Doctors Now Say It’s OK to Eat a Meal While Giving Birth
Two new studies on giving birth could give doctors and patients a little less to worry about in the delivery room. One debunks the conventional wisdom that people shouldn’t eat or drink while they’re in labor; the other confirms that new guidelines on delaying elective induced labor will not increase stillbirths.
At the American Society of Anesthesiologists’ annual conference last month, a Canadian research team presented data culled from 385 studies from the past 25 years that show that women in labor burn calories and use energy at rates comparable to marathon runners. But unlike marathoners, who get pats on the back, protein bars, and bananas at checkpoints along their routes, people giving birth are usually denied all but ice chips. Doctors have long believed that women would aspirate their food if they chose to eat during labor, especially if they were managing pain with anesthesia or painkillers.
But researchers found only one U.S. case of aspiration during labor between 2005 and 2013, and that patient had complications related to pre-eclampsia, a pregnancy disorder. It seems that the conventional wisdom of labor fasting was a holdover from the days before epidurals and spinal blocks, when women would give birth under anesthesia that required a face mask or a windpipe tube. Now, the anesthesiologists say that it’s fine for healthy people to eat a light meal during the birth process.
Many people lose their appetites during the strenuous physical pressures of labor, but others could benefit from a little calorie replenishment. The study notes that a lack of proper nourishment could prolong labor in two ways: Without food, bodies burn fat, making the blood of the baby and the person birthing it more acidic, reducing uterine contractions. Fasting can cause emotional stress, too, diverting blood away from the uterus and placenta. Then there’s the extreme physical exertion, which is much harder to keep up for hours on end without caloric intake.
So, pregnant people can now opt to eat while they give birth. But when should they schedule their labor? Doctors once thought that babies born between 37 weeks and 39 weeks after conception—just shy of the accepted 40-week gestation period—were just as healthy as full-term babies. Some patients with perfectly healthy pregnancies elected to induce labor during this period because they wanted caesarean sections, because the security of a planned date can be comforting, because they were expecting a particularly large baby, or because the last weeks of pregnancy can be uncomfortable.
But in 2011, the National Institutes of Health’s Eunice Kennedy Shriver National Institute of Child Health and Human Development issued a recommendation that all elective labor inductions be held until at least 39 weeks; infants delivered in the two weeks earlier ran a higher risk of respiratory problems, low blood sugar, and infections. Still, a number of doctors worried that fewer preterm births would lead to more stillbirths later in pregnancy, just because spending more time in the womb would make it more likely for a fetus to terminate there. A 2006 study showed that women aged 40 and up are more likely to give birth to stillborn children with each additional two-week period of pregnancy between 37 and 41 weeks.
On Monday, the NIH released a new study that challenges those beliefs. Researchers analyzed U.S. infant birth and death statistics between 2006 and 2012 (the year with the most recent data since the new recommendation) and found no difference in the proportion of births that were stillborn 34 to 36 weeks, 37 weeks, and 38 weeks. The key to their finding seems to lie in the data-crunching: Rather than comparing the number of stillbirths at each week of gestation with the number of total births that week, the researchers compared the number of stillbirths with the total number of people pregnant during that week. They claim that this method is a more accurate measure of stillbirth risk among pregnant people.
With the highest infant mortality rate of the world’s 27 wealthy nations and a maternal death rate on the rise, the U.S. has considerable room for improvement in pre- and post-natal health care. More food options for people in labor and better data on stillbirths are incremental developments, but they’re two much-needed steps in the right direction.
Pregnancy Surrogate Sues Marriott for Denying Her Lactation Breaks at Work
A Marriott employee in California is suing the hotel chain for discrimination under both state and federal law, alleging that Marriott denied her legally mandated lactation breaks. Marriott says it was not required by law to give plaintiff Mary Gonzales, a cashier and accountant at the LAX Marriott, breaks to pump breast milk because Gonzales is a gestational surrogate, not a mother with an infant at home.
The suit could expand legal grounds for claims of sex discrimination. In a motion to dismiss filed to the U.S. District Court of Central California, Marriott claimed that, since it allowed other members of Gonzales’ protected class (women) to breastfeed, Gonzales’ case for sex discrimination is bunk. On Wednesday, Judge Margaret M. Morrow denied the motion. “A reasonable jury could conclude that Gonzales was subjected to the treatment she was because Marriott perceived she did not conform to stereotypical views of how women act as it relates to motherhood or child bearing,” she wrote in her decision.
