If you want to make sense of the failure of neoliberalism, as typified by Hillary Clinton, and its vomiting up of proto-fascist leaders like Donald Trump, then author and journalist Chris Hedges nails it again, in this piece, Donald Trump: The Dress Rehearsal for Fascism:
Americans are not offered major-party candidates who have opposing political ideologies or ideas. We are presented only with manufactured political personalities. We vote for the candidate who makes us “feel” good about him or her. Campaigns are entertainment and commercial vehicles to raise billions in advertising revenue for corporations. The candidate who can provide the best show gets the most coverage. The personal brand is paramount. It takes precedence over ideas, truth, integrity and the common good. This cult of the self, which defines our politics and our culture, contains the classic traits of psychopaths: superficial charm, grandiosity, self-importance, a need for constant stimulation, a penchant for lying, deception and manipulation, and incapacity for remorse or guilt. Donald Trump has these characteristics. So does Hillary Clinton.
Our system of inverted totalitarianism has within it the seeds of an overt or classical fascism. The more that political discourse becomes exclusively bombastic and a form of spectacle, the more that emotional euphoria is substituted for political thought and the more that violence is the primary form of social control, the more we move toward a Christianized fascism.
Last week’s presidential debate in St. Louis was only a few degrees removed from the Jerry Springer TV show—the angry row of women sexually abused or assaulted by Bill Clinton, the fuming Trump pacing the stage with a threatening posture, the sheeplike and carefully selected audience that provided the thin veneer of a democratic debate while four multimillionaires—Martha Raddatz, Anderson Cooper, Clinton and Trump—squabbled like spoiled schoolchildren.
The Clinton campaign, aware that the policy differences between her and a candidate such as Jeb Bush were minuscule, plotted during the primaries to elevate the fringe Republican candidates—especially Trump. To the Democratic strategists, a match between Clinton and Trump seemed made in heaven. Trump, with his “brain trust” of Rudy Giuliani and Chris Christie, would make Clinton look like a savior.
A memo addressed to the Democratic National Committee under the heading “Our Goals & Strategy” was part of the trove of John Podesta emails released this month by WikiLeaks.
“Our hope is that the goal of a potential HRC [Hillary Rodham Clinton] campaign and the DNC would be one-in-the-same: to make whomever the Republicans nominate unpalatable to the majority of the electorate. We have outlined three strategies to obtain our goal …,” it reads.
The memo names Ted Cruz, Donald Trump and Ben Carson as candidates, or what the memo calls “Pied Piper” candidates who could push mainstream candidates closer to the positions embraced by the lunatic right. “We need to be elevating the Pied Piper candidates so that they are leaders of the pack and tell the press to [take] them seriously.”
The elites of the two ruling parties, who have united behind Clinton, are playing a very dangerous game. The intellectual and political vacuum caused by the United States’ species of anti-politics, or what the writer Benjamin DeMott called “junk politics,” leaves candidates, all of whom serve the interests of the corporate state, seeking to exaggerate what Sigmund Freud termed “the narcissism of small differences.”
However, this battle between small differences, largely defined by the culture wars, no longer works with large segments of the population. The insurgencies of Trump and Bernie Sanders are evidence of a breakdown of these forms of social control. There is a vague realization among Americans that we have undergone a corporate coup. People are angry about being lied to and fleeced by the elites. They are tired of being impotent. Trump, to many of his most fervent supporters, is a huge middle finger to a corporate establishment that has ruined their lives and the lives of their children. And if Trump, or some other bombastic idiot, is the only vehicle they have to defy the system, they will use him.
The elites, including many in the corporate press, must increasingly give political legitimacy to goons and imbeciles in a desperate battle to salvage their own legitimacy. But the more these elites pillage and loot, and the more they cast citizens aside as human refuse, the more the goons and imbeciles become actual alternatives. The corporate capitalists would prefer the civilized mask of a Hillary Clinton. But they also know that police states and fascist states will not impede their profits; indeed in such a state the capitalists will be more robust in breaking the attempts of the working class to organize for decent wages and working conditions. Citibank, Raytheon and Goldman Sachs will adapt. Capitalism functions very well without democracy.
