How We Do Harm by Otis Webb Brawley, M.D.

The financial benefits of screening for a long chain of medical businesses have been measured almost to a penny. This is a game with a predetermined outcome: everyone but the patient wins.



I tell my friend and patient Ralph about a conversation I had with a marketing guy at a major American cancer center. He explained that they ran free screenings at a local mall every September as part of a Prostate Cancer Awareness Month. As I struggled to control my anger, this gentleman explained the business formula:



“First, free screening provides free good publicity for the health system. People really feel good about us, because this is a community service. It will cause women to come to our women’s center and men to come to our chest-pain center. It increases almost all our product lines. It’s cheap, effective advertising.



“For every thousand men over age fifty who volunteer for free screening, one hundred and forty-five will have an abnormal screen. Given the demography of the mall, ten of the one hundred and forty-five will have insurance that our health system doesn’t take. So, one hundred and thirty-five will come to us to see why they have an abnormal screen. We make up for the cost of offering the free screening by charging for evaluation of the abnormal screens. About forty to forty-five will have cancer. We hit bingo with them. We know the number who will get radical prostatectomy, the number who will get radiation therapy, the number who will get hormones.



“We know the number who will have incontinence so bad that they will want an artificial urethral sphincter implanted. We even know the number who will not be able to get erections and will want Viagra. We know for how many Viagra won’t work. We know how many penile prosthesis we will sell.”



Realizing that I had been granted an audience with Lucifer, I asked a fundamental question: “How many lives will you save if you screen a thousand men?”



The marketer took off his glasses and looked at me as if I were a fool. “Don’t you know, no one knows if this stuff saves lives? I can’t give you a number on that.”



Ralph is shocked. “You mean its big business?”



I tell Ralph about the business model employed by the National Prostate Cancer Coalition, now called Zero (an organization that has attacked me personally, because I publicly questioned whether screening and aggressive therapy saves lives). Zero sends its employees to a particular locale, partners with a local cancer-treatment center, enlists some local celebrities, and offers free screening. That center pays to advertise the screening push and helps Zero get donations.



But most of Zero’s budget comes via corporate donations from drug companies, and surgical and radiation-treatment-device manufacturers. The groups funders include Amgen, AstraZeneca, Aventis, Cytogen, Merck, Pharmacia, and Pfizer. My personal favorite Zero sponsor is Kimberly-Clark, the maker of Depend undergarments. Prostate-cancer screening and aggressive treatment may save lives, but it definitely sells adult diapers.

National Breast Cancer Coalition by Otis Webb Brawley, M.D.

The path to advocacy at Share and other support groups that work through a coalition called the National Breast Cancer Coalition lies through Project LEAD, a series of vigorous week-long courses on basic science and clinical trials. If you work through the NBCC umbrella, you take it for granted that advocacy requires education, which means Project LEAD. It is not a specific requirement, but people like the course and are proud of it. Most of the NBCC leadership as well as the leadership of grass-roots organizations that work through NBCC have been through it.



Project LEAD has functioned so well for so long – sixteen years- that it’s taken for granted. It has graduated about fifteen hundred advocates, almost all of them women with breast cancer.



Genuine public movements begin with conversations. In the case of NBCC, the conversations began in the 1980s, when political groups focused on breast cancer started to form. In part, these groups were rooted in the feminist movement. In part they were emulating the AIDS movement, an offshoot of the gay rights movement that made AIDS a national emergency.



The breast-cancer movement is all the more interesting because of the role of one book, Dr. Susan Love’s Breast Book, which was first published in 1990 and is now in its fifth edition. Love, then a surgeon at Dana-Farber Cancer Institute, told a story of a fundamental misunderstanding of breast cancer: that clinical trials demonstrated that radical surgery for breast cancer was powerless to change mortality, and that life-threatening forms of breast cancer, even in their early stages, are systemic diseases that require systemic treatment.



There were breast cancer books before Love’s, but hers did something new: it laid out the science comprehensively, in a dispassionate manner, with the sole purpose of helping women make decisions on treatment. Love knew what was going on in breast cancer. She had been practicing at the hotbed of more-is-better, the institution where high-dose chemotherapy with bone marrow transplantation was a bread-and-butter procedure.



She fought it tooth and nail, and when Susan Love gets angry, you know it. Yet, the book is more measured than its author. “The reason I don’t say breast-cancer care sucks is you will have less influence,” she reflects. “I think there is a fine line if you want to get listened to, of how you lead people to realize there is a problem without completely pulling the rug out from under them of what they they are getting right now.”



Love was not surprised that the book was well received in Cambridge, Massachusetts, and in Berkeley, California. But, to her surprise, it did well in all the states in-between too. In June, 1990, about six hundred women showed up to hear her give a three-hour talk in Salt Lake City.



“In those days, I was going through the treatment options for breast cancer, I was teaching the whole thing: the surgical, the local, the systemic treatment, and it just seemed to be going on forever,” she recalls. “It was the middle of the day, the middle of the week, and there were all these middle-aged women there. I was looking for a laugh. I was looking to lighten things up.”



So she deadpanned, “We don’t know the answers, and I don’t know what we have to do to make President Bush wale up and do something about breast cancer. Maybe we should march topless to the White House.”



Love was looking for a laugh, and the line still amuses her two decades later. “It was Bush Senior, so the idea of these topless women marching to Bush Senior’s White House was funny. They all laughed.”



