Joffe, author of “Dispatches from the Abortion Wars: The Costs of Fanaticism to Doctors, Patients, and the Rest of Us,” about the effect of HRC on women’s reproductive rights and health. Joffe discusses the good, the bad and the ugly — which refers to the marginalization of abortion.

President Obama and Democratic Congresswomen repeatedly said, “This is a health care bill, not an abortion bill.” I understand why they said it. They felt this was the only way to get the bill through and perhaps they were right. But abortion is health care! One out of three women has an abortion during her reproductive years. One of the best ways to reduce the stigma around abortion is to normalize the procedure within mainstream health care settings. The mantra “this is a health care bill, not an abortion bill” reinforces exactly the opposite message.

Plus: In a separate piece written earlier this month, Katha Pollitt offers concrete suggestions on how the Democratic Party and the Obama administration can repay supporters of women’s rights for cooperating on HRC, including taking steps to improve maternal care and outcomes, and full funding for Title X and the Violence Against Women Act. I love the ending:

Speaking of violence against women, Dems, would you look in the effing mirror? New York’s Hiram Monserrate and David Paterson? Scott Lee Cohen in Illinois? That these men and others like them could get as far as they did says the culture of the party is tone-deaf when it comes to abuse and its warning signs. The only way to detoxify politics of tolerance for violence is to have lots more women in office. If India can pass a law requiring Parliament to be one-third women, surely the Democratic Party can figure out how to achieve equal numbers of women here. Pro-choice women. Feminist women.

Start by backing the grassroots campaign of former teacher and county commissioner Connie Saltonstall, who has announced her intention to challenge Bart Stupak in the August primary. “He has a right to his personal, religious views,” says Saltonstall, “but to deprive his constituents of needed healthcare reform because of those views is reprehensible.” Now there’s a woman with gumption and a gift for stating things clearly.

In Other News …

Revisions to On-Air Abortion Language: NPR reporters will no longer use the terms pro-choice and pro-life to describe both sides of the abortion rights debate. Instead, according to an internal memo:

On the air, we should use “abortion rights supporter(s)/advocate(s)” and “abortion rights opponent(s)” or derivations thereof (for example: “advocates of abortion rights”). It is acceptable to use the phrase “anti-abortion”, but do not use the term “pro-abortion rights”.

Digital News will continue to use the AP style book for online content, which mirrors the revised NPR policy.

Do not use “pro-life” and “pro-choice” in copy except when used in the name of a group. Of course, when the terms are used in an actuality they should remain.” [An actuality is a clip of tape of someone talking. So if a source uses those terms, NPR will not edit them out.]

Georgia Senate Passes Abortion Bill: The latest assault on women’s reproductive health in Georgia is SB 529, a Senate bill that makes it possible to bring criminal charges against doctors, boyfriends, pimps and even parents if they encourage a woman to have an abortion. The bill’s supporters frame it as a way to protect women — especially women of color — but women’s health advocates say the true motivation is to criminalize abortion.

“This bill was created under the false assumption that abortion doctors solicit women of color, particularly, black women,” said Democratic State Sen. Donzella James. “This bill calls into question all who make a deeply private and personal medical decision. Every woman, regardless of ethnic background, should have the ability to make personal decisions. Not the people in this room. It is between, she, her family and God.”

Heidi Williamson of Sister Song has more. “Publicly, white Republican men claim to care about pregnant black women who are allegedly being targeted by the abortion industry. Privately, those same men scramble to ‘opt Georgia out’ of national healthcare reform and find the perfect wedge issue for the mid-term elections to build the Republican base in African-American communities,” she writes.

We previously discussed an anti-abortion billboard campaign in Georgia targeting black women  that proclaims black children are an endangered species. Women’s eNews reports that the campaign may soon go national. For more on the difference in abortion rates among women, see this Guttmacher Institute policy report, which notes that black and Hispanic women have higher abortion rates than white women because they have higher rates of unintended pregnancy.

What’s Up With Lilith Fair?: After announcing that it would donate a dollar from every ticket sold to a women’s organization in each of the 36 host cities, Lilith Fair is coming under fire for including organizations that don’t support a full range of reproductive services.