In the 1990s I watched an impotent, nominally democratic liberal elite in the former Yugoslavia fail to understand and act against the population’s profound economic distress. The fringe demagogues whom the political and educated elites dismissed as buffoons—Radovan Karadzic, Slobodan Milosevic and Franjo Tudman—rode an anti-liberal tide to power.
The political elites in Yugoslavia at first thought the nationalist cranks and lunatics, who amassed enough support to be given secondary positions of power, could be contained. This mistake was as misguided as Franz von Papen’s assurances that when the uncouth Austrian Adolf Hitler was appointed the German chancellor in January 1933 the Nazi leader would be easily manipulated. Any system of prolonged political paralysis and failed liberalism vomits up monsters. And the longer we remain in a state of political paralysis—especially as we stumble toward another financial collapse—the more certain it becomes that these monsters will take power.
Fascism, at its core, is an amorphous and incoherent ideology that perpetuates itself by celebrating a grotesque hypermasculinity, elements of which are captured in Trump’s misogyny. It allows disenfranchised people to feel a sense of power and to have their rage sanctified. It takes a politically marginalized and depoliticized population and mobilizes it around a utopian vision of moral renewal and vengeance and an anointed political savior. It is always militaristic, anti-intellectual and contemptuous of democracy and replaces culture with nationalist and patriotic kitsch. It sees those outside the closed circle of the nation-state or the ethnic or religious group as diseased enemies that must be physically purged to restore the health of nation.
Many of these ideological elements are already part of our system of inverted totalitarianism. But inverted totalitarianism, as Sheldon Wolin wrote, disclaims its identity to pay homage to a democracy that in reality has ceased to function. It is characterized by the anonymity of the corporate centers of power. It seeks to keep the population passive and demobilized. I asked Wolin shortly before he died in 2015 that if the two major forms of social control he cited—access to easy and cheap credit and inexpensive, mass-produced consumer products—were no longer available would we see the rise of a more classical form of fascism. He said this would indeed become a possibility.
Bill Clinton transformed the Democratic Party into the Republican Party. He pushed the Republican Party so far to the right it became insane. Hillary Clinton is Mitt Romney in drag. She and the Democratic Party embrace policies—endless war, the security and surveillance state, neoliberalism, austerity, deregulation, new trade agreements and deindustrialization—that are embraced by the Republican elites. Clinton in office will continue the neoliberal assault on the poor and the working poor, and increasingly the middle class, that has defined the corporate state since the Reagan administration. She will do so while speaking in the cloying and hypocritical rhetoric of compassion that masks the cruelty of corporate capitalism.
The Democratic and Republican parties may be able to disappear Trump, but they won’t disappear the phenomena that gave rise to Trump. And unless the downward spiral is reversed—unless the half of the country now living in poverty is lifted out of poverty—the cynical game the elites are playing will backfire. Out of the morass will appear a genuine “Christian” fascist endowed with political skill, intelligence, self-discipline, ruthlessness and charisma. The monster the elites will again unwittingly elevate, as a foil to keep themselves in power, will consume them. There would be some justice in this if we did not all have to pay.
The parent conundrum here is how to create a way out of neoliberalism while dodging the rise of fascism. Both require a much more politically conscious and politically courageous populace, who on occasion may also be an electorate.
POEM: Farcical Optimism He said to me
"Your optimism is farcical."
I said
"You may be right."
Of course
Wisdom may just be
Realizing that
Farcical optimism
Is ever so slightly preferable
To ...
PROTEST POEM: Round The Public Square Theirs
Smoked filled plays
Behind closed doors
Where there is no room
In the halls of power
Fore the wrest of us
Relegated to copping democracy
Round the public ...
POEM: If I Were King If I were king of the world
My first official act
Would be to resign as king
It is a common fantasy to be a powerful ruler so that you could enact your will over others. ...