After the talk ended, the middle-aged, middle-class, middle-American women, one after another, inquired, “Okay, when is the march? When do we leave?”



This shocked Love. “Suddenly, it hit me that the time was right. I knew about breast cancer groups in Cambridge and Berkeley, but I thought, ‘That’s just Cambridge, that’s just Berkeley.’ But this was something else: Salt Lake City was ready to go. It was time to do something.”



Later that week, Love and her partner, surgeon Helen Cooksey, were driving to their cabin in New Hampshire. “I looked over to her and I said the time is here top politicize breast cancer. And I am afraid that this is the right moment for this. And I am in the exact right position to do it. And I gotta do it.”



To this Cooksey replied, “I’ll never see you again.”



Later that year, Love met with Susan Hester and brainstormed the idea of setting up an overarching organization. In those days, Love – who can be disruptive unless she multitasks –carried a stack of three-by-five index cards on which she scribbled notes to herself.



She saw her role clearly, with a surgeon’s precision: “You need somebody who is a catalyst, which is my role. I can see the vision, and I know it’s the right time, and I can get people together. And then you need somebody that’s going to run it, which is not my forte at all. You really need a hard-ass. You need somebody who doesn’t back down.”



Love and Hester spoke with all the groups they could locate, getting the conversation rolling. Then Hester asked a Washington law firm to provide a conference room, and everyone who knew of a breast cancer group or had a list of breast cancer groups stated to make calls. The groups were being invited to a meeting.



The organizers had no idea who – if anyone- would show up.



The word spread through political and peer-counseling groups nationwide. Everyone interested was to meet at a set place at a set time. More than a hundred groups showed up.



Many of the women who came forward had led movements before, marching for civil rights, protesting the war in Vietnam. There were also veterans of the women’s rights movement, gay rights advocate, and a smattering of Israeli peaceniks. For that eclectic bunch, street theater was entertainment, being maced, billy-clubbed, and cuffed was the stuff of fond memories of youth.

Fran Visco, a commercial litigator at a Philadelphia law firm, was one of the women who showed up. As a fifth-grader at a Catholic School, she wanted to be a medical missionary. During the Vietnam War, she volunteered with the Central Committee for Conscientious Objectors. In 1987, at age thirty-nine, as a mother of a fourteen-month-old boy, she was diagnosed with Stage II breast cancer. Two years later she answered an ad for a support group called the Lina Creed Foundation.



“I don’t have the gene that I’m driven to make a lot of money,” she says years later. “I have the gene that says I am driven to plague those in power to try to change things for the better, whatever that is.”



Visco showed up at the May 1991 breast-cancer meeting in Washington and was later elected the coalition’s president. “We wanted to make it a political issue, we wanted to impact the system of research and health care,” Visco says. “There were groups doing support, there were groups raising money for research through different avenues. But no one was looking at breast cancer in a systematic, overarching way and saying what needs to change in all these areas in order to help women.”



When she showed up at the Washington meeting in May 1991, Visco knew nothing about breast cancer. She had not read Love’s book and had no idea who Love was. Now Visco knows a lot: policy, politics, regulations, epidemiology (both classical and clinical), biostatistics and basic science. And she is not an exception. At least fifteen hundred people involved in NBCC know big chunks of what she knows, and some know more.



“We want to have a real impact on this disease,” says Visco. “We don’t want to just get more money for the scientific community and then just let them do what they want with it. We wanted to be able to oversee how the funds are spent and collaborate with scientists o set priorities and design research. To do that, we have to know what we are talking about.”



Yet, in 1991, the founders of the coalition had no plans to engage in systematic, rigorous education of the advocates. The mission evolved as the group started to adjust to its success ( which by 1993 tripled the $90 million the NCI was spending before the coalition’s appearance.)



Perhaps one important moment occurred at one of the early meetings of the board, when epidemiologist and breast-cancer survivor Kay Dickersin saw an old acquaintance, Patricia Barr, a Vermont Attorney.



The two had originally met at Bennington College, and Kay, who was two years younger, remembered Pat’s role at a teach-in in 1969, at a Moratorium to End the War in Vietnam. These events began on October 15, 1969, and continued on the fifteenth of each month.



“You can’t possibly remember me,” Kay started. Indeed, that was the case, Pat was a leader of the antiwar movement and Kay, a freshman. Even now, in middle age, Pat was as conspicuous as she was on the Bennington campus in 1969. At the board meeting, Kay remembers Pat wearing glasses with a super-bright aquamarine frame. Pat was clearly not about to let metastatic disease get her don. She would fight it the way she’d protested the war. Now she was building a grassroots network for the coalition – the firs of its kind in cancer – and Kay was there to represent a Baltimore patient group.



That Kay was a top-notch epidemiologist had not yet seemed relevant. But Dickersin was the first researcher to describe the publication bias – the tendency to publish positive studies and not publish negative studies. Though she didn’t completely understand it at the time, Dickersin was at the foundation of two important institutions of evidence-based medicine. In her day job, she was working in the Cochrane Collaboration, a worldwide collective of statisticians who pool data from existing sources for meta-analysis.



In the early days of the coalition, only one other member of the board – Love- understood the science and, alas, she was chronically over-scheduled. Dickersin wanted to spread out the responsibility of talking with congressional staff members.