Apparently, the only vetting Lilith did was to look online for women-focused organizations with federal tax ID numbers. Jessica Hopper interviewed Nettwerk CEO and Lilith cofounder Terry McBride about the selection process and received a less-than-informed response.

“The seeding at the start was done with a basic digital search in each market of woman’s charities,” he said. “It’s not perfect. Nor could it be, as we simply don’t have the local expertise even within our own city of Vancouver.”

Really? Lilith couldn’t have contacted local women’s health advocates, or put a few interns on the project? Perhaps the festival should include a booth for organizers on research skills.

There’s always a chance for improvement. Facebook fans will vote on the selected organizations, and the top three vote-getters in each city will be forwarded to Lilith founders — Sarah McLachlan, Terry McBride, Dan Fraser and Marty Diamond — who will hand pick the winners. And organizations not currently featured can self-submit for consideration. Read more at the Chicago Reader.

The committee writes that the list of priorities was determined not just by which conditions affect the largest number of people, but with balance in mind. The full report notes that rare diseases and conditions that disproportionately affect specific segments of the population were also considered. They also explain that while comparative effectiveness research often focuses on comparing drug A to drug B, the committee felt it was important to include a diversity of interventions and different types of therapies, and they also considered where the gaps are in existing research.

The priority list includes several childbirth related topics, including this: “Compare the effectiveness of birthing care in freestanding birth centers and usual care of childbearing women at low and moderate risk.” The report doesn’t specify what “usual care” is, so we can only assume that it means birth in a hospital with an ob/gyn. The list also doesn’t include details on how the effectiveness of birthing care will be judged, but we’ll certainly keep an eye out for more information!

Several other topics that are at least partially specific to women’s health made it into the top 25 priorities (the list of 100 was further broken down into quartiles). They include:

• Genetic and biomarker testing and usual care in preventing and treating breast, colorectal, prostate, lung, and ovarian cancer, and possibly other clinical conditions for which promising biomarkers exist.
• Interventions to reduce health disparities in cardiovascular disease, diabetes, cancer, musculoskeletal diseases, and birth outcomes.
• Clinical interventions (e.g., prenatal care, nutritional counseling, smoking cessation, substance abuse treatment, and combinations of these interventions) to reduce incidences of infant mortality, pre-term births, and low birth rates, especially among African American women.
• Innovative strategies for preventing unintended pregnancies (e.g., over-the-counter access to oral contraceptives or other hormonal methods, expanding access to long-acting methods for young women, providing contraceptive methods at public clinics, pharmacies, or other locations).

Other relevant topics include comparison of weight-bearing exercises and bisphosophonates for preventing fractures in older women with osteoporosis, film screen or digital mammography and mammography plus MRI for breast cancer screening in high risk women, outcomes with and without the use of obstetric ultrasound in normal pregnancies, and “strategies for promoting breastfeeding among low-income African American women.”

Feministing’s Jessica Valenti is quoted in this Associated Press story on the election and NOW’s generational divide.

Plus: I don’t think I’ve linked yet to Katha Pollitt’s excellent piece in The Nation on feminism’s false waves. It begins:

Can we please stop talking about feminism as if it is mothers and daughters fighting about clothes? Second wave: you’re going out in that? Third wave: just drink your herbal tea and leave me alone! Media commentators love to reduce everything about women to catfights about sex, so it’s not surprising that this belittling and historically inaccurate way of looking at the women’s movement — angry prudes versus drunken sluts — has recently taken on new life, including among feminists.

Losing Celebrity Weight Battles: When famous dieters like Kirstie Alley or Oprah Winfrey talk about being “disgusted” with their bodies, the comments have an effect beyond selling magazines.

“Kirstie looks the same as me, to the inch, height and weight,” Emily Schaibly Greene, 29, recently told The New York Times. “It took me a long time to get there, but I’m feeling good with how I look. But it’s difficult to keep liking the way I look when I’m reading that it’s gross.”

Lesley Kinzel, who writes for the blog Fatshionista, said, “When you have famous people turning their weight tribulations into mass-media extravaganzas, they’re contributing to a culture where passing comments on strangers’ bodies is considered O.K.”