This simple poem is a parody of commercialism. This poem mocks the lack of real content in many advertisements. Unfortunately, countless advertisements bombard most any available space in our lives. Such ads compete for our valuable attention and threaten to fill our minds with inane content My poem does have some real content though — yes, that is my real phone number.
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POEM: Mere Image I look in the mirror
At a real piece of work
And I thank God
That genius recognizes genius
Sharing more than mere image
I am more than the sum of the images that you can ...
POEM: Uncollecting Notions She collected
Dangerous notions
Putting them on
A shelf like
Sew many trinkets
Going know where
This poem is about living on the edge, the fringes, the margins -- which ...
POEM: When Butterflies Aren’t Free The butterfly has landed
A monarch of unspoiled nature
As we'd taken over
Urban land escapes
Of green carpet bombing
Convinced that lawn enforcement
Must be
On our ...
POEM: Flowing Inevitably Threw Us Our hearts were broke
A cache sow, well, spent
In solvent
In life
Long
Yearnings
Teaming tsunamis of solidarity
Of the largesse kind
Poor
Over us
Torn as under
A heavy ...
IMMIGRATION POEM: In A Parent Idiocy In a parent idiocy
Wee are tolled
The right
Thing to do
Is children
For sake
In wanting
To be a legitimate American
Leave your children behind
A crashing symbol
To not ...
CLIMATE CHANGE POEM: Donald Trump Has Gone Buggy Donald Trump has gone buggy
As in big ass hoarse drawn carriage
Making hay and whips
With great industry
As unbelievable
As nuclear-powered Amish
A trial balloon
Only to be ...
This short, one-line poem could be mistaken for half a poem. This poem may leave the reader wondering what I, the author, consider to be the worst thing about censorship. This poem may even beg the reader to fill in the blank, the censored blank, for themselves. Part of the point of the poem is that we will never truly know what we are missing when our ability to express ourselves in censored.
There are at least two types of censorship: self-censorship, and being censored by another. Most often censorship refers to the latter, typically in objection to censorship as an unjust social relationship. This type of censorship is important to identify and address because it is a direct threat to free speech. This type of censorship creates a climate of fear among those whose expressions may be threatened, and a mistrust of authority among those who question the legitimacy of such censorship. Censorship stands in almost direct opposition to free speech. No doubt, some expressions should not be considered free speech, such as the proverbial shouting “fire” in a crowded theater. Nonetheless, I suspect that such cases are quite rare. The fear and social control generated by direct censorship ripples far beyond a person’s expression being squelched, and beyond potential recipients of that expression losing out on that expression. The fear of some social sanction leads to countless forms and incidents of self-censorship. This is the insidiously successful child of direct censorship.
If those in a position of power to censor can cow us to become sheep, then their mold of our culture will grow more pronounced in our silence. I suspect self-censorship accounts for much, if not most, of the seemingly miraculous hold that the powers that be have over the masses. Self-censorship allows the illusion that power comes from above, top-down, rather than power being derived from the consent of the people. Of course, power from above, in the form of sheer force, is a scary reality. Social sanctions for simply speaking out can be large. In fact, the presence of a disproportionately large social sanction merely for speaking out is perhaps the surest clue that the underlying reality is unjust. After all, talk is cheap. But if questioning power structures is not dealt with early enough on, then the precarious illusion of top-down power masquerading as authority, and the seeming futility of bottom-up power, will continue unabated. A little shock and awe is sometimes needed to remind people of who is in control. Learned helplessness will do the trick the vast majority of the time.
Overcoming self-censorship is a necessary condition for a free society. We can only deal well with reality if we know what that reality is. This requires liberal self-expression. Heavily redacted realities make poor citizens and sick societies. This may be the best single reason for either avoiding most of popular media, or consuming it with a high degree of literacy, to see it for the spectacle that it is. The images and messages, both overt and subtle, in media have a powerful effect on how we view reality. The simple fact that there is a whole genre of “reality” television that has little to do with reality is probably the best illustration of how far afield we have become. TV is a poor representation of reality.
