So you all know I love awards shows, right?  That’s pretty well established by now?

As much as I’ve bloviated about the Oscars, however, it’s the Tony Awards to which I have an actual, real-life personal connection.

When I first moved to New York City, I got to be friends with a nurse at one of the hospitals where I was working.  This woman loved Broadway.  I mean looooooooved Broadway.  She saw everything and got autographs from everyone.  Her apartment was loaded with Broadway memorabilia.  I once stood outside the side door of a theater in the freezing cold with her so as to snag Lauren Bacall’s autograph for my mother.  (Not super friendly, that Lauren Bacall.)

Anyhow, she was on the invitation list for the Tony Awards every year.  And she invited me along with her and her friends the next year.  It would be something of an understatement to say I was crazy happy to go.

It was super space awesome to attend, even though that year it was hosted by Rosie O’Donnell and Nathan Lane and not my #1 celebrity crush Neil Patrick Harris.  While I didn’t technically meet many famous people (except Cherry Jones, whom I actually have met twice now and who is just incredibly nice even to total nobodies like me), I did get to mill around the same ballroom with them (and I rode up an escalator behind Marilu Henner!) and it was easily the most glamorous evening of my life and probably always will be.

So even though it makes me pine for New York City every time I watch, I always watch the Tony Awards.

However…

That’s not the reason I always scan the list of nominees when they’re announced every year.  No, I always look at a particular category for a particular name.  And while I’m not proud to admit it, it makes me a little bit happy any year when that name isn’t there.

The reason I look for this person’s name is that it’s actually been on the list on at least one prior occasion.  He’s a former Tony winner in the particular category I check every year.  [Updated: I just checked, and it turns out he's been nominated three times, with one win.]  And the reason I always indulge in a little bit of annual schadenfreude is that we dated briefly and he ended up dumping me via answering machine.  As I expressed in a follow-up e-mail to him, I was neither surprised nor especially upset at the break-up, and was pretty much on the same page, but it was maybe not the most courageous or gallant way of delivering the news.

I don’t actually wish him ill.  The break-up wasn’t acrimonious, and the relationship was brief and pleasant enough.  The year he won, I was even a little bit happy for him.  (It was long after we’d dated, and we’d long since lost touch.)  But it doesn’t break my heart when I don’t see his name on the list, either.

So that’s this week’s Question — what’s your own source of schadenfreude?  Out with it!  I know I’m not the only one who feels it.  (Heck there’s even a song all about it from a Tony-winning musical!)  Who will confess to feeling a frisson of not-entirely-admirable pleasure at the minor woes of others?  Please note — this is more along the lines of “I love to see the Dodgers lose” (I’m throwing you a bone with a sports reference, Kazzy, since I’m guessing the contents of this post might as well be in Farsi as far as you’re concerned) than “It makes me really happy to set fire to my old landlord’s properties.”  Sociopaths, please keep your answers to yourselves.

For some reason, it was the grocery store that did it.

In 2009, Maine passed a marriage equality bill through the legislature, and the governor signed it shortly thereafter.  That November, the bill was overturned in a “people’s veto” referendum.  Those of you who follow the issue closely and/or read this blog with any regularity know that already.  If you’re in that latter camp, you know that I worked hard on both the legislative piece and the follow-up “No on 1″ campaign.  The Better Half and I were absolutely devastated by the results of that vote.

When we saw that the part of the state where we lived at the time had voted decisively in favor of repealing the law, it informed our decision to leave.  (As I’ve noted in previous discussions of these events, it wasn’t the only reason, but it was a big one.)  For me specifically, there was something unsettling about going to the grocery store and pushing our son around in the cart with the man who would be my husband and wondering what the people around us thought, and how many of them had voted to keep us second-class.  I had never felt that exposed before, but immediately after the vote I felt strangely vulnerable.  It was not a feeling I could imagine tolerating indefinitely.

With that in mind, when I heard this report about the mental health effects on gay people of marriage bans in their state, I could only nod:

Beginning around 2004, several states banned gay marriage. Just before that series of bans, the National Institutes of Health happened to conduct a massive of 43,093 Americans. The questions elicited detailed information about respondents’ mental health. (To validate what people reported about themselves, psychiatrists also interviewed samples of the people in the survey, and their medical diagnoses closely matched the findings of the survey.)