Plus: Nia Vardalos, who rose to fame after starring in “My Big Fat Greek Wedding,” says her recent weight loss is all people want to talk about these days, pushing aside her personal and professional achievements. Her column is awesome.

And if you haven’t yet bought “Lessons From the Fat-O-Sphere,” go. Author Kate Harding – founder of Shapely Prose and contributor to Broadsheet — is still on the book tour this month and is looking forward to speaking at colleges in the fall. 

Summer Reading List: From Women’s eNews: From sensational memoirs to serious sociology, check out what women are writing about and the prizes they’ve been snapping up so far in 2009. Sarah Seltzer has the goods.

Women’s Health Clinic to Close: The University of Chicago Medical Center is closing its women’s health clinic, an essential community health resource, at the end of the month. Ironically, this is being done under the Medical Center’s Urban Health Initiative; U.S. Rep. Bobby Rush has called for a congressional investigation into whether the Medical Center has engaged in “patient dumping” by steering the poor to other health facilities.

“Medical center executives have said the steep downturn in the economy has forced them to trim $100 million from the hospital’s budget to maintain running a prestigious hospital, research center and medical school. They also have said the Women’s Health Center, which cares for thousands of Medicaid patients, is a money loser,” reported the Chicago Tribune last month, in a story on protests against the closing.

Plus: While looking up information about the closing, I came across a 2008 New York Times story on Michelle Obama, who at that time was on leave from her job as vice president of community affairs at the University of Chicago Medical Center. Stories like this made me wonder what she could/would have done about the closing:

When the human papillomavirus vaccine, which can prevent cervical cancer, became available, researchers proposed approaching local school principals about enlisting black teenage girls as research subjects.

Obama stopped that. The prospect of white doctors performing a trial with black teenage girls summoned the specter of the Tuskegee syphilis experiment of the mid-20th century, when white doctors let hundreds of black men go untreated to study the disease.

Too Poor to Make the News: Over on The New York Times op-ed page, Barbara Ehrenreich has written the first in a series on how the recession affects people who don’t neatly fit the downwardly mobile narrative: the already poor.

“This demographic, the working poor, have already been living in an economic depression of their own,” writes Ehrenreich. “From their point of view ‘the economy,’ as a shared condition, is a fiction.” She continues:

The deprivations of the formerly affluent Nouveau Poor are real enough, but the situation of the already poor suggests that they do not necessarily presage a greener, more harmonious future with a flatter distribution of wealth. There are no data yet on the effects of the recession on measures of inequality, but historically the effect of downturns is to increase, not decrease, class polarization.

The recession of the ’80s transformed the working class into the working poor, as manufacturing jobs fled to the third world, forcing American workers into the low-paying service and retail sector. The current recession is knocking the working poor down another notch — from low-wage employment and inadequate housing toward erratic employment and no housing at all. Comfortable people have long imagined that American poverty is far more luxurious than the third world variety, but the difference is rapidly narrowing.

Health Care & the Arts: NPR interviews Anna Deveare Smith about her show “Let Me Down Easy,” which is based on interviews with doctors and patients (previously discussed here). Her newest role: artist in residence at the Center for American Progress, which Smith will use as a perch for studying changes in Washington. Smith also plays a doctor in the new Showtime series “Nurse Jackie.”

Speaking of “Nurse Jackie,” David Bauder of the Associated Press notes that the ethically challenged nurse at the head of the show (wonderfully played by Edie Falco) has appalled some nurses — but is that a bad thing for Showtime? Well, no.

Apologies from California: I meant to post this next one when it first came out, but I still think it’s amusing — San Francisco Chronicle columnist Mark Morford would like you to know California is really, really sorry about the whole Prop 8 thing.

Meanwhile, tony Greenwich, Conn., has become wedding central for same-sex New York couples who no longer have to drive as far as Massachussetts. California sure could have used money spent on wedding bliss.

Yep. The March/April issue of Quilter’s Home magazine is wrapped up in plastic like Playboy and JoAnn Fabric and Crafts has refused to sell it.

So what’s inside? Monica Hesse has the goods:

Flip past the ads for stencil companies and portable ironing tables to Page 24. Behold, seven straight pages of shocking quilts. We’re talking fabric phalluses. Gun-toting Jesuses. A newborn peering out from his mother’s lady parts (constructed out of lots of soft, embroidered orange cloth).

