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I haven't closely followed the kidney-donation discourse, but it feels like everyone else has. (I never thought I'd type those words.) In very brief, The Times ran a weird and fascinating story that's tangentially about kidney donation, but really more about white savior syndrome, narrative ownership, and the high drama of Boston short-story writerly existence. The mix of which is apparently how you get people excited to read about kidney donation.
Whatever, I'll take it. Millions of people die of kidney disease every year, and many millions more are in the early stages of kidney failure without knowing it. Meanwhile most people don't even know what kidneys do.
My first act as surgeon general would be to ban bar graphs where the Y axis doesn't go to 100. My second through tenth would be to expound on the origins of urine. (Where do people think it comes from?)
Most people who refuse vaccines do so, in part, because they believe they'll be okay without one (and don't fully consider the risk they pose to others via transmission). But in this case, a person is refusing vaccination even knowing that unless she can find another transplant option, going without a kidney would mean a life of serious complications and very possibly even death due to organ failure.
It's illegal for doctors to assist in suicide actively (in most places), but patients can refuse life-saving treatments like organ donation—as long as they're of sound mind. So the additional layer of complexity here is that this woman is reportedly making the decision because "as a Christian, I can't support anything that has to do with abortion of babies, and the sanctity of life for me is precious."
The COVID-19 vaccines do not have anything to do with abortions. The only way to conceivably argue that they do would be by narrowing in on one step in the testing process used in the J&J vaccine that involves distantly removed replicas of what were once fetal cells. Per the University of Pennsylvania's Vaccine Education Center:
It's one thing to disagree with people's value systems and watch them make self-destructive decisions. It's another to know that their decision is based on false information and feel unable to reach them. Which brings us back to misinformation, the fundamental cause of incalculable suffering these past 18 months. And also before that.
Which is interesting because comparisons to the tobacco industry are a cliche that I'm not sure is helpful. When something is a threat to public health, it's almost inevitably compared to the tobacco industry. And it's a tremendously damning claim. The tobacco industry worked for decades to discredit scientists and deny basic facts while its products killed millions of people. In 2016, when legislators were comparing the NFL's downplaying of brain injuries to tobacco, my former editor Dan Engber wrote about this:
I've made this comparison, too, I'm sure. But not every industry that tries to downplay criticism or make its product appear safer than it may be is comparable to big tobacco. And solving problems involves accurately characterizing them. When we jump to the worst known case study in history, it's polarizing and desensitizing. Like breaking out comparisons to Nazi Germany when people are required to show proof of vaccination before entering a casino. We need a broader bank of references for ... things.
Healthy use of social media is tremendously important, and I'll continue to follow the research and update you if it ever seems possible. (This letter is self-published on a Facebook-owned platform but is editorially independent from the company, which I do not speak for or represent.)
Speaking of limited imagination and vocabulary, Rachel Gross wrote a fascinating story recently about bias in human anatomy. It centered on the pudendal nerve, whose linguistic origins I did not know:
Only recently has there been a quest to change the name, and it was not straightforward. As Gross recounts, many members of the anatomy establishment saw this as "a step too far." For some, the pudendum was their crumbling statue of Stonewall Jackson.
Ultimately, it flew. Just like every change that seems big at the time but you forget about a week later.
Next up will be changing the name of the kidney, which means "bean of shame."
I don't know how we become more imaginative and open to nuance. Language matters so much. It's hard to overstate. Maybe that's where we come back to teaching and valuing the arts, which really are central to restoring the social cohesion and cultural literacy needed to advance any issue in public health. This is also my attempted segue (trying to avoid overuse of "speaking of") back to the subject of high-drama fiction writers in cold cities.
Because I just wanted to mention in closing that Franzen's new novel Crossroads is out, and I started reading this week. I did so with temerity. Some of his work is great, and some of his commentary in the past has been weird, and I find it hard to separate authors from their fiction. But it's a book about redemption, so I figured I'd give it a shot.
Then, in the very first sentence, he described the clouds as "full of moist promise." And I had to stop. It pulls me out of the moment when writers use phrases no one would ever say. Imagine looking up at the clouds and instead of saying "it looks like it's going to rain" opting to go with "the sky is full of moist promise." It would be one of those situations where you slowly back away or instantly ask the waiter for the check. The scene is now burned into my imagination. I'm vaguely worried I'm going to say it accidentally.
In any case, I've been encouraged to continue reading the book, and I will. Maybe there's something related to the redemption theme here, involving deliberate and immediate alienation of the reader. Also, further reading recommendations always very welcome. Fiction has helped me get through this pandemic.
That's all for this week. My kidneys have filled me with moist promise. Next week should be a big one. We'll know a lot more about mixing vaccines, as FDA experts are slated to meet. I'll be watching. Stay tuned, keep in touch.
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super informative, funny and thought-provoking newsletter!