Overcoming self-censorship requires courage and sacrifice. As Amelia Earhart said, “Courage is the price that life exacts for granting peace.” We can flow with the idolatrous, heavily redacted realities that invade our consciousness unrelentingly through media and advertising. Though such illusions are unsustainable in many ways, there is a lot of force applied to maintain them. Adding your consent to those forces may benefit you in many ways. Or, we can freely and courageously express our own realities which often differ profoundly from the heavily promoted narratives around us. This may exact a price, but, at least it is a price paid in homage to reality, not illusion. Who knows, we may very well find that the realities of the vast majority of humans on this planet have more in common with one another than the dreams foisted upon us. This is the making of peace. As Gandhi so simply and profoundly stated, “Peace is possible.” This reality is so routinely obscured. You can be a living expression of this reality. You are the channel.
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POEM: Cameras Everywhere Cameras, cameras everywhere
Yet what do they survey?
Eyes, eyes everywhere
Yet few can see the way
Big brother is here. Whether it is surveillance cameras, web or cell ...
POEM: Light ‘n Darkness To face darkness
Lighten up
Facing darkness is a serious issue. Nonetheless, the solution is light, or to double the meaning, to lighten up. Perhaps unsurprisingly, I've ...
In Politics Stupidity Is Not a Handicap In Politics Stupidity Is Not a Handicap--FUNNY PEACE QUOTE BUTTON
In Politics Stupidity Is Not a Handicap--FUNNY PEACE QUOTE BUTTON
This cool design is linked to a button, ...
POEM: Escaping Hubris Indigency is the quickest road
Out of hubris
Few of us can afford
Its high price
Hubris, or arrogance, is powerfully seductive in the human mind. This excessive ...
POEM: Treatment…Like…Sewage Treatment...Like...Sewage
I lived in Libertarianville
They said
"If you want sewage treatment,
Just go to some place that has it."
So I did
Many don't live there long
I ...
POEM: Taken In Taken In
What powerful minds
Can wrap themselves around
Pails in comparison
To the sea of mysteries
Taken in
By an open heart
Keys to a door unlocked
Incite weighting
A ...
Poets are like ninjas They come from anywhere They come from nowhere Everybody has heard of them Yet few actually see their work
There are lots of poets. Though some might say not enough. Most people do not read poetry at all. That is, unless you include clever advertising as poetry! I may just. I see poetry everywhere. This is probably why I write more poetry than I read. While I am inspired by others’ poetry, I tend to go straight to the source: life itself. After all, poetry is just a written result of the heart and mind making love in response to life. The inspiration is in the source, not necessarily the effect or interpretation of the source. Poetry may just be a grasping for God, just another elucidation of a deeper, even ultimate, reality. Poets are like priests. In an ideal world, there would be no need of priests. There would be no class of people to mediate our experience of God, and deep realities. We would directly experience such realities. But, alas, we do not live in an ideal world, and poets play a role of elucidating, perhaps even inspiring, others into experiences of deeper realities. Though good poets want to work themselves out of a job, to see others read directly from the depths of reality and offer up their observations, not for some other end, to publish or convert, but as an inescapable expression of joy, grief, and every human emotion and experience. Our lives would be our poetry. Then, everybody would be a poet and nobody would be a poet. Hey, and who doesn’t want to be like a ninja?!
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POEM: I Suspect Here is a May Day poem, where metaphysical optimism crashes into empirical skepticism. Will we simply crash and burn? Or, will we rise like a Phoenix from the ashes? Stay ...
POEM: Shame Old Story A little bit
Of shame
Goes along
Weigh
Too much
With blinders
Knot visible
In a sense
Lost
To over looking
As awe full as life is
This poem is about the overabundance ...