Soon after the wave of state bans on gay marriage, in 2004 and 2005, the NIMH conducted a second round of interviews, managing to reach 34,653 of the original respondents. (That’s a high rate compared to most polls and surveys.)

[snip]

“Lesbian, gay and bisexual individuals who lived in the states that banned same sex marriage experienced a significant increase in psychiatric disorders,” says.

“There was a 37 percent increase in mood disorders,” he says, “a 42 percent increase in alcohol-use disorders, and — I think really strikingly — a 248 percent increase in generalized anxiety disorders.”

To put those numbers in perspective, although Hatzenbuehler did find more than a doubling in the rate of anxiety disorders in states that eventually banned gay marriage, in absolute numbers he found that anxiety disorders went from being reported among 2.7 percent to 9.4 percent of gay, lesbian and bisexual people.

No surprise to me at all in those numbers.  In fairness, I haven’t actually read the study itself.  As with studies that tend to confirm my biases, and in this case my personal experience, I’m inclined to give them more credence than those that seem wrong on their faces.  YMMV.

But I remember the strange, ineffable feeling I would get when traveling in a state that had marriage equality and thinking “We could get married here.”  It made me feel oddly comforted, like we were safer and more welcome there.  And then we’d cross state lines and the feeling would evaporate.  Conversely, I feel distinctly insecure in states where there is a ban in their constitutions, and I frankly refuse any travel to (except transit through) the state of Virginia because of its ban on any legally-recognized contract between same-sex couples.

Of course, Maine’s story has a distinctly happy ending.  Last year we got a much better result at the p0lls.  And once again I was left with a feeling that was hard to describe.  The admixture of joy and gratitude, of feeling welcomed and celebrated by the people who surround us in our state and who voted to recognize our right to equal protection under the law, of unbelievable relief — I don’t really know how to put it in words.  It is a wonderful feeling, and one I hope everyone gets to feel everywhere one day.

Can someone please explain the point of the following to me?  (Via TPM.)

Two days after President Obama’s commanding reelection victory, House Speaker John Boehner (R-OH) solemnly declared Obamacare the “law of the land” — apparently signaling that it was time to move beyond the GOP’s now-hopeless quest for repeal.

The conservative pushback was swift and brutal. Immediately, Boehner’s office was forced to clarify that he remained committed to repealing the law.

And so House Republicans will vote on Thursday — yet again — to wipe out the Affordable Care Act. By their own count, it’ll mark the 37th time they’ve voted to fully repeal or partially dismantle the President’s signature achievement.

Seriously, this is yet another of those political phenomena with a purpose that eludes me entirely.

Given the monument to ineptitude and dysfunction that is the US Congress, there are plenty of wholly legitimate issues on which we can hope to make zero progress in the foreseeable future.  Gun control was one recent casualty of the partisan split, and I suspect immigration reform will be another.  Pretty much anything that isn’t a non-binding resolution in praise of apple pies baked by Jesus gets a one-way ticket to Impasseland these days.  I get it.

But with those other issues, there is at least a gesture toward tackling a problem that both parties pretend they want to fix.  They disagree on how to fix it (background checks vs something something mental health care for gun violence, path to citizenship vs border security for immigration reform, etc), but there is at least some kind of shared notion that Something Must Be Done.

Repealing the Affordable Care Act?  Not so much.  Is there a single human being on the face of the earth paying the merest scintilla of attention who thinks there is any chance at all that it will get repealed, at least during this session of Congress?  Even the most violently frothing Obama hater out there must recognize the utter, unalloyed pointlessness of holding a repeal vote in the House, right?

Fine, sure, OK.  I can grok why House Republicans would need to have a vote to repeal it.  Dumb, but marginally understandable.  But multiple votes on the same issue that will accomplish diddly-squat?  WHY?!?  How could anyone think that’s anything other than a tremendous waste of time?

I swear, the only truly reliable thing about this Congress is that no matter how stupid I think it is, it will always find a way to act stupider.

All I could remember was an illustration.  It featured an old man transforming into a dragon.

I couldn’t remember the plot very well, other than it involved an old man turning into a dragon.  I couldn’t remember any of the characters, and I didn’t recall any of the other pictures.  What memory I had of the book was limited to one picture, and a sense that I had loved it as a small child.

