Saturday, September 26, 2009

Anti-Semites from Topeka, Birth Control Pills, and The New York Times

I had some troubles with the first amendment today.

I was awakened from a blissful, Saturday morning sleep by the cries of a woman urging me to die and burn in hell. Actually, not just me, as it turned out. I live in Park Slope, Brooklyn, across the street from the large synagogue where my daughter had her Bat Mitzvah. This morning, the day before the start of Yom Kippur, the most important and solemn day on the Jewish calendar, the synagogue was being picketed by representatives of another congregation—the Westboro Baptist Church of Topeka, Kansas.

Looking out my living room window, I saw that the demonstration consisted of about four women, one man, and two stunned-looking children no more than 8-years old, all sporting tee shirts emblazoned with the URL, Which goes to show you this internet thing really is catching on. Each of the demonstrators carried a sign with a little piece of wisdom such as God Hates Jews, Jews Killed Christ, and God Hates Obama. (No matter that the only two things I've never heard the president accused of are being Jewish—too calm—or gay—wife too hot. For haters, the guy's a one-stop shopping mall.)

So these fine Americans are on the sidewalk, right in front of my house, fenced in by a little pen made of police barriers. Across the street on the temple steps are about 200 Saturday morning worshippers, guests of the 13-year old girl having her Bat Mitzvah today, neighborhood people, and passersby. The harridan who seemed like the demonstrators' captain led them in anti-semitic chants and songs, as she danced a jig with an Israeli flag, merrily pretending to blow her nose in it. Clearly, she was having the time of her life, protected by a small army of grim looking cops.

The crowd around the temple shouted back fitfully, not wanting to allow themselves to be provoked, not sure what to do. At the top of the temple steps, Rabbi Andy Bachman stood urging calm and occasionally attempting to lead the crowd in song. Then he had a better idea. Suddenly the rabbi was holding the shofar, the traditional ram’s horn blown to usher in the new year on Yom Kippur and, in biblical times, to rally Jewish armies against their enemies. Rabbi Andy blew the shofar, and its ancient sound filled the street more beautifully than I have ever heard it before. Many in the crowd chanted the traditional response. My beautiful daughter and her friends began singing Havah Nagilah and joyfully dancing the hora in a circle, as the rest of us clapped and sang along, some through tears.

The first amendment protects free speech, even hate speech, and I would never want to see that right abridged. But I was taught, in elementary school, that the guiding principle of the Bill of Rights was that the rights of all groups are assured, as long as they don’t infringe upon the rights of others. So my view is, let the hate mongers picket in Times Square. Let them rent Madison Square Garden for a Hitler’s birthday weekend hate-a-thon. But when they come to a synagogue to attack Jews, or an African-American church to attack people of color, or an AIDS clinic to attack gays, they are infringing upon the rights of others as clearly and purposefully as if they were throwing rocks and bottles. And no American should have to tolerate that.

As the Westboro Baptist Church members packed up to slink away to their next shul, I was impressed by the neat, black portfolio cases that seemed custom-made to hold their signs. I guess when you’re moving around between hate demonstrations, without a police escort, you’ve got to keep a low profile. I’m even guessing that, once in their car, they covered their tee shirts with some Topeka RoadRunners minor league hockey jerseys. After all, even hate nuts have to eat. As long as they’re in New York, they might want to make an incognito stop at a deli for a pastrami on white with mayo. It shouldn’t be a total loss. Without doubt, however, the best sign of the day was held aloft by our pretty 15-year old upstairs neighbor, btw, not Jewish. It told the demonstrators, “You’re not in Kansas anymore.”

Part II

Next, I took part in my daily first amendment ritual, I read The New York Times. Let me say up front that the Times is my second favorite paper, next only to The Castine (Maine) Patriot, and I read it every day. That’s why I cannot fathom the paper’s near comical obsession with skewering the pharmaceutical industry, a goal they pursue as relentlessly as lesser papers go after glimpses of Paris Hilton’s thong. On the front page of today’s (9/26/09) Business Section, The Times attacks Bayer under the headline, Health Concerns Over Popular Contraceptives, by Natasha Singer. (I should mention at this point that I work for Flaum Partners, a healthcare consultancy that has done work in the past for Bayer. One thing I’ve noticed The Times is scrupulous about is disclosing possible conflicts it may have.)

In the story’s lead, Ms. Singer introduces the oral contraceptives Yasmin and Yaz as Bayer’s top products, “…largely as a result of (insert evil musical accent here) MARKETING…” She continues, “Yaz, in particular, the top-selling birth control pill in the United States, owes much of its popularity to multimillion-dollar ad campaigns that have promoted the drug as a quality-of-life treatment to combat acne and severe premenstrual depression.”

Excuse me? This is like saying that the iPod is successful, because Apple has cool commercials. Women and their physicians have switched to Yaz, because it’s a great product. If a woman who is using an oral contraceptive anyway can get relief from pre-menstrual dysphoric disorder and help controlling her acne, why wouldn’t she switch to Yaz?

Of course, the Times’ answer to that question is that “the Yaz line’s image has been clouded by concerns from some researchers, health advocates and plaintiffs’ lawyers. They say that the drugs put women at higher risk for blood clots, strokes and other health problems than some other birth control pills do.” The article continues, “Those critics, though, are up against a large European health study, sponsored by Bayer, the German pharmaceutical giant, that reported the opposite conclusion. The Bayer-financed study said that cardiovascular risks in women taking Bayer products were comparable to those taking an older formula of birth control pills.”

Okay, a few things. First, let’s address the nasty implication that the European study is skewed, because Bayer paid for it. Clearly, if Bayer hadn’t conducted this study, The Times would be excoriating them for failing to responsibly monitor Yaz’s performance in the real world. Conducting clinical trials on new drugs, even after they’ve come to market, and spending billions of dollars in the process, is what pharmaceutical companies do. How does the Times imagine new drugs get developed? Who does Ms. Singer think usually foots the bill, the tooth fairy?

Let’s get to the crux of the medical issue. Yaz contains a relatively new progestin called drospirenone, which, in rare instances, can raise potassium levels in the blood to dangerous levels. (As The Times notes, 5.81 million prescriptions for Yaz were filled in the first half of this year alone, yet all the ambulance chasers in the country have been able to round up only 74 women willing to sue.) But even that very low risk can be made nearly undetectable, if doctors and patients follow the recommendation in the drug’s label that potassium levels be monitored with a simple blood test.

“Not so fast, Sparky,” I can already hear the managed care companies screaming, “We’re not paying for any clot preventing, defensive medicine blood tests!” (Memo to NY Times: Looking for people who don’t give a damn about a few strokes here, a few heart attacks there? Think Insurance Industry.) Even from a health economics point of view, I would argue that the cost of those blood tests would be more than offset by dollars not spent on dermatologist visits, acne medications, antidepressants, ob-gyn visits, and menstrual pain medicines. And that’s without factoring in—excuse the expression—the well-being of patients.

The article also notes that the FDA recently sent Bayer a warning letter about a quality control problem at one of the plants manufacturing Yaz in Germany. Maintaining manufacturing standards is one of the most important things the FDA does, and discovering irregularities is not uncommon. Bayer has responded that it will take the matter seriously and fix it. But portraying a technical problem in a factory as additional proof that Bayer is trying to trick women into using an unsafe product is just plain irresponsible on the part of The Times.

I never thought I’d say this, but where’s Paris Hilton when you need her?