As a surrogate, Gonzales gave birth in April 2014 and, upon returning to work in June, took two 30-minute breaks each day to pump breast milk to send to the child’s parents. Once her obligation to send milk to that family ended at the end of the month, she decided to continue pumping for the “personal health benefits” of lactation and to donate to the Preemies Milk Bank and women who are unable to breastfeed. Gonzales alleges that her boss told her she could continue taking lactation breaks for another 30 days; when those 30 days were up, she began using her 30-minute lunch break instead, and ate lunch during her 10-minute morning rest break. As a result, Gonzales says, she suffered from clogged ducts, breast pain, blisters, and loss of sleep as she had to pump at night.
Gonzales says she offered to bring in a note from her doctor attesting to the benefits of her continued breast pumping, but her boss refused. “Marriott’s dismissal of the ‘personal health benefits’ of lactation—which it compares to ‘exercising during the workday’—is unfounded,” Morrow wrote in her response to Marriott’s dismissal motion. “Whether it is ‘reasonable’ to require an employer to accommodate an employee’s desire to express milk that she intends to donate or sell is a question of fact for the jury.”
Gonzales’ suit raises the question of whether employers have the right to know why an employee is pregnant, and what she plans to do with the pregnancy, in order to determine whether or not she deserves workplace accommodations such as lactation breaks. Gay-rights advocates have already used expanded definitions of sex discrimination to gain traction in court. Morrow’s decision suggests that surrogates—and anyone who pumps breast milk without an infant to care for at home—might have standing as a segment of a gender-based protected class, too.
On the View, Carly Fiorina Bashes Hillary Clinton for Pulling the Gender Card
After telling the hosts of The View to “man up” earlier this week, Carly Fiorina appeared on The View this morning in defense mode. Through video feed from New Hampshire, Fiorina sparred with the liberal-leaning hosts over reproductive rights, minimum wage, and jokes about Fiorina’s appearance, which the candidate has used to gin up donations in recent emails.
Host Joy Behar was quick to call out inconsistencies in Fiorina’s statements about women. “You believe a feminist is a woman who lives the life she chooses…yet it seems to me that you are against programs that let women make choices for their lives,” Behar said, pointing to Fiorina’s opposition to Roe v. Wade, universal paid maternity leave, and raising the minimum wage. Fiorina called Behar’s list of issues “the litany of the left,” which says “the only way you can be pro-woman is to agree with the left’s prescription for women.”
It’s hard to imagine a world in which paid family leave for all workers isn’t pro-woman, but Fiorina’s imagination has cleared higher hurdles than that. “Whether you’re pro-choice or pro-life…the majority of Americans are horrified by the reality that we’re harvesting baby parts through late-term abortions,” she said. The View’s hosts were having none of it. “Carly, you know no one’s harvesting baby parts,” interrupted host Whoopi Goldberg. Behar chimed in: “That offends my sensibility to hear you say something like that when you know it’s not true."
Then, Fiorina moved on to minimum wage. “Let's ask ourselves why women do better in a meritocracy,” she said. “Women do better when they’re paid not for time and grade but where they’re paid…for what they produce. … Government and union jobs pay on seniority.” She claimed that a meritocracy—which rewards that good ol’ fashioned, pick-yourself-up-by-your-bootstraps work ethic, a mythological means of social mobility—is what got her “from a secretary to a CEO.”
Fiorina doesn’t think women should get special treatment at all: not when they need time off to recover from childbirth or care for an infant, and certainly not when they’re running for president. She claims her most formidable potential Democratic opponent is leaning too heavily on the gender card. “I think Hillary Clinton has made a case for her candidacy based on being the first woman president,” Fiorina said. “On the other hand, I would never ask people to vote for me just because I’m a woman.” What should Clinton talk about instead? The real issues, Fiorina says, like Benghazi and Clinton’s private emails:
The best part of Fiorina’s segment came when she addressed the comment she made at the last Republican debate about people telling her to smile more. “Do you have people coaching you to act a different way?” asked host Michelle Collins. Fiorina demurred, defending her capacity for joy and humor. “I love to smile and laugh," she said, "but there’s a time to smile and there’s a time to be serious.”
Correction, Nov. 6, 2015: This post originally misquoted Fiorina; she said, “When you’re talking about burying a child, it is not time to smile,” not bearing. The reference to the misquotation has been removed.