When the memory emerged during my adulthood or why, I cannot remember either.  Suffice it to say that into my mind drifted a hazy picture of an old man transforming into a dragon, accompanied by a longing to find the book again.  The longing was strong enough that, when I happened to find myself in book stores with children’s books, I would see if I could find one about an old man turning into a dragon.  I would ask the workers in the children’s sections if they’d ever heard of such a book, but invariably these conversations took place in gigantic stores with helpful but inexpert staff who had no idea what I was talking about.

I suspected that the picture was really just the memory of a particularly plangent childhood dream.

Then one day I entered a bookstore for children in the city where I was living at the time.  I had been past it several times, but had never been moved to go in.  And that day, on a whim, I decided to go in and ask.

In keeping with the theme of this post, I don’t remember the woman who greeted me that well.  She was middle-aged, if memory serves.  She was very friendly, as one would expect for a children’s bookstore.  I sheepishly asked if she’d ever heard about a book I’d been looking for, the name of which I’d forgotten and the existence of which I couldn’t confirm, about an old man who turns into a dragon.

“Oh,” she said.  “You must mean ‘Everyone Knows What a Dragon Looks Like.”  In a matter of a few seconds, she had ducked around a bookshelf and returned with it in her hands.

It was the book I remembered.  There, toward the back, was the very picture from my memory.  An old man leaps into the air and transforms into a magnificent dragon.  Along with that picture were many, many others, once lost and immediately familiar again.

The memory of that moment fills me with joy even as I write this.  Whoever that woman was, she will probably never know how her simple familiarity with a wonderful children’s book made one guy for a brief minute the happiest person on the face of the earth.  I don’t know what about its magic made me love it so much as a child that it lingered so long in my subconscious, but linger it did and I loved it all over again when I finally found it.

It is a charming and delightful story, a spin on the notion of not judging people’s worth based on how they look.  It is subtly witty and (as noted) gloriously illustrated.  For children who can tolerate a little bit of threatened violence (the dragon shows up to defend a city against a rampaging horde of marauders), it’s a gem.  My son (who adores books) was for a time prone to proclaiming “The enemy is coming” like the messenger who comes running to warn the Mandarin in the tale.  I hope he will love it for the rest of his life, too.

So that’s this week’s Question — what treasured thing have you lost and found?  What have you rediscovered under the buried layers of time?  What called out just loudly enough to make you look for it again?

Kermit Gosnell, butcher, was found guilty today on three of four counts of murder, and of involuntary manslaughter of a woman whose abortion he botched.

Good.  Since it would serve no purpose to try expressing the depths of my contempt for the man, let it suffice to say I am glad to read of this verdict.

But there is something more I want, and I’ve said it already.

[O]ne reason I hope this story gets lots and lots of attention, in Pennsylvania if not the nation as a whole, is that I hope many, many, many people lose their jobs.  I hope some are brought to trial for their own negligent, incompetent and/or indifferent contribution to the mutilation and murder of women and infants.  I hope that the brightest glare of media scrutiny shines on every single person who was charged with overseeing the practice of medicine in that city and state, and that a full accounting of their failures is made.

If you click the link in my first paragraph, you will read a litany of regulatory failures.  I find them both utterly baffling and utterly disgraceful.  I want to know who was responsible for them, and if they are also facing legal penalties of some sort.

Women entrusted their lives to this monster, and they did so assuming the state was doing its job to remove from practice those who were flagrantly untrustworthy.  The state, in the form of its employees, failed, and failed miserably.  I am pleased by the Gosnell verdict, but not satisfied.  Someone else is responsible for allowing his crimes to continue for decades, and deserves a fair portion of attention and shame, as well.

So let’s have it, Pennsylvania.  What else do you have?  Today’s verdict is a good start, but don’t think the work is done.

One of the pitfalls of trying to keep a blog going with new material is that, sadly, the irritations and frustrations of its author may persist unchanged with time.  The worry that one has griped about something already and the related temptation to gripe about it again regardless are probably best kept under a vigilant blogger’s gaze, lest his loyal readers (all dozen or so of you!) mutter discontentedly and grow bored.