HOPE POEM: Why God Invented Dark God invented dark
As a respite
From high noon
That searing sun
Of which mortal men are made
To see
Sow much more
Innumerable lofty stars
Unseen in mere day dreams
Beyond ...
POEM: Fore Awe That Can Be Souled He lived buy
The law of the jungle
Except for that whole jungle thing
And law
Fore that madder
Welcome too
Living bye
A-morality
A-weigh of living
A-lien from nature
As ...
POEM: A Musing Co-Mission — Nein Poems! Owed to Know One This is nine separate poems comprising one poem, each and all on the theme of the muse mercilessly striking in the middle of the night with irrepressible inspiration from God ...
Managed Democracy And The Illusion Of Politics This article pretty much sums it up. Managing the air, apparent electorate, and the "for most" illusion of politics. Great contribution from The African American Intellectual ...
I seek boundless horizons
Beyond what can be billed
What you can have
Fore walls
No bull work
A retainer for passable living
A cistern to dammed dreams
Reining upon you
Only knot to be brothered with
As some look out
Your winnows
Punctuating all that you can
A fort
Out to sea
A veritable glass menagerie
To one’s peers
Pipe dreams
Leading too
A fire place
Your hanker chief
Scant comfort you
As most daze
Facing a cold hearth
An exhausting flue
And ashen remains
Yet why carp it
When you can have
Your Parkay® floors
For butter or worse
As you slip
Pitter pottering a bout
Your life cast
Dangerously close to kiln
For my ran some
I seek the earth’s bounty
To rise up
To meet my feat
And when I fall
I shall look up
Sharing a ceiling with the stars
No guise worrying
A bout some prostrate iffy canopy
For without
You might lose your marble’s
Stony ledges looking good
As the Tao plunges
And to the great abyss plumb it
To one’s own depth
This poem explores the relationship between the commonplace cubicles of the workplace, both literally and figuratively, and the great abyss singing its siren song, daring skilled sailors to plumb it, risking one’s own depth. A life, well, lived, requires effort. Beyond that, I’m not a big fan of work. This is particularly true in modern America, pawning itself off as the pinnacle of Western civilization. You’d think that the timeless questions of humanity had been answered once and for all, and all that you had to do is buy (and sell) one of the many great brands available. Well, in my book, brands are for cattle. Plus, my preference for vegetarianism leaves me with little use for cattle — or sheep — or chickens. These days, people expend huge amounts of energy, and cash, to dress themselves up with others’ brands, defining themselves by what they own — or what owns them — by what they consume — or by what consumes them! The fact that many people will pay extra for essentially advertising another’s brand shows the vacuousness of our own unique lives. Gee, at least get paid to be a walking billboard. And as I like to say, if you are going to sell yourself, at least get a good price! It seems that living vicariously through someone else’s image, identity, celebrity, or sheer familiarity in pop culture, commands more value than undamming our own dreams.
The Tao is a masterful critique of the superficial. The Tao in Chinese history and culture plays, perfectly synchronously with itself, a balancing role in contrast to Confucianism with its focus on set rules, set roles, and the centrality of propriety. Unfortunately, Western civilization suffers from the worst of both worlds. Modern America lacks both the harmony and balance of the Tao, and suffers a sociopathy, even nihilism, that Confucianism holds in check. Perhaps America can harness its restlessness to throw off the dehumanizing forces of greed and undue focus on economic necessity. The Tao offers a vision of the rest that gives rise to all. The Tao is more than serendipitously short. The Tao is concise, poetic, and sparse on words precisely because reality and relentlessly emerging life cannot be reduced to any imperial plan assuring a particular outcome. It surely cannot be reduced to a brand! The awesome abundance of nature’s bounty and the beautiful openness of human experience invites us, even begs us, into continual re-birth and re-creation. All of creation groans for our freedom and participation in its bounty. So, if it should seem that your life is ever in the toil it, be mindful as the Tao plunges, bypassing technological fixes and vexations, your dammed dreams may very well be unplugged.