Why “Need A Mom” Is the Next Chapter of the Outsourced Self
Need a Mom is a service through which busy and/or emotionally needy customers can purchase, for $40 an hour, “a short-term, temporary” mother, as Nina Keneally’s website puts it: “When you need a mom … not just YOUR mom.” Keneally, a Brooklynite, will sit with you at a coffee house listening to your love-life woes. She will teach you how to sew a button back on a shirt. She’ll accompany you to Whole Foods and help you cook a meal with the groceries you buy.
One thing Keneally won’t do: actually be your friend, as in for real. Forty dollars an hour can’t buy you love.
In the few weeks since she’s been in business, Keneally’s attracted a bevy of press coverage that belies the size of her actual business—just six paying clients so far, with some more who have expressed interest. An agent from William Morris Endeavor has also gotten in touch about television possibilities, as Keneally told me when I caught up with her earlier this week.
Need a Mom started as an informal freebie, or what a less commercial age would call “talking to acquaintances.” Keneally and her husband, a stagehand on the Book of Mormon, moved to Bushwick two years ago after raising two sons in suburban Connecticut. Over time the twentysomethings surrounding her at yoga classes or volunteer projects began confiding in her, no doubt seeing her as a stand-in for Mom—she was, after all, the oldest person in the room.
After talking several of them through job losses and bad breakups, it occurred to Keneally—who worked for a number of years as a substance abuse counselor—that maybe there was a business model lurking in these new relationships. “There are people who have a mentor in their professional lives; now I am doing that in their personal lives,” she told me. Her clients need help with, for example, “writing an intelligent letter to a landlord to get a rent deposit back.”
But Keneally’s parenting skills have another application. “I am happy to talk to young parents, whose own parents are far away,” she says. “If you are a young parent without any parent nearby to talk to, that can be one of the loneliest things in the world.” Just one thing: Don’t call her a “substitute grandparent.” She’s not your child’s grandma any more than she’s your mom.
Is Need a Mom, as tiny and nascent as it is, a sign of the times? People of means can buy emotional labor and all the fawning attention they want. Haute nannies who have college degrees and speak Mandarin can watch their kids while they attend sessions with “wealth therapists.” They can even buy friend equivalents, as Richard Kirshenbaum pointed out in the New York Observer a few years back—everyone from the art consultant to the fashion stylist might also be getting paid just to hang around.
In The Outsourced Self: Intimate Life in Market Times, Arlie Hochschild writes about how overworked Americans, used to living in a society where almost any human contact can be reduced to a financial transaction and outsourced, have turned to the service sector to meet needs that were formerly provided by family, neighbors, and friends. Hiring help for everything from organizing a closet to planning a child’s birthday party has been normalized. Toddlers who once played in parks now go to outfits like My Gym.
Paid companionship is drifting down the food chain. While kiddie-play classes and rent-a-relative services are not for the poor, the amount of money they actually cost is, for some, an affordable luxury. It’s sort of the equivalent of buying a Gucci-branded keychain—you need to have some means to make the purchase, but you don’t need to spend a few thousand dollars on a handbag.
If you can’t afford Need a Mom’s rates, by the way, Keneally says she’s happy to barter. She has a Shar-Pei, for instance, and can always use a dog walker.
Justin Bieber, Drew Barrymore, and the Perils of Being a Child Star
If you’re not already a fan of the Canadian popstar responsible for the Internet’s latest unauthorized dick pic, Billboard’s latest cover story just might make a Belieber out of you. Chris Martins’ profile of the reformed, repentant Justin Bieber renders the musician as a sincere, self-aware guy who’s still trying to have a childhood at age 21.
Bieber’s adolescence, to the extent that he had one, was marked by the pressures of sudden stardom and ruthless public scrutiny. It sounds like he’s reflected quite a bit on the surreal nature of celebrity life, which briefly found him better known for public urination and driving under the influence than for his music. “I wouldn’t suggest being a child star,” he told Martins. “It’s the toughest thing in the world.”
It’s easy to see why Bieber might bemoan celebrity culture as based “on people’s looks and stuff.” The public has shuttled at warp speed from making fun of him for allegedly stuffing his underwear to compensate for a tiny penis, to ogling his actually-quite-large penis in paparazzi photo. “I do feel the photo was an invasion of my privacy,” he says in the Billboard piece. “I felt super violated.”