And yet, sometimes life pushes the temptation button a bit too hard.

So I apologize for ranting this morning about something I am certain I have already ranted about before.  I regret that it could not be helped.  Furthermore, I apologize to readers who may or may not be my mother (it was nice chatting with you yesterday!) that the swearing that is shortly to commence also cannot be helped.  This post will not be sufficiently cathartic without it.  I regret this defect in my character and beg your indulgence.

Ahem…

ATTENTION, PARENTS OF AMERICA!  I UNDERSTAND THE SIREN CALL OF CONSTANT COMMUNICATION AND CONTACT WITH THE WORLD ALL TOO WELL!  IT IS A MARVEL OF OUR AGE THAT WE CAN STAY IN CEASELESS TOUCH WITH FRIENDS AND LOVED ONES, AND DISCOVER HOW KIM KARDASHIAN LOOKS AT ANY GIVEN MOMENT SHOULD WE WISH TO KNOW!  HURRAH!

But if you are accompanying your child for a medical appointment, I implore you to put your goddamn fucking cell phones away for the duration of our time together.  Away entirely!  This does not mean “pause briefly in your texting to look up when I enter the room.”  This does not mean “answer my questions in a manner you consider satisfactory while simultaneously checking your Facebook updates.”  This means “taking the device from your hands and placing it in an appropriate receptacle until such time as our interaction has concluded.”

Is the world a fascinating place, full of scintillating new facts and rumors and fun?  Boy, howdy!  I get it.  But there is literally nothing in the whole wide world more important than your child’s health, at least as far as you should be concerned.  Nothing.  And if the reason for your coming in to see me was important enough to get you here, it’s important enough for you to disconnect from the datastream for the duration of the appointment.  Period.

As I drove home after running an errand last night, I was listening to the awesome Boston-area music station I love when I heard the DJ make brief mention of something called “mangagement rings.”  For those of you unable to parse that appalling portmanteau, these are apparently the new thing in jewelry — engagement rings for men.

The name is, of course, ridiculous.  If we’re stretching the concept of “engagement ring” to include men, I’m not sure why we cannot also stretch our understanding of the term.  Unless we’re going to start referring to betrothed men as “mangaged” (please let us not start referring to betrothed men as “mangaged”!!!!!!!!!!!!!!!), there is no reason to refer to rings signifying their betrothal as “mangagement rings.”  While not as hideous as “manscaping,” I would like to declare a permanent ban on any neologisms that attempt to make “man-” a prefix.  It is not.  Please desist, America.

However, I believe I’m going to have to bait Kathy Shaidle and cast my vote in favor of the rings themselves.

First of all, I actually wore a ring on my left fourth finger after the Better Half agreed to marry me.  (I’ve considered myself “married” since we had a religious service with the whole wedding hoopla the better part of a decade ago.  It seems an odd demotion of sorts to now think of him as my “fiancé” as we approach the date of our “legal” wedding.)  It wasn’t a new ring, it was one he already had that fit me, and I liked wearing it.  He didn’t ask me to do it, but rather it was something I chose to do because it made me happy to have a visible symbol of my exit from the dating world.

Thus, I am all on board with gender parity with regard to engagement jewelry.  If we expect women to sparklingly declare “off the market!” to the world, I’m not sure why men should not so declare themselves.  They’re both “taken,” so to speak, not just her.  Why is she the only one we expect to make it known to possible paramours on the prowl?

This is not to say that I don’t think gigantic, extravagant diamond engagement rings are an idiotic frippery.  (Sorry to any readers who have gigantic, extravagant diamond engagement rings!  I will add you to “chronic Lyme patients” and “James Franco fans” on my “People Who Hate Me” list.)  I don’t know when it became de rigueur to sink a certain percentage of one’s liquid assets into a material testament of one’s beloved’s worth, but I think it’s silly.  Saving up for a mortgage down payment seems a more sensible and more meaningful way of saying “I love you” to me.  But then, I’ve never really understood status symbols as a whole.  Seeing some of the more affluent mothers in my practice with one of the Pillars of Hercules slapped on their left hands, I am often tempted to say “I see that you are very, very rich” because it is so obvious that that’s what I’m supposed to think.