Some of the images are disturbing — and moving — like quilter Gwen Magee’s “Southern Heritage/Southern Shame,” which depicts five lynching victims hanging in front of a Confederate flag.

Others are whimsical. Consider “Helping Hands,” a Charlottesville quilter’s ode to Viagra. The work was inspired by a present from a friend: “A fat quarter of fabrics with all these itty-bitty penises and sperm,” says Mary Beth Bellah, describing the pile of remnants with delight.

The finished product is asymmetrical and somewhat abstract: dozens of little blue pills spiraling out from a central hand. It’s nothing like what you could buy in Amish country, although it does seem appropriate as a wedding quilt. Bellah considers herself an artist and has displayed her quilts in private shows. At a recent show in a hospital, “Helping Hands” ended up stashed in a closet after a few complaints.

Of course quilting had always been tied with social and political history. Rarely, though, do we hear of quilters making waves.

I appreciated the quotes featured at the end. While these works would hardly be considered “daring” if created using another artistic medium, in the world of quilting, they’re unsettling, and the quilters know their potential impact:

Magee says that the contrast between her soft fabrics and her harsh social messages is exactly what makes her work effective. She did see a letter from one guy protesting her quilts, asking, “Who would want to cuddle under such a thing?” “He had no concept that this wasn’t that kind of quilt,” Magee says.

You can see a close-up of  “Helping Hands,” the ode to Viagra, at Mary Beth Bellah’s website, where she writes: “I personally think the topic is ideal for a hospital setting and someday hope it finds a permanent home in an ED specialist’s office or clinic.”

Lisa Jervis, the founding editor and publisher of Bitch magazine, and Brad Perry, sexual violence prevention coordinator at the Virginia Sexual and Domestic Violence Action Alliance, take on popular perceptions of rape and what needs to be done to transform regressive attitudes toward sexual violence — in both the media and among young men.

In “An Old Enemy in a New Outfit: How Date Rape Became Gray Rape and Why it Matters,” Jervis deconstructs the latest blame-the-victim terminology. Perry’s essay, “Hooking Up With Healthy Sexuality: The Lessons Boys Learn (and Don’t Learn) About Sexuality, and Why a Sex-Positive Rape Prevention Program Can Benefit Everyone Involved,” revisits advice Perry received as a teenager and the more enlightened strategies he has encountered in his work.

Ultimately, they grapple with how to create an atmosphere for a healthy and empowering sexual experience for both women and men.

Please add your thoughts on the discussion, or your questions for Lisa or Brad, in the comments. And don’t miss the next stop on the “Yes Means Yes” virtual book tour: a live chat on Feb. 9 at Shakesville with co-editor Jaclyn Friedman.

Our Bodies, Our Blog: What is the allure of so-called “gray rape” for anti-feminists? How does it help serve a conservative agenda?

Lisa Jervis: The construct of gray rape does two things: it minimizes rape, seeks to make it seem like less of a big deal — if it was a “gray area,” can it really be that bad? — and it also justifies victim-blaming and its close friend, slut-shaming. This actually serves anti-feminists in two really different ways, though they’re both pretty much classics of sexism and misogyny.

The minimizing encourages an attitude of, “What are all those angry women complaining about now?”; and almost every feminist issue has been minimized at some point over the history of the struggle for gender equality.

The victim-blaming part is even more disturbing, as it updates and revitalizes one of the biggest obstacles to transforming rape culture. And it’s particularly insidious because of how it cultivates self-doubt and self-blame even more than previous victim-blaming discourses have. And, especially when paired with slut-shaming — which makes women and girls feel bad about the existence of a strong sex drive and any entitlement they might feel to (gasp!) satisfy their desires — it serves as an attempt to keep a tight cultural lid on women’s sexuality. It’s an updated and vastly more complex version of “good girls don’t.”

OBOB: Brad, how has the notion of “gray rape” complicated your teachings?

