Reforming Johns; Paging All Rubberneckers

Gawande and Williams

Reforming Johns; Paging All Rubberneckers

Gawande and Williams

Reforming Johns; Paging All Rubberneckers
An email conversation about the news of the day.
March 18 1999 2:28 PM

Gawande and Williams

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Like you, I was fascinated by this morning's New York Times story from China, which takes me back to your earlier question, about the choice between writing China off as an Evil Empire or coaxing her to liberalization with little lumps of nice capitalist sugar. (This is not, of course, precisely how you put it.) I tend to think that reform from within is an ultimate inevitability; I don't see total shunning as a real option, and feel quite sympathetic to the dilemmas our leaders face in trying to calibrate the appropriate level of engagement. I wish this morning's story could have told us more about the people who produced the article criticizing official policy (though obviously this is a delicate matter, and the author of the report in question wrote under a pseudonym, sensibly enough). I don't follow China closely enough to understand how the factions go--exactly why an action that would get its author thrown in prison for life one day is tacitly encouraged or tolerated the next, by at least some element in power. But the men and women who keep testing those boundaries are one of life's wonders. In some ways, it strikes me as an even braver endeavor than challenging an enemy who is everywhere and always bound to try to kill you, from whom you at least know what to expect.

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But all my favorite parts of the paper this morning were features. The Washington Post has a great only-in-Los Angeles offering about an entrepreneur who, for a few bucks a month, will page or e-mail you any time there's a police chase being covered live on local TV. "No one really likes to admit it, but when a freeway chase is going, they want to watch," says the author of the scheme. "They can't help themselves. You never know what might happen." The Post's Rene Shanchez notes without comment that the founder of the Pursuit Watch Network, as he calls it, is also a cop "in Southern California"; I did wonder if the vagueness of the description was part of a deal between writer and subject, and whether this new gig might interfere with the officer's day job.

And the Times has a striking front-page story on San Francisco's success with punishing first-time offenders for soliciting sex with prostitutes by sending them to a daylong "john school." There, they see a horrific slide show of venereal diseases, get harangued by business owners and residents whose neighborhoods are blighted by the trade, and hear former prostitutes lecture about the error of their ways. Reporter Evelyn Nieves notes that the men seem particularly impressed by these women's accounts of how often and fervently they thought about maiming or killing their customers. Talk about piercing a fantasy! City officials say that of 2,181 men who have been through the class in the past four years, only 18 have been rearrested on similar charges.

I too was glad to see the latest medical-marijuana report. Here in D.C., we have a strange plethora of policies on this matter: the current, official policy, which is that it is illegal; and whatever policy we all voted in by referendum last year, which is a secret, because Congress voted to suppress the results and so far litigation has failed to uncover the tally or put it into effect. I actually voted against it, because its language offered little clue to how the use was to be regulated or administered, and public activists I've trusted in the past saw it as dangerous. (A really interesting fact about the murder rate in D.C., which is declining much more slowly than in other places, is that according to the Post it has more to do with the marijuana trade than with any form of cocaine.)

But I've also watched a family member die from a wasting cancer, the kind that had him counting as an achievement each unappetizing bite of food he swallowed and kept down. Marijuana didn't really work for him, as I remember it, but then it wasn't really available to him in any form he could manage well. So I'm all for it, along well-regulated lines. I wished this morning's stories could have told us more about the economics: what the likelihood is that one of those big-hearted drug companies will soon find it worthwhile to develop an inhaler or patch delivery system.

It does raise the blood pressure, doesn't it, to hear from the really single-minded opponents, who can't even brook the idea of its being used in the limited, highly controlled way you describe? One such woman is quoted in the Times, along the lines that if children hear that marijuana is good for anything at all, why, there goes all hope of keeping their little mitts off the stuff. "Zero tolerance" is just the right name for such a cramped view of the human capacity to make distinctions.

Intolerantly,

Marjorie

Atul Gawande has written about medicine for The New Yorker and Slate, is a surgical resident in Boston, and is a fellow at the Harvard School of Public Health. Marjorie Williams is a contributing editor at Vanity Fair.