Bieber seems to have cleared the bulk of his coming-of-age hurdles, despite the adorable fact that he’d never tried seared tuna before his Billboard interview dinner and still grimaces at the taste of hard liquor. He feels for his younger peers who are still figuring it out:
“I want people to be more kind to young celebrities, like Kylie [Jenner]. Look at her world: She has been living on TV since she was a kid. Every time she’s looking around she sees a camera, and that’s affecting how she’s thinking and how she’s perceiving people and why she has to do certain things ... Situations that happen taint your mind, especially in this industry. Especially for girls… Look at the statistics on how many child stars have crumbled and turned out to be wack jobs. It’s because—it’s fucked, bro, this lifestyle.”
If anyone knows about the trials of child stardom, it’s Drew Barrymore. The actress’s new collection of essays, Wildflower, is lighter on salacious Hollywood teen party stories than her 1991 memoir, Little Girl Lost, but it puts some of her adolescent struggles with alcohol and drug abuse in context.
When Barrymore was 11, she writes in Wildflower, she spent several months in Munich filming a made-for-TV Christmas movie called Babes in Toyland. “I really have no idea how or why I was given such a long leash, but I could go anywhere I wanted by myself, and I loved it,” she recalls. Along with the other kids in the film and some teens from an area army base, Barrymore’s regular pastime on the trip was to “sit around, get drunk, and listen to heavy metal.” One night, she and the others got wasted, stole laundry bags off other hotel patrons’ doorknobs, and threw them off hotel balconies into a stream below.
In Barrymore’s narration of the guilt she felt (and still feels) afterward, it’s painfully clear that she lacked any real boundaries or guidance to help her figure out her relationship to the world. Ditto the charmingly naïve segments on finding her first apartment and learning how to use a laundromat at age 14 after filing for legal emancipation from her parents. Her fridge filled up with near-empty takeout containers and half-eaten sandwiches, molding away, because she didn’t realize she was supposed to throw them out.
Bieber’s parents had him in their teens and didn’t lead an easy life. They’ve both had periods of no contact with him; it sounds like he’s weathered his turbulent ride through puberty and fame largely on his own. It’s not hard to imagine a world where Bieber’s gone the way of the “wack job” celebrities who didn’t survive their addictions and reclaim their careers like Barrymore has. But in the Billboard interview and other recent appearances, he seems humbled, even faintly mature. “I've done some things that might not have been the greatest,” he said on the Ellen DeGeneres Show earlier this year. “I just want to be able to laugh about it and…own up to some of the things." I have a feeling Justin Bieber, former child star, is going to be just fine.
Why Blake Shelton Is a Total Loser Who Doesn’t Deserve Gwen Stefani
Perennial cool chick Gwen Stefani and backwards skirt-chasing doofus Blake Shelton confirmed their romantic relationship yesterday, a move that’s inspired a mini-identity crisis as I reevaluate the standards of a music-industry hero I’ve held dear since childhood.
Stefani and ex-husband Gavin Rossdale announced their divorce in August. To my eye, Rossdale made a perfect subdued, bottom-y counterpart to Stefani’s brash glamour and fabulously loud personality. Still, no one knows what the behind-the-scenes of that 13-year marriage was like, and some sources say he cheated, so, whatever—good riddance, if Stefani wants him gone.
But why would this extraordinarily talented, unapologetically sexy woman, who’s used her platform to make feminist noise and give outlandish weirdos a role model, choose her loutish, insecure Voice co-star as her next mate?
My guess is that Stefani never read the People interview Shelton gave just a month after he filed for divorce from fellow country musician Miranda Lambert, in which he makes two boring quips about hot women being hot. When asked which of the other Voice judges he’d want to trade places with, he picked Maroon 5’s Adam Levine: “He's married to a super model. Need I say more?" When pressed on whether Levine would be surprised by the choice, Shelton doubled down. "I don't give a fuck,” he said. “That's who I'm picking and it's because of his wife. Period." He also said he’d swap lives with Stefani “just so I could stand in front of a mirror naked.” What a charmer!
Stefani probably also doesn’t remember when Shelton tweeted in 2011 that he’d gay-bash any guy that came on to him. “Re-writing my fav Shania Twain song.. Any man that tries Touching my behind He’s gonna be a beaten, bleedin’, heaving kind of a guy,” he wrote. Earlier that year, in an equally transparent attempt to preserve his fragile manhood, Shelton made a tired Brokeback Mountain joke about Jake Gyllenhaal at the Acadamy of Country Music Awards.