Brad Perry: In my experience, the attitude about acquaintance rape (which is what the term “gray rape” is usually referring to) amongst most policy makers, many students, and a good chunk of the general public has not changed drastically since it first entered the public’s awareness 20 years ago. There has been some progress in getting people to understand that usurping another person’s sexual autonomy is rape under any circumstances, but old mindsets die hard.

In that context, the gray rape thing just seems like more of the same but with a new name — as Lisa eloquently discusses in her essay. The only way my work has been complicated by the notion of “gray rape” is that now people have a convenient label. I don’t think it’s necessarily changed many people’s minds on whether or not to take acquaintance rape seriously — the people who are going to deny it are usually going to find a reason to do so until something happens to change their mind — but it has given those folks some hip new contemporary language to dismiss acquaintance rape.

We’re a country found by patriarchal religious fanatics who were (among other things) obsessed with denying human sexuality, so it’s not at all surprising to me that we keep revisiting the issue of social control over women’s sexualities. That’s not too say I think we should throw our hands up and say, “Oh, well” — in order to remember how much history we have to overcome so that we don’t lose our minds trying to make progress.

_________________________________________________

When you’re steeped in messages about looking hot at the expense of (or as a substitute for) feeling aroused or having sexual desire, it becomes all the easier for you to question your own judgment about what happened to you and believe the cultural forces telling you that your assault was just miscommunication and bad sex.
– Lisa Jervis in “Yes Means Yes”
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OBOB: We seem to be making gains in educating young women that date rape is indeed rape, but there remains a backlash in the broader media discourse. How do activists intervene in larger, public spaces?

LJ: That’s a hard one. I wish I had some brilliant answers. I think we have to just keep repeating our message, in a variety of ways and in a variety of settings: calling out the bullshit in the backlash, promoting education around healthy sexuality and exposing how rape culture operates. But I actually think that the smaller, private spaces may be more important. As Brad’s work shows, we need to educate boys and men about rape in the way we’ve educated women.

The percentage of guys who want to be rapists is infinitesimally small, and a lot of the ones who do end up committing assault are confused and hurt by it — and if they had different cultural training, they wouldn’t have done it.

It comes back to one of the ideas at the core of “Yes Means Yes”: that a true embrace of enthusiastic participation as the baseline of consent would prevent an entire category of rapes. And the way to get there is probably more through interpersonal interactions than other activities more traditionally understood as activism.

BP: I agree with Lisa that repeatedly calling out the bullshit is important. A good technique to use is to get the backlashers to at least admit that unwanted sex is a very hurtful thing — even if they refuse to call it “rape” or “sexual assault.” That can cut right through the semantic hemming and hawing. Responding to the backlash — as well as proactively getting our messages out there — across multiple levels of our social environment is also crucial.

OBOB: Lisa, what do you think are some positive images in popular culture that encourage women to be sexual for themselves?

LJ: This is a little hard for me to admit, since so much of my career has been spent as a pop culture critic, but I don’t watch a lot of TV or go to a lot of movies these days. I’ve had to unplug from my intense consumption of mass media in order to preserve my sanity and, frankly, free up my time for other things. So I don’t have any specific examples I can cite.

But I do see a few cultural trends, however gradual, that bring me hope: The first is the proliferation of feminist- and woman-run sex toy shops. When Good Vibrations was founded in the San Francisco Bay Area 30 years ago, they were unique. But slowly over the last three decades — and, it seems, more quickly over the last five years or so — such spaces have proliferated. Toys in Babeland, the Tool Shed, the Smitten Kitten, Early to Bed — I could go on (check out the thread at Feministing for a look at how geographically widespread these shops are becoming).

I also think the proliferation of erotica aimed at women, and the fact that the selection has generally become a lot more broad — the expectation that women want to read about soft-focus, romantic scenarios is slowly wearing away — is a heartening sign.

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… I propose playing matchmaker with two disciplines that have always seemed to be like ships passing in the night: sexual health promotion and sexual violence prevention. They’re the perfect couple — philosophically complementary, yet with their own things going on. Whether they’re engaged in stimulating research comparisons over dinner, flirting about the REAL Act on a walk through the park, or making sweet, back-arching, toe curling collaboration at home with the lights on, our society can only benefit.
– Brad Perry in “Yes Means Yes”

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OBOB: Brad, are there images that encourage men to see women as collaborative partners in a healthy sexual experience?