Visco remembers the discussion. “Kay Dickersin said ‘If we want to influence NIH, if we want to influence science, all of us need to know what we are talking about.’ And that certainly resonated with me. When you are a trial lawyer, you don’t walk into that courtroom, you don’t walk into any argument or deposition, unless you knoweverything. You have to know the sttengths, the weaknesses, you have to understand it all I knew that when I was practicing law that if my client had a business that made windows, I had to learn about that. Now I had to learn science.”



The first teach-in, was conducted in conjunction with a board meeting. “They really got it,” said Dickersin. “It was cool for me as a teacher.” Ultimately they took their teach-in on the road, developing a core curriculum and a group of teachers – all of them top-notch scientists. The curriculum changes over time, sometimes to reflect new science and sometimes to add new areas of emphasis. The course is designed to push patients outside their experience. To produce something like Project LEAD you need skepticism and a cadre of tough, dedicated people who safeguard it. “You need a culture,” says Love.



“The problem is, people don’t realize they are not getting good-quality care,” says Love. “So the first step is to show them. And that’s really hard, because when it’s you, it’s too scary to think you are not getting good-quality care. Even if somebody gives to a cogent intellectual argument, when you are sick, you have to believe you are getting good-quality care.”



This is a battle that needs to be fought. Rational health care has the potential to save millions of lives over the next several decades. It must include preventive medicine and could actually have an amazingly positive effect on the economy. To o it requires accepting that there is a significant problem, and resolving to solve that problem. Patients and health-care providers must work together, constantly asking these two questions:


“What is rational?” followed by “What is reasonable?”



How do we protect ourselves, our loved ones, our neighbors? There is only one way. We do it by demanding a health-care system that can say “Prove it”, a system that can say “No” and make it stick. For this to happen, real people – ideally, all 300 million of us – will have to say “Enough!”



How We Do Harm; A Doctor Breaks Ranks About Being Sick In America by Otis Webb Brawley, M.D. with Paul Goldberg; St. Martin’s Press, N.Y. 2011

Gossip by Joseph Epstein

Years ago a friend in London told me that the playwright Harold Pinter wrote rather poor poems – my friend called them, in fact, “pukey little poems” – that he sent out in multiple Xerox copies to friends, then sat back to await their praise. One such poem was about the cricketer Len Hutton, the English equivalent of Joe Dimaggio; the poem, in its entirety, runs: “I knew Len Hutton in his prime,/ Another time, another time.” After Pinter had sent out the copiers, its recipients, as usual, wrote or telephoned to tell him how fine the poem was, how he had caught the matter with perfect laconic precision, how touched and moved they were by it – with the single exception of a man who made no response whatsoever. When Pinter hadn’t heard from this man after two weeks, he called to ask if he had in fact received the poem. “Yes,” said the man, “I have indeed.” Unable to hold back, Pinter asked, “Well, Simon, what did you think of it?” Pausing briefly, the man replied, “Actually, I haven’t quite finished it.”



This is gossip on the model of a joke – gossip with a punch line. What is of greatest interest about it as an item of gossip is the continuing need on the part of its subject, a world-famous playwright, a Nobel Prize winner, for these driblets of praise. One might think so successful a writer had already had more than his share of praise, but no scribbler seems ever to have had enough of what Thomas Mann called vitamin P. This is gossip as analysis, or test, of character, with the character, as in almost all good gossip in this realm, failing to pass.




Vanity Fair recently ran a story reporting that Arthur Miller had had a Down syndrome child with his third wife, the Swedish photographer Inge Morath. Soon after his birth, Miller clapped the boy into a less than first-class institution and didn’t deign to see him ever again. The existence of the boy was revealed only after Miller’s death, when it came time to divide his estate among his children, including this son, who was by then forty-one years old. Sorry though I feel for the son, I like this bit of gossip because it illustrates deep hypocrisy, and since the best gossip tend to be about hidden behavior, this qualifies, with four oak leaf clusters. The hypocrisy involved is that of Arthur Miller, a man always ready to offer moral lessons to others, to entire nations in fact, when he himself had done something in his personal life most people would consider morally repugnant. Miller often fell into the sermonizing mode. He was never uncomfortable instructing people how to live, or governments how to conduct their business. He spoke at all times with an unrestrained moral authority, dispensing advice on right conduct. Pity he didn’t take that advice to heart with his own son instead of dispensing it so generously to the rest of us. All saints must be judged guilty before proven innocent, as George Orwell noted, and Arthur Miller, a false saint, fails the test.



The author identifies Four Great Gossips of the Western World:


Duc de Saint-Simon whose posthumously published, forty-plus volume Memoir is more than three thousand pages long.



Walter Winchell, whose easy arrogance and power to break reputations and spoil lives made him greatly feared. Arthur Brisbane, his editor at the New York Mirror, once told him, “You have neither ethics, scruples, decency or conscience.” To which Winchell replied, “Let others have those things. I’ve got readers.”



Barbara Walters, to whom one’s dues must be given: week after week, year after year, she has created gossip through the simple agency of asking the most tasteless questions of famous people, who were themselves tasteless enough to answer her. Not just anyone could have brought it off. Yet to her it all seems to have come so naturally.