Therefore, I hope that if this idea catches on that men won’t also start trying to one-up each other with ever more ostentatious displays of wealth.  (While I’m at it, universe, I’d also like a wine cellar.)  But as far as gender parity whether or not to wear engagement jewelry at all is concerned, I say bring on the engagement rings for dudes!

Just don’t give them a stupid name.

Oh, Adam Gopnik.    Are you aware of how ironic this is?

When I was a child, two piles of magazines, pillars of this misplaced faith in a leisurely reading future, rose in adjacent basements. In our house, Scientific American, dense with Feynman diagrams and unplayed mathematical games, accumulated, month after month; in my grandparents’, it was National Geographic, yellow-bordered, and with a bright, unpredictable photograph—as likely an Afghan child as a space shuttle—on its cover. Though occasionally the Scientific American pile got upturned by an eleven-year-old searching for science-project material, as far as I could tell the National Geographic pile was never disturbed by its owners, and was there merely to ascend, ever higher.

National Geographic?  A pillar of misplaced faith in a leisurely reading future?  Sure, I guess.  We, too, received it in my childhood home.  I remember leafing through it absently as a boy from time to time.  I guess my impression of that publication dovetails well enough with Mr. Gopnik’s.  But what other publication has held undisputed primacy in my home as a scornful reminder of leisure reading time a long time gone?

The New Yorker, of course.  The very publication from whence the above  musings came.  I just happened to come across the passage as I happened to flip through a recent issue on one of the fleetingly rare occasions I had to sit down with a copy.  I found it deeply ironic.

Yes, my home is festooned with unread copies of the New Yorker.  Indeed, I get the sense that mine is not the only one.  It has gotten to the point where I approach the mailbox with dread, fearing to find another issue to join its contemptuous unread brethren on various flat surfaces of my home.

I have written about this before:

When I finally became a New Yorker in real life, I subscribed shortly after I arrived in the City.  For three of the years I lived there my apartment was on the Upper West Side and I worked just south of Murray Hill, and for my last year I lived in Chelsea and worked on the Upper East Side.  (For two intervening years I lived on the Upper West Side and worked on the Upper East Side.)  Because of this, I usually had a commute to work that lasted about 45 minutes twice a day, almost all of it sitting on subways and buses.  It afforded ample time to read the whole thing cover to cover every week.

While many of the things included in the “Goings on About Town” were too pricy for my meager salary at the time (to say nothing of many of the restaurants featured in “Tables for Two”), I still gloried in the multitude of activities and events I could be experiencing.  I went to enough of the obscure and exotic films, caught enough of the Off-Off-Broadway plays, saw enough of the exhibitions to feel like I was getting as much as I could out of the offerings at hand.  And of course I learned a lot of fun stuff about interesting subjects by reading the articles.

[snip]

Alas, it is now rare that I do more than glance through them at all.  I have the same commute time, but it is now spent driving along the ruthless highways of the Boston exurbs.  While this has allowed me much more appreciation of another Great Liberal Media Icon (NPR), it offers no time to read my erstwhile beloved.  Days at home are spent largely wrangling The Critter.  What time remains is often spent on such frivolous pursuits as writing posts like this one.

But still I will not let my subscription lapse.  I am still an urbane sophisticate, dammit!  And so they pile upon themselves, instantiating both my vanity and my sloth.  I read them just often enough to perpetuate this sorry state of affairs, which looks to last forever.

Since I wrote those words, things have changed even more.  We now have both Critter and Squirrel, each of whom need their own particular kinds of wrangling.  And I no longer read enough to perpetuate anything.

I have finally accepted the fact that it will be a long time before I will be sitting down to read the New Yorker again with any regularity.  When my heart actually sinks when I find the magazine in the mail, it’s time to call it quits.  However I may like to think of myself, there’s no point in paying money for a publication I don’t read at all anymore.

So this past weekend I had the Great Symbolic Recycling Purge.  I went through our pile of “to be dealt with” mail and extracted all the copies I could find.  So, too, the ones on random countertops and bookshelves.  The issues that have, in a fit of optimism, found their way to my office are destined for the dustbin.  And I’ve thrown out the subscription renewal card they just sent me.

In the not-too-distant future and for the first time in over a dozen years, I will no longer be a New Yorker subscriber.  And while that’s a mild bummer, acknowledging it is a small price to pay for a wee bit less clutter and minor guilt in my life.