BP: Hmmmm … this is a tough one because mainstream media imagery does not usually graphically depict sexual expression, lest they be fined by the FCC and/or spark a shit-storm of outrage from concerned citizens and the like. So we’re left with either hints (the man is generally a nice guy, and we assume the sexual encounter we only see the beginning of was consensual and/or good), or the apparently equally acceptable option of making the interaction violent (which is usually shown in more detail, albeit in a LifetimeTV/”SVU”-esque sensationalized manner).

What this means is that in the mainstream media we are never able to see what a collaborative sexual encounter would actually look like. And when I talk to groups of young men about navigating a hook-up culture, it’s precisely that how-to piece that they want to know. We’re all raised to see sex as this mysterious thing that just happens. And boys are also told that they’re supposed to just know what to do without anyone ever going into detail about anything beyond why they should make sure they “call the shots.”

So they look where ever they can to get a clue. The mainstream media is one of those places, and all they’re getting there are the same old boring and dangerous “dominate her” messages, episodes of sexual violence, and a collection of vague hints for any potentially healthy options.

This is one area where I have seen some improvement though, in that at least when we’re shown the lead-up to a sexual encounter it seems more collaborative than it used to be. It used to always be either flat-out coercion or a “sweep her off her feet” vibe, so it’s not like the bar was set all that high to begin with, but at least it seems headed in the right direction.

OBOB: Brad, you discuss institutional obstacles — government-funded abstinence-only programs, the lack of sex education classes — to teaching healthy sexuality. What are some of the obstacles you encounter with boys themselves? In other words, how do you get boys to see “the game” as a game, and a damaging one at that?

BP: I haven’t actually worked directly with groups of young men in a few years, so I can only answer based on what I’ve been hearing from my colleagues who are doing that work on a day-to-day basis. There are a lot of techniques used by rape prevention specialists when working with groups of young men, but perhaps the most common one is to get them talking about what it means to be man. Pretty soon they’ll start to see how rigid gender roles can be, how they’re enforced, and how their lives are limited as a result.

Eventually, you can get to the topic of how this all relates to sexuality (assuming the school or youth institution in which you’re working allows you to even talk about sex). When that happens, you’ll find — after a few days or so of savvy facilitation — that most young men don’t want to be the ones always pursuing, always calling the shots.

Once you get them to realize/admit that, then the door is open for a deeper conversation about how to flirt and engage people to whom they’re attracted outside of the bullshit of “the game.” Such conversations can explode “the game.” But you need that institutional support to make any of this happen — the support of legislation, funding, the local setting in which you’re doing the work, the parents — across the spectrum of their social environments.

Otherwise, you might not have enough time to have these conversations, or even if you do, they might come undone in the face of resistance from other influential forces in the lives of the young men. Public health folks call this working at multiple levels of the social ecology.

OBOB: Lisa, in your essay you mention several examples of books and articles that have bombarded girls and women with damaging messages about sexuality and rape. Besides “Yes Means Yes,” what other books or resources would you recommend to combat those messages?

LJ: This is another really hard one. As with the earlier question about images, I have more general than specific recommendations. Since what’s damaging about these messages is often that they contradict or are divorced from women’s actual experiences, I think reading first-person accounts and talking to other people is one of the best antidotes. So zines, blogs, and message boards discussing rape and assault are key.

Also, for teenagers and older preteens of all genders, the absolute best place for nonjudgmental, affirming sex information is Scarleteen.com. Founder Heather Corinna’s book “S.E.X.” is also brilliant and focuses a lot on figuring out what you want and learning to communicate about it with others.

OBOB: Brad’s essay opens with him at age 13, getting advice about sex from a friend’s older brother. The instructions can be summed up as: give girls beer, make a move, and if you’re lucky you’ll “get some.” This introduction to sex is commonly passed down by siblings, friends and throughout popular culture. A question for both of you: What would an equally compelling counter-narrative look like? How would it compete with the swagger?

LJ: The simplest counter-narrative is that good sex can’t happen if it’s not 100 percent mutual and wanted by everyone involved. That if you tell someone you’re into them, find out if they’re into you, and go from there, everyone will have a much better time. Of course that’s a tough sell for any 13-year-old — communication is hard even for the most mature adults among us, and asking for what you want makes you vulnerable. But without it, any sexual experience will ultimately be unsatisfying.