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POEM: Owed To Stormi, The Poetess It was a dark and stormy night
The starry heavens
Replaced by blinding light
Striking as lightning
Startling awe
But the bravest
From places unseen
With undeniable ...
POEM: Anew Page Delivering I am
Subject too
The very inquisition
Wanting too a void
Axing the quest in
Who would halve me
Believe
Know
One
Wrote
The book
In my heart
Anything but stone
Nothing ...
POEM: A Full Life Charlie's life was full
Every available space laden to wrest
His productivity well suited
To his interests
Taxidermy and robotics
This short poem offers a challenge to what ...
POEM: Patriot My name is patriot
I am a force to be reckoned with
That few dare oppose
Just tell me what country I live in
And I'll know exactly how to behave
“Patriotism is the last ...
POLITICAL POEM: Among Politicians For Sail In the art of politics
We are the wind
Awe that madders
To those who sea
Among politicians for sail
Transcending them to helm
In their infernal riggings
And whatever ...
I am finally uploaded a new batch of Occupy Wall Street designs. This batch of 125 political designs is mostly Occupy Wall Street designs, but there are also a large series of “stop socialism” designs, a large series of Fox news parodies, and a new line of designs: vegetarian. I still have hundreds of other designs made that I still need to upload, so stay tuned.
The designs below are linked to button products, but each of these designs is available in all of Top Pun’s products such as T-shirts, bumper stickers, mugs, magnets, key chains, sticker sheets, posters, and caps.
If you like what you see, you can check out all of my political designs, which also include more Occupy Wall Street related designs.
Gandhi Quote: First Ignore, Then Laugh, Fight, Win – POLITICAL BUTTON
If you like what you see, you can check out all of my political designs.
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POEM: Skin in the Game Skin in the Game
The gods are at war
A blood sport for many
The spectators are plenty
Seeded at the rite and
Overlooking the arena
As bleachers whitewash
The stain power ...
POEM: To Un-Jar Your Thinking My point is not to jar your thinking.
My point is to un-jar your thinking.
This two-line poem, with a simple wordplay, addresses a fundamental dichotomy that is present in ...
POEM: Nature’s Guardin’ This poem goes out to all those who showed up on May Day for the groundbreaking of Toledo Occupy the Garden.
Nature's Guardin'
Nature spills
From pots unpurchased
It knows ...
Double Oh No: The Name’s Cadabra, Abra Cadabra God's
Name is knot
Abracadabra
Too be unloosed
Unwhirled
As owed man
Putting on
Some kind
Of spectacle
Who's genesis
Giving
No quarter
To years
Behind
In a ...
POEM: A Dubiously Fresh Pickle They effaced a moral dilemma
Support human rights
Or economic favor
A dubiously fresh pickle
In a blue moon
That hoary question
Of prophets verses
Profits
And what they ...
I just returned from donating blood at the American Red Cross. I have been a regular blood donor for a long time. I usually donate blood two or three times a year. Unfortunately, I have been deferred as a blood donor for two of the last four years. I was deferred as a blood donor twice for one year each time, both due to traveling to an area where there may be some malaria risk. The first time that I was deferred as a blood donor was because of travel to Haiti. The second time was due to travel through rural Colombia. In my case, these deferrals resulted in a loss of 4 to 6 units of donated blood to the American Red Cross.
The American Red Cross is constantly trying to recruit new blood donors and to get previous blood donors to donate again. From the regular calls and advertising campaigns, I get the impression that the US blood supply may be low at times and that my blood donations are greatly needed. However, I am struck by the huge range of reasons for deferring willing blood donors. It seems to me that the threshold for deferral is very low. The willingness to accept any nonzero risk is very low. This approach is insane, or least pretty darn close. The vain quest for absolute security and zero risk is a dangerous fiction. I understand the reasons for wanting to avoid blood transfusion related adverse events. However, deferring extremely low risk willing blood donors and potentially depriving someone of a needed blood transfusions is not a zero risk enterprise either. As stated by Richard Benjamin, MD, PhD, chief medical officer for the American Red Cross, “The most dangerous unit of blood is the one we don’t have. Not having blood for someone who needs it is worse than giving someone a unit of blood that carries a 1-in-5 million chance of disease.”