And that’s this week’s Question — what eras have you passed in your life, and how have you marked them?  What have you done to declare, to yourself or others, “I once was this, but now I’m that”?  What once-cherished thing has become a burden, and how did you let it go?

“Because I want to help people.”

When you’re going through medical school interviews, you can expect to answer many variations on the theme of “Why do you want to be a doctor?”  (I know I’ve written about this before, but whatever I said and whenever I said it are lost in the misty ethers of the Internet.)  And there are all manner of things one could say that would make an acceptable answer.  An affinity for life sciences, for example.  (“Money,” though perhaps admirably honest, is  nonetheless a response best avoided.)  However you mix it up, though, you’re going to need to work “I want to help people” in there pretty quick.

And it had better be true.  If you don’t derive a good measure of professional satisfaction from knowing you’ve been of service to people who needed you, the money won’t be worth it and the frustrations and annoyances of medical practice will weigh you down.  Leaving an encounter with the certainty that you did right by your patient must be a meaningful reward, and one that motivates you to get up in the morning the next day.

We like to help.  We’re trained to fix things.  We like it when people get better.  (A patient population comprising mostly healthy people was one of the signal reasons I chose pediatrics.)  We do not like to be confronted with our own collective inefficaciousness.  (See also: death and dying.)

One of the things modern medicine is not particularly efficacious at fixing is obesity.  Losing weight sustainably is incredibly difficult, and (short of bariatric surgery) medical interventions don’t have a great track record of being all that helpful.  Overweight and obese patients are a population we haven’t been able to fix.

So it doesn’t surprise me much to learn (thanks for the tip, Rose!) that we’re not as nice about it as we should be.

Are doctors nicer to patients who aren’t fat?

A provocative new study suggests that they are — that thin patients are treated with more warmth and empathy than those who are overweight or obese.

For the study, published in the medical journal Obesity, researchers at Johns Hopkins obtained permission to record discussions between 39 primary care doctors and more than 200 patients who had high blood pressure.

[snip]

…when researchers analyzed transcripts of the visits, there was one striking difference. Doctors seemed just a bit nicer to their normal-weight patients, showing more empathy and warmth in their conversations. Although the study was relatively small, the findings are statistically significant.

[snip]

…expressions of concern and empathy are not remarkable on their own, what was surprising was how absent they were in conversations with overweight and obese patients.

It seems we’re simply not as kind to these patients.  I wish I could say I was surprised by that, but I’m not.  We are no less human than anyone else, much as we’d like to believe otherwise.

In dealing with patients who are overweight, Dr. Katz added, doctors often show the same biases and prejudices as the culture at large. The problem may be compounded by the fact that doctors are trained to deal with immediate medical problems that have specific solutions, like a pill to lower blood pressure or emergency treatment for a heart attack. But obesity is a far more complex problem that isn’t easy to solve, and that can be frustrating to doctors.

“When we can’t fix what is broken we tend to behave badly,” he said.

I should pause here and note that I haven’t read anything but the abstract, linked in the Times excerpt above.  If I were a truly industrious medical blogger I’d use the hospital databases to find the full text and learn more about the measures and analyses.  Because my own biases incline me to believe these results are an accurate reflection of a real effect, I’m willing to grant it more credence than I might a study about which I had a greater degree of skepticism.  YMMV.  (Hope that meets your standards, Nob.)

Anyhow, I can see how all manner of factors might contribute to this disheartening effect.  As much as we ought to know better, physicians are probably still plagued by the notion that obesity is a failure of willpower on the patient’s part.  Add in the frustration of having a clinical problem that resists solving, and it’s no surprise at all to learn that we fail to treat our overweight patients with the same simple courtesies as our other patients.

For my own part, I hope I don’t really fall into that “we.”  I’d certainly like to think not.  The article goes on to mention patient complaints that their obesity seems to become the topic of conversation with their doctor even during visits for totally unrelated issues, and I’m reasonably confident that’s not something I do.  But how to introduce the subject of a patient’s weight and the impact it might be having on health is an extremely fraught question.  I try to allow enough time for the patient or parent to mention it as a concern first.  Keeping in mind risk of eating or mood disorders as a result of weight, I make a point of saying that any discussion is about health, not appearance.  And I try to keep recommendations realistic, attainable and limited.