Tina Brown



A young editor of Talk called one day to tell me that a department of reputations was planned, and Tina would love it if I were to take down some overrated figure in American life. I suggested Arthur Miller. “He’s a terrible writer and even less impressive as a guru or a political saint,” I said. The young editor thought it a swell idea, and said he would get back to me after he had run it by Tina. The next day he called to say that an Arthur Miller piece didn’t feel quite right to Tina, but did I have any other ideas. “How about Walter Cronkite,” I said, “a man with a face only a nation could love, and a genuinely unintelligent man, though the confident cadences of his broadcaster’s fluency served to camouflage this over a long and hugely successful career.” Great idea, the young editor said.. The next day he called to say that Walter Cronkite didn’t seem quite right to Tina, either.



Although she may have judged such subjects less than buzzy, my reading of these decisions was that Tina Brown thought these men too important to attack, whatever salutary stir it might have caused. She was in fact only half an iconoclast, the other half a woman still on the way up and still in need of important people to get to higher places. We finally settled, the young editor, Tina Brown, and I, on the pompous literary critic Harold Bloom. I wrote the article, it was accepted and paid for ($5,000), but it never ran because Talk went out of business soon after I completed it.



Tina clearly hopes that the Daily Beast will at last be the white ass upon which she will ride into Jerusalem. It’s possible. But there are many competitors out there in cyberspace: the Huffington Post, the Atlantic Wire, and many more. Still, with her bounteous energy, as she approaches sixty, she’s not a woman to be counted out.



Gossip; The Untrivial Pursuit by Joseph Epstein; Houghton Mifflin Harcourt, Boston &N.Y., 20-11

American Empire Project by Peter Van Buren

The reconstruction of Iraq was the largest nation-building program in history, dwarfing in cost, size and complexity even those after World War II to rebuild Germany and Japan. At a cost to the U.S. taxpayer of over $63 billion and counting, the plan was lavishly funded, yet, as government inspectors found, the efforts were characterized from the beginning by pervasive waste and inefficiency, mistaken judgments, flawed policies, and structural weaknesses. Of those thousands of acts of waste and hundreds of mistaken judgments, some portion was made by me and the two reconstruction times I led in Iraq, along with my good-willed but overwhelmed and unprepared colleagues in the State Department, the military, and dozens of other US government agencies. We were the ones who famously helped paste together feathers year after year, hoping for a duck. The scholarly history that will one day write about Iraq and reconstruction will need the raw material of failure, and so this story will try to explain how it all went wrong.



As a longtime Foreign Service Officer, I was sent by the Department of State to Iraq for one year in 2009 as part of the civilian Surge deployed to backstop the manlier military one. Along with a half dozen contractors as teammates, I was assigned to rebuild Iraq’s essential services, to supply water and sewer access as part of a counterinsurgency struggle to win over the hearts and minds of the Iraqi people. It was Vietnam, only better this time around, more T.E. Lawrence than Alden Pyle. I was to create projects that would lift the local economy and lure young men away from the dead-end opportunities of Al-Qaeda. I was also to empower women, turning them into entrepreneurs and handing them a future instead of a suicide vest. A robust consumer society would do the trick, shopping bags of affirmation leading to democracy.



Executing all this happiness required me to live with the Army as part of an embedded Provincial Reconstruction Team (ePRT) on a Forward Operating Base (FOB). I spent the first six months on FOB Hammer in the desert halfway between Baghdad and Iran before moving to FOB Falcon just south of Baghdad for another half a year. In the aftermath of the 2003 invasion, the United States established massive military bases throughout Iraq. Some,. Like the grows-like-crabgrass Victory Base, were as big as cities, with thousands of personnel, a Burgher King, samba clubs, Turkish hookah bars and swimming pools. Some were much smaller, such as FOBs Hammer and Falcon, with a couple of hundred soldiers each, Army food and portable latrines.


[All of these bases generated tons of garbage daily the lack of proper disposal of which simply added to the nightmare of native trash, untreated sewage and contaminated water… problems American reconstruction efforts never addressed effectively.]



ECONOMIC CONFERENCE BLUES


If bullshit were water, we’d all drown, so take a deep breath.. A couple of days at the Embassy for an economics conference left my head spinning. The participants were the usual pickup team that runs the war’s civilian side: slick, private job shoppers (3161s), retired thises, a former that, and a few once-wases, people who incestuously briefed one another – all of the facts, none of the understanding, the big picture, our “legacy”. The new adjective of choice was robust. Iraqi Americans increasingly figured on the team, some remembering Baghdad from their youth, most still struggling with English, but all empowered to spend, spend, spend – money is a weapons system. So much cash in play, there’s a new slang word in Iraqi Arabic, duftar, a tall pile of Benjamins totaling $10,000-Ka-Ching!



A session on car loans, a new front to spur the economy, but the challenge: Iraq has no repo law. A name needed for a bridge to Diyala, “American Freedom Bridge” our choice, a plaque to be bought. USAID briefs, gonna spend $82 million to strengthen government-provided health care. Forward movement, money equals progress, activity is achievement, $60 million to revive the financial sector, most definitely time to form a bankers’ association so there’s someone to work with. Will plan webinars and roundtable discussions, maybe a blog, oh yes, a blog is modern, get an intern on it, they know this online stuff.



The State Department up next, tells us we must double down on our government of Iraq partners, help them spend Iraqi money on reconstructing Iraq, take the R out of PRT, and make the locals pay, spend, spend, spend, volume the key to success. Create Chambers of Commerce to facilitate investment, maybe with a nice brochure, the lack of a chamber the last obstacle on the road top prosperity.