I am not your average blood donor. I have a master’s degree in public health, so I have training in epidemiology, the scientific study of the distribution of disease, health and their determinants. Also, in the 1990s I worked in a health department managing an HIV-AIDS program. I am familiar with the political and cultural forces that can distort our scientific assessments of risk management. However, you don’t need a graduate degree to recognize that our culture has great issues around security and fear of losing or risking most anything.
Less than 38% of Americans are eligible to donate blood according to the American Red Cross. Today, as I read through the pages of reasons for which you could be deferred from donating blood, I was struck most profoundly by the deferrals based simply on where one has lived. If, in fact, the scientific basis for avoiding such blood donors is sound, then the entire continent of Europe should refuse blood donations from virtually its entire population. This cannot be sound scientific reasoning.
In the last decade or so, there’s been a lot of hysteria about mad cow disease. According to the federal Centers for Disease Control and Prevention (CDC), there have been 22 cases of mad cow disease in the United States since 2003. Three of these cases originated in the United States. Most of the other cases were from Canada, which you may note is not one of the restricted countries that will put you on the blood donation deferral list by the American Red Cross. The United Kingdom was the epicenter for the mad cow disease epidemic. While in the United Kingdom there had been thousands of cases of mad cow disease in years past, in 2010 there were only 11 cases reported. Maybe it’s time for the American Red Cross to relax its deferral requirements related to mad cow disease. Or, maybe we should come up with a new diagnosis for this irrational insanity, and declare that the American Red Cross has Mad American Disease. You are literally dozens of times more likely to be killed by being struck by lightning in the US then getting mad cow disease. I’m not sure what the chance is of lightning striking the American Red Cross, but I would settle for a light bulb above the head of somebody who makes these crazy decisions.
Over the decades that I have donated blood to the American Red Cross, I have noted the quickly changing and almost always growing list of reasons to defer a willing blood donor. As a personal example, I had malaria when I was an infant in Haiti where I was born. During the ensuing 50 years I’ve not had any symptoms of malaria. However, how the American Red Cross deals with this distant case of malaria changes back and forth. Many years ago, the American Red Cross simply asked whether you have ever had malaria, and if you indicated yes, the nurse would ask more specific questions. This always made for an interesting blood donation visit as I suspect there were few Ohio blood donors who had ever had malaria, and the nurses often had to consult with other professional healthcare staff to figure out what to do with me as a blood donor. Although sometimes it took a while for them to figure it out, it never prevented me from donating blood. Then, at some point later, they changed the question as to whether you had malaria in the last three years. I can answer no to this question, and this streamlined my visit quite a bit. Now, in recent years, they are back to the more general question of have you ever had malaria. Fortunately, there seems to be better training among the nurses during the screenings and they do not seem to need to consult anyone else to determine that I am, in fact, eligible to donate blood.