BP: Focusing on the pleasure to be had in mutual and enthusiastic sexual encounters — based on informed and consensual decisions — is a start. Mind-blowing sexual experiences and the tenets of healthy sexuality go hand-in-hand. Mind-blowing sexual experiences and “the game” typically don’t.

Of course, what constitutes “mind-blowing sex” is subjective, but I think that the freedom and knowledge inherent in a healthy sexuality paradigm is more likely to yield satisfaction consistently. On a very practical level, we need to find ways to “cool” and mainstream these concepts in the same way that the swagger and boys-will-be-boys have been.

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Use this link to order “Yes Means Yes” today and a percentage of the sale will automatically go to Our Bodies, Ourselves.

For those in poor urban neighborhoods and isolated rural areas, including Indian reservations, the clinics are often the only dependable providers of basic services like prenatal care, childhood immunizations, asthma treatments, cancer screenings and tests for sexually transmitted diseases.

As a crucial component of the health safety net, they are lauded as a cost-effective alternative to hospital emergency rooms, where the uninsured and underinsured often seek care.

Despite the clinics’ unprecedented growth, wide swaths of the country remain without access to affordable primary care. The recession has only magnified the need as hundreds of thousands of Americans have lost their employer-sponsored health insurance along with their jobs.

In response, Democrats on Capitol Hill are proposing even more significant increases, making the centers a likely feature of any health care deal struck by Congress and the Obama administration.

(Another) Survey Says: Abstinence Pledges Ineffective: “The new analysis of data from a large federal survey found that more than half of youths became sexually active before marriage regardless of whether they had taken a ‘virginity pledge,’ but that the percentage who took precautions against pregnancy or sexually transmitted diseases was 10 points lower for pledgers than for non-pledgers,” reports the Washington Post.

“Taking a pledge doesn’t seem to make any difference at all in any sexual behavior,” Janet E. Rosenbaum of the Johns Hopkins Bloomberg School of Public Health, whose report appears in the January issue of the journal Pediatrics, told WaPo. “But it does seem to make a difference in condom use and other forms of birth control that is quite striking.”

Abortion Battle Brewing in South Carolina: “Abortion foes in the Legislature have sown the seeds of what could develop into another battle over regulating abortion in South Carolina,” reports The State. “Seven S.C. House lawmakers have prefiled a bill that would require women seeking abortions to be given a list of clinics and other facilities that provide free ultrasounds. That list could include pregnancy crisis centers — many run by antiabortion groups — that actively discourage abortion and encourage women to choose other alternatives.”

Genetic Testing and Ambiguity: “‘Information is power,’ has become a common mantra. But for many people seeking answers through genetic testing, all the DNA probing ends in this twist: Less certainty, not more,” begins this NPR report. The story focuses on Nashville novelist Susan Gregg Gilmore, who sought testing for mutations in the genes BRCA 1 and BRCA 2, which are associated with an increased risk of breast and ovarian cancers.

Cut Costs, Not Care: The L.A. Times has published the first installment of an ongoing feature on reducing health care costs. Part one covers drugs, doctor visits, surgery, flexible spending accounts, preventive care and insurance. Scroll down for links to online resources.

The Year in Medicine A-Z: Time magazine offers its annual alphabetical roundup of health stories and breakthroughs that made the news. (Ed. note – reading through it all requires clicking through 37 pages. “Single page” feature, anyone?)

Don’t Blink: Via Feminist Peace Network: “As we come to the final stretch of 2008, plagued as we are with the usual collection of horrors–Gaza burning, Tennessee buried in toxic ash, women and children being raped and killed in the Congo, and on and on, I’m sure y’all were just as relieved as I was to know that the FDA is considering approval of a glaucoma drug for eyelash enhancement, an idiocy I would have previously thought would be confined to the cable shopping networks.”

Missing on TV: GLBTQ Women: “Though 2008 comes to a close with word of possible new queer female characters on the horizon in the coming year, the prospects for lesbians and bisexual women on television over the last twelve months have been somewhat grim,” writes Karman Kregloe at AfterEllen.com. “This has been particularly true for lesbians, whose numbers on scripted network television have now dwindled to zero.”