Quick bright things come to confusion, said Shakespeare. Don’t slow down. Integrate. Act, engage, facilitate, mentor, promote, task, develop. There are no problems just challenges and issues. Security is an issue; a guy murdered in front of his family a challenge to stability. Language employed to keep thought at bay, said Harold Pinter.

Task One:

Suspend disbelief, rewire your brain, accept that people at the Embassy who never stray outside the Green Zone tell you about Iraq, the place you live 24/7. Safety improving, suicide bombings down, democracy up, cognitive dissonance not a problem, you can’t really tell but we’re winning (the preferred narrative of the war). From the head PRT office, “Due to security concerns, we are unable to visit the Baghdad Flower Show, which the Mayor intended to be a symbol of stability.”


Task Two

Convince yourself of the overall premise of US efforts, that Iraqis want to be like us. They want to have banks like us, farms like us, governance like us, repo laws like us, fast food, rock and roll, MTV like us. Hire Iraqis who see it our way, find young women who change from hijabs into club wear on campus, happy natives top confirm our vision in the heat. Enjoy the Kool-Aid, sweet even when it is bitter.



Much crowing over success in persuading Craigslist to add a page for Iraq – most sections not used (it is in English), still definitely a step to economic growth. Rabbit-quick checked my computer: lots of Men Seeking Men personals, military-age male Americans looking for boy sex in Iraq, (XXX)...



New briefer, just in from Washington, pretty junior, given the spot right before lunch when no one was interested in another rap. Things slowed down. She said Iraq ranked 175th out of 180 countries as the hardest place in the world to start a business, that illiterate and high school graduates command about the same salaries because most hiring is for government patronage jobs (maybe 60 percent of everyone employed in Iraq now works for the government, no one knows). Most people in the room looked away, embarrassed for her not getting the memo. She offered a formula to explain it all: Corruption= Monopoly + Discretion – Accountability. She believed that the social fabric of Iraq is now in “survival mode.” Woooh, awkward, suicide right on stage. We exchanged glances, some signifying fear of agreeing, most shock over the heresy; she’d be reeducated. Conference organizers hit 911, rushed into the breach with a quick lunch, club sandwiches with crunchy bacon, then ice cream from Baskin-Robbins, brought in from the States, because we could. Back on track, no mind to the interruption, jury should disregard the last witness.



Next up, tourism briefing. This could be a big thing, says some reservist who was handed the portfolio as his way to fight the war. US government spent $700,000 in Babylon to build restrooms and a gate near the ruins, $300,000 to create the Baghdad Tourism Institute, $2 million for the Habbaniyah Tourist Village, to include $698,000 for beach refurbishment, literally paying for sand in Iraq. Guy says that in 2009 sixty-five Western tourists visited Iraq (including 18 Taiwanese, stand-in Westerners, and seventeen Americans). US Army polled them, learned they loved Iraq but hated the hotels, hoping to attract more next year. United States not involved in the five to seven million Shia tourists who visit Iraq each year, kinda ceded that market to Iran, we’ll focus on those sixty-five Westerners. Good news: US Army will spend $100,000 to fly a hundred travel agents from around the world (including from Iran and this time Japan) for “Iraq Tourism Week” in early October. Market looking up for tourism, for sure, for sure.



Last briefing: Foreign Commercial Service will hold a “trade mission” charging US companies $6,000 to meet Iraqi business people. The $6,000 includes personal security detachment (good value), but you’ll need to stay at the al-Raheed Hotel, an additional $300 a night, plus pay for your own meals, US cash only, please. Brochure has the word business misspelled, oops, pointed that out to the guy, he wasn’t happy with me, says they already sent out two hundred copies. Brochure also does not list the dates of the trade mission, security concerns, ssshhh, in October. Foreign Commercial; Service briefer admits he has not been outside the Green Zone but relies on an Iraqi New Zealander to make contacts.

Final Notes: good conference overall, a lot to take back, not much to remember.



MISSING HIM



Private First Class (PFC) Brian Edward Hutson, in Iraq, put the barrel of his M-4 semi-automatic assault rifle into his mouth, with the weapon set for a three-round burst, and blew out the back of his skull. He was college-age but had not gone and would never go to college. Notice appeared in the newspapers a week after his death, listed as “non-combat-related”.



Of the 4,471 American military deaths in Iraq, 913 were considered “non-combat-related,” that is, non-accidents, suicides. In 2010, as in 2009, more soldiers died by their own hand than in combat. Perhaps related, mental disorders in those years outpaced injuries as a cause of hospitalization. The Army reported a record number of suicides in a single month for June 2010. Thirty-two soldiers in all, more than one a day for the whole month. Given that suicides sometimes occurred after soldiers departed from Iraq, and given that death by enemy action was no longer as common, their lives were probably in as much danger at home as in Iraq.