I’ll forgive Stefani for overlooking Shelton’s possible past as an unrepentant turtle-killer in her background research. Bragging about hitting a turtle with his car was bizarre enough, but when people expressed concern on Twitter, Shelton couldn’t take the heat: He told them to “shut up” and called them “turtle freaks” who eat their own boogers. Bullying random, non-famous Twitter critics seems to be the M.O. of this multi-millionaire, actually. He has a history of retweeting negative comments, egging on his fanbase to come to the defense of his paper-thin ego.
And I’m sure Stefani didn’t watch Shelton co-host last year’s ACM Awards, where he made a cheap dig at Britney Spears for lip syncing at her live shows, then watched approvingly as Rascal Flatts lip-synced their own way through a performance.
But however and whyever Stefani ended up with Shelton, my love for her is getting harder to preserve. Rumor has it the two have written a country song together, although I guess it could be worse—the world doesn’t need one more homophobic poser trying out ska.
Child Care Is Crazy Expensive, but Child Care Workers Still Can’t Make Ends Meet
Last month, the Economic Policy Institute told us that child care costs are more than rent in many U.S. cities and more than in-state college tuition in others. In its latest report, a study on the wages of U.S. child care workers, the EPI follows up with the understatement of the year: “The unaffordability of child care is not driven by excessively lavish pay in the sector.”
In fact, in most cities and regions in the country, more than 90 percent of child care workers (excluding preschool teachers) don’t make enough money to achieve a “modest yet adequate living standard” for one person where they live, a standard drawn by the EPI’s family budget calculator. Child care workers who support other family members have it even tougher, which is one reason why 1 in 7 live below the poverty line and nearly half use one or more public support programs to make ends meet, compared with just a quarter of the total workforce.
Across the country, the median hourly wage for child care workers is $10.31, compared with $17 in all other lines of work. Study author Elise Gould points out that 95.6 percent of the country’s 1.2 million child care workers are women, and a disproportionate number are immigrants and people of color, which would make them more likely to earn lower-than-average wages in any other job, too. But even when Gould controlled for demographic disadvantages, she found that the hourly wages of child care workers were 23 percent lower than those in other occupations.
The worst wages-to–cost of living ratio in the U.S. for child care workers who aren’t preschool teachers is in Honolulu, where a full-time worker will only make 39 percent of a one-person family’s basic budget. The best is in rural Nevada, where she’ll make just about enough to make ends meet: 104 percent of the basic budget for the region. And the actual picture could be even grimmer: Gould notes that the study has probably overestimated child care wages, because data on self-employed workers, including those who provide care in their own homes, are unavailable. This population makes up nearly a quarter of all child care workers and is likely to earn lower wages than the rest.
When you consider the compounding effects of skyrocketing child care costs and meager child care worker wages, it’s clear that parents who work in the industry are getting doubly screwed. The Department of Health and Human Services sets the threshold for affordable child care at a laughable 10 percent of a family’s income. The wages of an average child care worker, including higher-paid preschool teachers, are not enough to meet that standard anywhere in the country. Washington, D.C., has the highest average child care costs ($1,472 per month), meaning a D.C. preschool teacher with an infant will spend 66 percent of her income on child care. For non-preschool child care workers in 21 states and D.C., it takes more than half of a year’s full-time wages to put one infant in a day care center.
Making child care more affordable is an economic quandary for the business world. “In the child care sector—unlike in other sectors—it is impossible to improve productivity (and hence decrease costs) without lowering quality,” writes Gould. Increase the child-to-caregiver ratio, and kids suffer. Child care workers are already earning far less than other workers—poverty wages, in many cases—for doing one of the most important, taxing jobs out there. It’ll take the concerted action of both private employers and government entities to fix this tightening double-bind.
OG Star Wars Hipsters Might Disagree, But CoverGirl’s New Makeup Line Is Kind of Awesome
In a new commercial for its Star Wars–themed line of mascaras, lipsticks, and nail polish, CoverGirl asks viewers to weigh in on the age-old faceoff between good and evil makeup: “Will you be enticed by the dark side, or embrace the light side?” Choose the former, and you get a stormtrooper’s geometric black-and-white accents; pick the latter, and you can look like a golden, glowing interpretation of the droid C-3P0.