Deep Thoughts for the New Year: “As the country plunges into recession, will financial hardship demote the pursuit of physical perfection?” asks The New York Times. A classic response:

“There comes a point when you are putting too much time and money into your vanity,” said Peri Basel, a practice consultant in Chappaqua, N.Y., who advises cosmetic doctors on marketing strategies. “For me, the vanity issue is: Where does it stop? If you are going for buttock implants, do you really need that?”

After months of obsessing over tracking polls and following up-to-the-second campaign news round the clock, much of the nation seems to be going through a withdrawal of sorts. New York Times health writer Tara Parker-Pope points to several news stories about our collective crash, some of which include suggestions from psychologists on how to bounce back and re-focus.

Of course, there are still many important issues that demand our attention. Elissa Epel, an associate professor in the psychiatry department at UCSF, tells the San Francisco Chronicle that we are likely to continue intense discussions, though perhaps on different terms: “People will be less plugged into the political pundits each day. They will start to pay attention to neglected longer-term issues – how to survive the recession, how to take of their family and health better. We may notice we are in one of the most stressful eras in recent history.”

Over at Slate, Farhad Manjoo offers suggestions for new topics to obsess over if you’re still glued to your computer screen. The list also includes social networks to join and cool games to play, if you’re looking to take a vacation from the news.

Here’s what Stephanie Dolgoff wrote:

Women finally get straight talk about their bodies
If you need to know something about your body, what do you do? Look it up, of course. But before 1970 there weren’t any good resources. That year a group of Boston women published a stapled-together booklet — the precursor to Our Bodies, Ourselves — and fueled the burgeoning idea that women should be full participants in their medical care. Three years later, the radical publication (which discussed such issues as sexuality and birth control) was beefed up and released by Simon & Schuster. It’s now in its eighth edition.

Very cool.

Other standouts: After realizing that what works for white men doesn’t necessarily work for the rest of us, the National Institutes of Health in 1993 started including more women and minorities in clinical trials. And tubal litigation is now a real option. Dolgoff describes when it wasn’t:

Until 1969, a woman couldn’t elect to have her tubes tied unless she fit a formula — her age multiplied by the number of children she’d delivered had to equal 120 or more. (What that means: If you were 30 years old, you would have to have had four kids before a doctor would have agreed that you’d done your share of “women’s work” and sterilized you, unless another pregnancy would have posed a health risk.)

Though the list is supposed to cover “highs and lows in the last 20 years of female wellness,” a number of “best moments” are from older decades — in the case of the tampon’s development in 1929, much older. And some might be remembered more as milestones in popular culture that led to a greater acceptance of women’s health issues: Judy Blume novels (swoon); Edith Bunker going through menopause on “All in the Family” in 1972 — or to a greater respect for women’s physical abilities: U.S. women winning the World Cup in soccer in 1999 and Billie Jean King defeating Bobby Riggs in “The Battle of the Sexes.”

On the more medical side, there are a couple of items that deserve a closer look — such as the FDA in 1960 declaring birth control pills safe for women. It’s great that we have the pill, but it took the work of health activists like Barbara Seaman to improve their safety.

The FDA’s approval of Gardasil, the first vaccine introduced to prevent cervical cancer, also deserves an asterisk. While Gardasil’s approval was met with great fanfare, the distribution and cost has come under scrutiny, and researchers have raised doubts, most notably in the New England Journal of Medicine, about whether Gardasil and another vaccine, Cervarix, will ultimately reduce rates of cervical cancer (read the articles here and here).

Dolgoff nailed the “seven lows in women’s health.” The list includes the refusal of pharmacists to dispense emergency contraception (Plan B), forced sterilization of women of color, and the Virginia Slims campaign — “You’ve Come a Long Way, Baby” — that co-opted feminism in the name of promoting lung cancer and other smoking-related diseases.

My only question is: Why only seven? Many other “worst” moments come to mind, including misinformation about hormone replacement therapy and the Global Gag Rule.

So readers, what other best or worst moments would you add to the list?