A week before Hutson’s death, another soldier lost his life. This soldier, a turret gunner, was killed when his vehicle unsuccessfully tried to pass at thirty-five miles per hour under a too-low bridge. The Army counted deaths by accident as “combat deaths,” while suicides were not. Under a policy followed by George W. Bush and for more than two years by Barack Obama, the families of suicides do not receive a condolence letter from the President. Suicides apparently do not pertain to freedom. They died of the war, but not in the war…




Other books in the American Empire Project by Metropolitan Books [Henry Holt &Co., N.Y.):

Noam Chomsky; Hegemony or Survival and Failed States
Chalmers Johnson The Blowback Trilogy
Andrew Bacevich; The Limits of Power and Washington Rules
James Carroll; Crusade
Michael; Klare; Blood and Oil
Walden Bellow; Dilemmas of Domination
Robert Dreyfuss; Devil’s Game
Alfred McCoy; A Question of Torture
Howard Zinn; A People’s History of the American Empire
Nick Turse; The Complex
Greg Grandin; Empire’s Workshop

Paper Garden by Molly Peacock

Imagine starting your life’s work at seventy-two. At just that age, Mary Granville Pendarves Delany (May 14, 1700-April 15, 1788) a fan of George Frideric Handel, a sometime dinner partner of satirist Jonathan Swift, a wearer of green-hooped satin gowns, and a fiercely devoted subject of blond King George III, invented a precursor of what we know as collage.




One afternoon in 1772 she noticed how a piece of colored paper matched the dropped petal of a geranium. After making that vital imaginative connection between paper and petal, she lifted the eighteenth-century equivalent of an X-Acto blade ( she’s have called it a scalpel) or a pair of filigree-handed scissors the kind that must have had a nose so sharp and delicate that you could almost imagine it picking up a scent. With the instrument alive in her still rather smooth-skinned hand, she began to maneuver, carefully cutting the exact geranium petal shape from the scarlet paper.


Then she snipped another.



And another, and another, with the trance-like efficiency of repetition – commencing the most remarkable work of her life.



Her previous seventy-two years in England and Ireland had already spanned the creation of Kew Gardens, the rise of English paper-making, Jacobites thrown into the Tower of London (among them her uncle), forced marriages, woman’s floral-embroidered stomachers and the use of the flintlock musket.



She was born Mary Granville in 1700 at her father’s country house in the Wiltshire village of Coulston. She would see the rise of the coffee house and of fabulously elaborate court gowns. She would hear first- hand of the voyage of Captain Cook (financed partly by her friend the Duchess of Portland) and be astounded by that voyage’s horticultural bonanza (instigated by her acquaintance Sir Joseph Banks). She would attend her hero Handel’s Messiah, share a meal with the soprano Francesca Cuzzoni and read in rapture Samuel Richardson’s epistolary novel Clarissa. She would flirt with Jonathan Swift. In middle age at mid-century, she would see the truth of his cudgel of an essay on Irish poverty, and in her old age she would feel the sting of a revolution on the other side of the world.



By the time she commenced her great work, she had long outlived her uncle, the selfish Lord Landsdowne (a minor poet and playwright and patron of Alexander Pope); she had survived a marriage at seventeen to Alexander Pendarves, a drunken sixty-year-old squire who left her nothing but a widows pension; she tried to get a court position and found herself in a bust-up of a relationship with the peripatetic Lord Baltimore. But with a life-saving combination of propriety and inner fire, she also designed her own clothes, took drawing lessons with Louis Goupy, cultivated stalwart, lifelong friends (and watched her mentor William Hogarth paint portraits of them), played the harpsichord and attended John Gray’s The Beggar’s Opera, owned adorable cats, and wrote six volumes’ worth of letters – most of them to her sister, Anne Granville Dewes (1701-61), signifying a deep, cherished relationship that anyone with a sister would kill for.



She bore no children, but at forty –three she allowed herself to be kidnapped by love and to flout her family to marry Jonathan Swift’s friend Dean Patrick Delany, a Protestant Irish clergyman. They lived at Delville, an eleven-acre estate near Dublin, where Marry attended to a multitude of crafts, from shell decoration to crewelwork and, with the Dean, renovated his lands into one of the first Picturesque gardens in the British Isles. She painted uncounted canvasses for her husband’s new chapel at Delville, copies of works such as Guido Reni’s Madonna and others by Van Dyck, Lely and Rubens.



But she made the spectacular mental leap between what she saw and what she cut four years after Patrick Delany died. She was staying with her insomniac friend Margaret Cavendish Bentinck, the Duchess Dowager of Portland, at the fabulous Bulstrode, and estate of many acres in Buckinghamshire. The Duchess, who would stay up being read to for most of the night and rarely rose before noon, was one of the richest women in England. Her Dutch-gabled fortress, presiding over its own park, with its own aviary, gardens, and private zoo, housed her collections of shells and minerals and later the Portland Vase, a Roman antiquity which now occupies a spot in the British museum. By then the two women had been friends for more than four decades (They met when Margaret was a little girl and Mary was in her twenties.

Snip



Mary Delany took the organic shapes she had cut and recomposed them in the mirror likeness of that geranium, pasting up an exact, life-size replica of the flower on a black piece of paper.



Then the Duchess popped on.


She couldn’t tell the paper flower from the real one




Mrs. D, which is what they affectionately call her at the British Museum, dubbed her paper and petal paste-up a flower mosaic, and in the next ten years she completed nearly a thousand cut-paper botanicals so accurate that botanists still refer to them – each one so energetically dramatic that it seems to leap out from the dark as onto a lit stage. Unlike pale botanical drawings, they are all done on deep black backgrounds. She drenched the front of white laid paper with black watercolor to obtain a stage-curtain-like darkness. Once dry, she’s paste onto these backgrounds hundreds – and I mean hundreds upon hundreds – of the tiniest dots, squiggles, scoops, moons, slivers, islands and loops of brightly colored paper, slowly building up the verisimilitude of flora.