The last time CoverGirl tried a movie-inspired tie-in, it fumbled. A line affiliated with the Hunger Games film series in 2013 drew from the Capitol’s over-the-top fashion and makeup, a symbol of the contrast between that district’s material indulgence and the rest of the country’s poverty. Tumblr users puzzled over CoverGirl’s lack of regard for the inconvenient context of the books and film, in which Capitol residents obsess over luxury goods while watching poorer teens kill each other as entertainment. Some Nostradamus-in-training at the Daily Dot mused that “CoverGirl’s makeup line (which ‘celebrates’ the 12 Districts that work to support the super-rich Capitol) is basically the equivalent of a Star Wars marketing campaign inviting fans to join the Empire as an entry-level stormtrooper.”
Now, CoverGirl is doing something like that. And the results seem promising! The six looks in the commercial make both the Star Wars and CoverGirl brands—two heavily marketed, highly recognizable imprints—into something bold and new. The line gives familiar Star Wars characters a feminine, contemporary spin, and it offers CoverGirl the chance to dive into today’s trend toward loud, performative makeup like metallic lipsticks, a far cry from the the fresh-faced “easy, breezy, beautiful” look on which it made its name.
Predictably, True Star Wars Fans® have spoken out against the makeup company’s unjust cooptation of their sacred, hypermonetized franchise.
I just saw a commercial for Cover-Girl, the makeup, and their “Star Wars Edition.” This is the end.— Jeremy Birmingham (@Birm) November 3, 2015
These OG Star Wars hipsters might not approve of a lowered bar for fan participation, especially one that’s motivated by women. But Star Wars–inspired makeup—whether made by CoverGirl or improvised with other brands—seems like a natural entry point for the green or modestly committed fan of any gender.
The best part of the CoverGirl campaign is its spot-on spokesperson: Janelle Monáe, whose music and android alter-ego have taken cues from sci-fi paradigms and space-age aesthetics in the tradition of Afrofuturism. “The android to me represents the ‘other', the new ‘other,’” Monáe told the BBC last year. “There are so many parallels to my own life; just being a female African-American artist in today’s music industry.” Given Monáe’s politics, the CoverGirl commercial’s use of an old labor slogan (“which side are you on?”), and circling theories about the erasure of oppression and racism in the popular history of the Star Wars universe, you might think CoverGirl’s just given Star Wars fans a new way to radically deconstruct the films while still collecting all 10 limited-edition mascaras like good capitalist citizens. The Capitol would be proud.
Why Are Middle-Aged White People’s Death Rates Rising? A Researcher Explains.
Two Princeton economists released a study on Monday that puts the United States’ recent spike in heroin and prescription drug overdoses in alarming perspective. Overall death rates among middle-aged white Americans are rising due to a huge jump in suicides and certain drug- and alcohol-related deaths, while at the same time falling in every other age group, racial or ethnic group, and wealthy nation in the world.
The study’s authors, Anne Case and Angus Deaton, a married couple, were each working on unrelated research projects when they hit upon this trend. Though deaths from suicides, accidental drug and alcohol poisonings, and liver diseases related to alcohol abuse are on the rise among all education groups in middle age, they’ve had a particularly detrimental effect on whites with a high school level education or less. In this education group, the mortality rate for whites aged 45 to 54 rose by 134 deaths per 100,000 people—from 602 to 736—between 1999 and 2013, enough to turn around the previous downward overall trend of mortality rates for the entire age and race group.
Over email, Deaton explained why the data surprised him, how this epidemic compares to the HIV/AIDS crisis, and why the study matters to discussions of income inequality. (This interview has been edited for length and clarity.)
It sounds like you sort of stumbled across this discovery while looking at other data. How did that happen?
Anne was working on [researching] pain and morbidity, and I was working on suicide. At some point, I thought it would be useful to put the suicide data in the context of overall mortality, and did so in comparisons with other countries. We then immediately saw that the U.S. was doing very badly in this group, discovered the rising mortality rate, and saw that it could not all be suicides, though suicides contributed. So then we went through the causes of deaths, and found the poisonings. At first, we thought of cyanide, or accidentally drinking Drano, but then we realized what it was [alcohol and drugs].
What did you think to yourself when you first noticed the trend?
That it surely must be wrong! We spent an enormous amount of time going over the data over and over, and checking and triangulating it.
You told the New York Times that HIV/AIDS is the only good analogue as far as these death rates go. Can you expand on that comparison?