The American Red Cross’ quest for zero risk seems to be marching on. Since I last donated blood less than three months ago, they have added yet another safety precaution. Now, when they stick your finger with a needle to get a drop of blood to check your hemoglobin, they place a plexiglass barrier between your finger and the nurse. Really now, how often does anyone ever got blood splashed in their eyes from giving a finger prick? More importantly, does this represent any risk worth worrying about. If it does, I’d hate to see what such risk assessment would do to health care workers in hospital settings. Perhaps we should expect nurses in hospitals to soon be wearing spacesuits just to be sure. According to the CDC, “Health care workers who have received hepatitis B vaccine and have developed immunity to the virus are at virtually no risk for infection…the estimated risk for infection after a needlestick or cut exposure to HCV-infected blood is approximately 1.8%. The risk following a blood splash is unknown but is believed to be very small…The risk after exposure of the eye, nose, or mouth to HIV-infected blood is estimated to be, on average, 0.1% (1 in 1,000).” For instance, for hepatitis C, “the risk is considered to be less than 1 chance per 2 million units transfused.” That’s for a blood donation recipient who has an entire unit of blood transfused into them. The risk of the nurse getting infected by pricking the finger of a potential blood donor would be on the order of that one in a million TIMES the chance of getting a drop of blood splashed in their eye when pricking a blood donor’s finger TIMES the chance that such an event could cause disease. You can do the math yourself. For the example of hepatitis C, conservatively, we are talking about one in a million times one in thousands times one in a thousand. In the end, we are talking about no more than a chance of one in many billions of getting infected by hepatitis C by pricking the finger of a potential blood donor without having eye protection . For the number of blood donations every year in the US, it would take centuries for this practice to expect to prevent even one case of blood borne pathogens. The risk for hepatitis C is the highest and adding in hepatitis C and HIV would not substantially change this basic calculation. From the resource perspective, the question becomes how many billions of times do you want to place a plexiglass barrier between you and a potential blood donor to prevent a single case of infection?
I am well aware of the emotional place from which the quest for zero risk comes. Unfortunately, the emotional experience of wanting to live in a zero risk world does not match up with a simple costs and benefits calculation of going very far down that road. It quickly leads to unjustifiable contradictions. Why defer blood donors due to a nearly incalculably small risk for mad cow disease from people who spend significant time in Europe but not Canada, where most of the US cases have originated from? Well, I’ll tell you. Starting a deferral process for people who spend significant time in Canada would expose the insane balance between actual risk and actual costs in trying to avoid the risk. It seems that we can “afford” to ban, for example, military servicemen who were stationed in Germany or England from donating blood in order to “buy” some unscientific sense of security in our blood supply. I recognize that plenty of people are willing to pay such prices. I just ask that we don’t fool ourselves into thinking that these choices are based on scientific evidence and well-reasoned analyses of risk management.
Another example of blood donor deferral that rests more on cultural biases than scientific and well-reasoned risk management, is The Lifetime Ban on Blood Donations from Gay Men, where policy analyst Robert Valadez writes:
“So where did this policy come from? And why is it still enforced despite advances in technology that can identify HIV in a unit of blood within days of infection?
The policy dates back to the early days of the HIV epidemic, when knowledge of transmission was nonexistent. Recognizing the disproportionate incidence rates among gay and bisexual men, the FDA responded by enacting a policy that prohibited all men who had sex with other men from donating blood. The year was 1985. Twenty-six years later, the policy remains unchanged.
Current blood donor eligibility criteria are largely inconsistent, imposing significantly less restrictive deferrals to heterosexual men and women who engage in high-risk sexual behavior. For example, a heterosexual person who has sex with a partner who is HIV-positive is eligible to donate blood after only 12 months. Yet the policy permanently bans all gay and bisexual men, even those who are HIV-negative, consistently practice safe sex, or in monogamous relationships”
Like many experiences in my life, I find that even the wonderful experience of saving lives by donating blood, comes with the collateral costs of having to participate in the system that is driven by an insane quest for zero risk. This insane quest has costs. It has costs for the blood supply and the people who depend on it. This insane quest for zero risk has costs for those who are subjected to its unscientific cultural biases, and for all of us who live in an environment that unnecessarily models for us this insanity and vanity. Life has risks. There are reasonable and scientific ways to reduce these risks. We should pay attention to these. However, we should not be driven and reduced by unreasonable fears, unfounded fears. As is often the case in life, that which we feel threatens us gets a disproportionate amount of our attention. Nonetheless, we should look at the full range of costs associated with trying to avoid some threat, and realize and accept that risk is an integral and unavoidable part of life. I would hope that the entrepreneurial spirit of Americans, in its broadest sense, would kick in as we live into the fact that taking and accepting risks can far outweigh the costs of those risks. Maybe even the American Red Cross will take a risk and pare down its blood donation deferral list. We can always hope — though this entails some risk…
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