“I invented a new way of imitating flowers,” she wrote with astonishing understatement to her niece in 1772.




How did she have the eyesight to do it, let alone the physical energy. How, with her eighth decade knuckles and wrists, did she manage the dexterity? Did her arm muscles not seize up? Now Mrs. D.’s work rustle in leather-edged volumes in the British Museums Department of Prints and Drawings Study Room, where they have been sequestered since donated by her descendant Lad Llanover in 1895.



Seventy-two years old. It gives a person hope.
.............................


Living a full life requires invention, but that needs a previous pattern, if only to react against it, happily to re-figure in the making of something new. A multitude of vectors bring us to the moment where we are, and where we love, or cough, or say the wrong thing or fail, of feel our fate in what we fear, or to a moment where clarity descends, and we understand the world simply from having observed it. Uncontrollable events hurtle towards us until the very moment of our deaths, yet in each instant figuring out how to go on, even on to the next world, repeats the confusion of youth. Of course we need our role models long past adolescence.

To search a drawer or a pocketbook or a botanical bibliography, even to search a littered table or beneath the leaf of a geranium, means feeling for one’s conscience and one’s heart, looking for something that will compete – with a key, a tissue, a truth, a love, a victory, a seed –an instant of one’s being or perhaps one’s whole life. In a sliver of knowledge, time is obliterated and reinstated. A single instance, the fall of a petal, or the swirl of the paper that imitates and becomes it, flourishes an answering likeness.




The Paper Garden; An Artist Begins her Life’s Work at 72; by Molly Peacock; Bloomsbury, N.Y. 2010

Julian of Norwich by Amy Frykholm

In the midst of what historian Barbara Tuchman has called the ‘calamitous’ fourteenth century – marked by war, famine, plague, and unrest – one woman wrote a book. It was the first book composed by a woman in English and remains one of the greatest theological works in the English language. So little is known about this woman and even her name – Julian of Norwich – is in question. Yet her achievement – A Revelation of Love - is extraordinary. Very few people – male or female – at that time wrote anything in English. Even though it was the language of the common people, English was rarely used for literary purposes. But Julian’s achievement isn’t just in having written a book in English, but in the nature of what she had to say.



Playfully and subtly maneuvering amid political dangers and social limitations, with open curiosity and dry humor, Julian took a heavy world of religious obligation and turned it on its head. In her book, which is both an account of visions she received and a book of spiritual direction and theological reflection, she wrote, ‘The soul must perform two duties. One is that we reverently marvel. The other is that we humbly endure, ever taking pleasure in God.’ In Julian’s understanding, the right relationship between God and the soul was not primarily guilt for sin, but wonder, release and unity. She wrote that the righteousness required of us was simply this: delight in God’s good world.



This delight traveled a hard road through Julian’s life. To reach it Julian had to traverse the enormous suffering she saw around her and experienced herself…



By the time of Julian’s birth in 1342, Norwich was six hundred years old, and had a population of ten thousand. It was the second largest city in England and growing fast. Waking early to the morning mist, Julian would have heard the chatter of the first women on their way to draw from the city’s wells, and the rattle and clang as butchers and blacksmiths welcomed first customers. In the churches, sleepy priests started mass early for travelers, workman and pilgrims headed out beyond the city walls. The noisy snuffles of pigs and lowing of cows filled the streets as children released animals from their pens and drove them out through the city gates to pasture. As she and her mother walked the streets they saw boats and barges arriving from Yarmouth that carried sea coal, barrels of iron from Sweden, herring and onions, wood from Riga, Flemish lace and light dry Rhennish wine, the color of sun through white curtains. The boats sent back fine wool, leather, latten and wheat along with the proud products of the city’s artisans – stained glass, intricately carved wood, illuminated manuscripts, and jewelry.



Julian and her mother would have avoided the main thoroughfares of the city, sometimes paved though often pits of mud. Down the center of the streets ran a ditch into which people threw slop water, the remains of supper, and butchers the smoking entrails of the daily slaughter. But avoiding rank smells was impossible. Norwich was caught up in the construction of new churches and chapels, along with thriving industries of dying, tanning and fishing. The ripe scent of butchering and the dung-soaked hides of the tanneries added to a thick stew of human and animal stench: sweat, rotted standing water, lime, dripping animal fat, and malt.



Often Julian watched and heard the procession of the parish priest, headed by his clerk holding a lantern and ringing a bell and an acolyte carrying the cross, headed to the home of a neighbor to give the last rites to the sick and dying: “Hail! Light of the World, Word of the Father, true Victim, Living Flesh, true God and true Man. Hail flesh of Christ, let Thy blood wash my soul.”



Whenever Julian entered the Church, a scene of judgment and damnation spread out before her. There on the chancel arch in vivid reds and yellows, greens and blues was the Last Day. Tiny naked white sinners sent from God’s throne to hell. Money lenders boiled in oil. Adulterers stripped and beaten. Grinning devils that dragged, prodded, and beat souls into hell while Christ sat above watching, unmoved.



But preoccupied as people were with eternal damnation, the hell that descended on Norwich during Julian’s childhood seemed to have been handcrafted for the living. The first pestilence arrived when she was six years old, after the season of Epiphany in 1349. Within a year more than three quarters of the population of Norwich were dead; an entire world erased amid the wails and shrieks of her neighbors and huge open pits of decaying bodies. Boats stopped coming to port. No one went to market, crops went unplanted, there was no one to collect trash or repair the streets. No one rang the bells or took animals to pasture. All the priests had died or fled. It was three years before the painful process of reconstruction could begin. In 1362 the pestilence struck again, this time its target being infants and children, perhaps Julian’s own. The visions that formed the basis of her lifetime search for sacred meaning and her book came to her at the crisis of her own illness ten years later.