But given how deeply the bias against obesity runs in our society (which can cut both ways in the physician-patient relationship), perhaps I kid myself to think I’m not affected by it.  Perhaps I am no different from the physicians who participated in this study.  It would dismay me to have it somehow demonstrated.  In any case, my overweight patients are already forced to live in a world that stigmatizes them.  They are more vulnerable and more needing of my attentive courtesy than other patients, not less.  And I am grateful to the authors of this study for the reminder.

I like to tell myself that, if I put my mind to it, I can make sense of the world.  Or maybe not The World, but most aspects of it when viewed discretely without too many confounding variables.  Perhaps it is a happy lie, but it is one I tell myself with enough frequency to give it the patina of truth.

So it was deeply unsettling to my sense of balance when I could find no even vaguely plausible explanation for this:

The Obama administration announced late Wednesday that it will challenge a decision by a federal judge to eliminate all age restrictions on over-the-counter sales of morning-after birth control pills — a continuation of a rare split with women’s rights advocates that has created unusual animosity toward a Democratic White House.

[snip]

Late in 2011, Health and Human Services Secretary Kathleen Sebelius blocked the Food and Drug Administration’s effort to approve over-the-counter sale of the morning-after pill without age limits. President Obama supported her decision. Last month, Korman overturned the decision, accusing the administration of acting on the basis of politics and not science. Citing scientific data, he ordered that the pill be available to women and girls of all ages.

Late in 2011, you say?  Why, I wonder if I might have had something to say then!

Whether or not you think younger adolescents would use the medication right, one thing that is not open to serious question is whether the medication is safe: it is.  It is safer than a great many medications that are sold without a prescription, including Tylenol, Benadryl and aspirin.  If (as he said when defending the Secretary) the President is worried about selling medications to young girls that may “have an adverse effect,” he should probably start with those.  Having dispensed Plan B personally to hundreds of patients, I have never seen a single case of a serious adverse side effect.  By way of contrast, I have taken care of at least three cases of near-fatal Tylenol overdose.

Ms. Sebelius’s statement is a canard.  Gesturing toward the vanishingly small number of 11-year-old girls who would seek non-prescription emergency contraception (and who, assuming they were genuinely capable of becoming pregnant, have reproductive systems similar to older adolescent girls) is handy way of putting off this politically unpalatable decision until the 17th of Never.  Ms. Sebelius surely knows that getting a sufficient number of fertile 11-year-olds to power a high-quality efficacy and safety study is nigh impossible, as would be getting any institutional review board to approve a study of sexually-active 11-year-olds that didn’t also include lots of very complicated safeguards to determine why these girls were sexually active in the first place.

I see no reason to revise my previous opinion.  I believed then and believe now that the decision to keep an age limit on non-prescription emergency contraception was and is entirely political.  There is absolutely no scientific basis for questioning the safety of the medication for a thirteen-year-old but not a fifteen-year-old.  (In another transparently political compromise, the administration is allowing OTC sales for young women 15 and above.)

However, as unpalatable as I found Sec. Sebelius’s political calculations, I could at least understand them.  I could wrap my mind around not wanting to be seen as “allowing” teenagers to have sex with each other with a lower risk of unintended pregnancy.  As short-sighted and self-defeating as I found the logic, I could discern it.

What I simply cannot grasp is why the administration would fight this decision.  It seems to provide remarkably good political cover in a rare theoretical win-win.  The President can express some kind of half-hearted objection to the decision but shrug and say it’s out of his hands, and allow the medication to be sold as per the judicial order.  The people who most stridently object to emergency contraception, either because they (mistakenly) consider it an abortifacient or because they don’t like the idea of consequence-free sex for teenagers, aren’t going to support the President anyway.  And people like me who are ostensibly on his side and broadly in favor of expanded reproductive health choices for women will be glad to see unfettered access.

But no!  No, they’re appealing the decision.  And I really don’t grok why.  Perhaps I am too stupid to see the reasoning behind this move on the administration’s part, which seems like the political equivalent of striking out in T-ball.  If anyone would like to explain this to me in comments such that my pea-brain can understand it, I’d be all ears.