We calculated that about 500,000 middle-age Americans died who would still be alive. AIDS has killed more than that but the numbers are in the same ballpark. The comparison is useful because people have a hard time thinking about changes in mortality rates—so many per 100,000. And everyone knows about HIV/AIDS: People wear ribbons and it is seen as a national tragedy. But there are no ribbons, no awareness for this, and there should be.
In the study, you present a few possible reasons for the climb in morbidity, including the fact that middle-aged people are experiencing more chronic pain than in previous years, which could lead to suicide or drug abuse. What implications could this study have on discussions of U.S. health care?
I am not sure this has much to do with health care. Addiction is very hard to treat, and it is not clear that insurance, even with the extension to mental health, is helping as much as it can.
This paper could contribute to conversations on income inequality, too, considering that suicide rates have gone up among poor Americans as their real income has fallen.
Yes, I hope so. We already know that income gaps are widening between better-educated and less-educated people. This study says the people with low incomes are losing out not only on income, but also on health.
Did you look at any regional data breakdowns within the U.S.?
There are broad regional patterns in the paper. It is not so easy to break down the increase in deaths by state and education, [though], and it is a colossal amount of work. We do know that some of the patterns of self-reported morbidity worsening in middle-age are increasing in the same way in every one of the 50 states.
Why did you combine alcohol poisoning with drug overdoses, and heroin with prescription opioids, in your data analyses?
It seems sensible to put all of the accidental poisonings together. Also, some of the literature suggests than when people can’t get opioids, they turn to opiates. And alcohol is also a drug in a similar sense. But we grouped those with liver disease and with suicide because drinking and drugging can all be thought of as ways of killing yourself, just more slowly than with a gun.
Rising death rates are troubling for the country at large, but many of the calls from white people for a kinder, gentler drug war and better drug treatment have only come after this enormous recent spike in opioid-related deaths. What do you make of the fact that this study may finally get white people to pay attention to how the U.S. treats people who are addicted to drugs?
There is a famous history of drugs and drug policy on opiates in the U.S. by David Courtwright called Dark Paradise, which notes that how America treats opiates (and opioids) has always depended on who are the users: rich or poor, black or white, educated or not. So what we are seeing now, with a kinder gentler war as addiction moves from blacks to whites, has happened before.
Abercrombie & Fitch’s New Ads Are Less Sexy, and Therefore Worse
Abercrombie & Fitch is bundling up for winter—and for the rest of eternity. On Tuesday, the brand launched a new winter line and ad campaign that lean a lot lighter on its trademark hypersexualized advertising. It's one part of a company-wide effort to recapture some of Abercrombie's quickly diminishing market share, which has led to the closure of hundreds of stores in recent years.
Craig Brommers, the company’s senior vice president of marketing, told Women’s Wear Daily that the decision was based on customer feedback. “With the evolution of the brand, we wanted to try something new,” he said.
New, indeed. There’s nary an areola nor abdominal ridge to be found in the promotional images for this winter’s line, which consequently reads as shockingly off-brand. For a company whose cool factor has tanked so far that it’s had to scale back production of any clothes that bear its logo, that may be a good thing. That one certain breed of shirtless dude—not too twinky, not too beefy, and not at all furry—was so entwined with the Abercrombie look that it had basically become the company’s signature T-shirt. The store's gimmick wasn't just fun for people: The hormonal catnip on Abercrombie shopping bags allowed curious felines with adolescent family members to mimic a strapping set of muscles for a sexy pic. Even in the winter months and colder climes, Abercrombie made sure to leave some of its models’ rippling muscles exposed beneath their ski-lodge outerwear (see: the half-naked gents in Munich, above).
Now, Abercrombie must rely on the aesthetic value of its garments, not its hired torsos, to sell its wares. The new line is called “From Past to Present,” and it’s fine. There are Nordic-inspired sweaters. There are jeans and flannel and a godless crossbreed called “sleep leggings.” But without the softcore imagery, I’m not sure what I’m supposed to feel. Can I have sex in these clothes, or nah? Will people want to have sex with me when I wear them? Will I want to have sex with other people who wear them? Must the pants be worn with a shirt, or is that a mere suggestion?
Abercrombie’s thoroughly clothed clothing campaign is a sad departure from its oversexed and, I like to think, self-aware advertisements of yore. As Slate's Forrest Wickman pointed out in an essay this week, subtlety is overrated. I’m going to miss the gloriously unsubtle, teenage-wet-dream Abercrombie. Here’s hoping the store-bought clothes still come drenched in cologne.