During her visions and for decades afterward, Julian wrestled with understanding what she had seen. The God of her visions and the God of the Church to which she was devoted contradicted each other, sometimes painfully. The church of her time was beginning to take violent measures to protect its powers. By the time Julian took up a pen putting words to parchment, the church hierarchy had actively banned the use of English in religious contexts, except in sermons, confessions and other practical matters. People were carried out of the city of Norwich and burnt if an English-language Bible was discovered in their homes.



Breathtaking for its daring, Julian’s book was formed outside the structures of the church hierarchy, not for clerics or even nuns, but for her ‘even Christians’, the common people of the church who she loved. Her language, as it developed, was a mix of the spiritual and material. Her images – hazelnuts, herring, pellets, eaves – were drawn from everyday life and were meant to remind her readers that we are united with God even through our physical being. Her language had the quality of finely made homespun. Crafted, yes, but refined, no. It had the echoes of stories told. around peat fires and the smell of their smoke, of rhymes and songs sung by mothers to their children.



“God is being and wants us to sit, dwell and ground ourselves in this knowledge while at the same time realizing that we are noble, excellent, assessed as precious and valuable and have been given creation for our enjoyment because we are loved.”



After a lifetime of seeking Julian finally saw that God and the soul shared something so intimate that even sin could not disrupt it – the soul and God were one.




Julian of Norwich; A Contemplative Biography by Amy Frykholm; Paraclete Press, Brewster, MA, 2010

The Question of Food by Adam Gopnik

In the early morning –six-forty, precisely – of May 24, 1942, a young professor of German, a resistant who had taken the name of Jacques Decour (his real name was Daniel Decourdemanche) and who taught before the war at Lycee Henry IV in Paris, wrote a letter to his parents:



You know that for the past two months I have been expecting what is to happen to me this morning; so I have had time to prepare myself for it: but since I have no religion, I have not given myself up to any meditation on death. Here are a few requests. I was able to send a word to the woman I love. If you see her – soon I hope – give her your affection. This is my dearest wish. I also wish that you could keep an eye on her parents who need help badly. Give them the things that are in my apartment and which belong to their daughter. The volume of PLEIADE, THE FABLES DE LA FONTAINE, TRISTAN, LES QUATRE SAISONS, two water colors, the menu of the inn LES 4 PAVES DU ROY.

All these last days I have though a lot about the good meals that we should have together when I was free. You will eat them without me, all the family together – but not sadly please! I don’t want your thoughts to dwell on the good times we might have had but on those that we really have shared. During these two months of solitude without even anything to read I have run over in my mind all my travels, all my experiences, all the meals I have eaten. I even composed the outline of the novel. I had an excellent meal with Sylvain on the 17th. I often thought of it with pleasure, as well as of the New Year’s supper with Pierre and Renee. Questions of food, you see, have taken on great importance.



Three hours later, what was going to happen to Decour happened to him. He was shot by the Nazis in the courtyard of the prison. Yet there he was, in the last hours of his life, thinking about sending a menu from a little inn near Versailles to his girlfriend’s parents. His last thoughts turned to his best loved meals. Of course, he’s nobly trying to ease the horror of his parents, but he’s also trying to find something to hang on to. Questions of food, you see, have taken on great importance.



Well, today, the Auberge des IV Paves du Roy turns out to have a whole Web page, a menu, a brief history – the works. It is a nice place, a very nice place, in that half-in-the-country, half-not-in-the-country way of French inns. Madame had a table for us in the garden. We sat and waited, at first a bit awkwardly – what were we doing here, after all?- and then, comfortably, as the commis, right out of Marcel Pagnol, brought us bread, which reassured the children, and then Sancerre rouge, nicely cold, which reassured the parents. I doubt that anyone can completely despair when menus appear (in movies and television shows, when they want to create a mood of absolute alienation they always set the thing in a cafeteria.)



So we ordered and then we talked, naturally enough, about the Resistance. Luke, now sixteen, asked me if “in the big picture” the Resistance had made any difference. I tried to explain. No, they hadn’t really done much, spending a lot of time on guard against one another’s betrayals and fighting among themselves, socialists against Christian Gaullists and communists, who were courageous but committed to Stalin, against everyone else. And the were victims of horrible retaliations by the Germans, satanic cruelty even in a relatively placid occupation zone like France. So, no, they hadn’t really made much difference to the outcome of the war.



But in another way they had made all the difference. They had saved the honor of France, which was not just an abstraction but a living reality; you could hold your head up after the war and say, Some people didn’t submit, and that was true, too. They had acted with so much courage – courage for its own sake, courage because you could be courageous and couldn’t live with yourself without it – that they had supplied a kind of moral pattern for the rest of the country. Their fiction had become a feeling. Any country that could produce men and women as brave as Jacques Decour didn’t have to feel lost, or ashamed of itself. So it depends on what you mean by difference, I said, and then I realized that it didn’t depend on what you mean by difference so much as on what you thought the big picture was.



Then, at Olivia’s insistence, I narrated, rather lamely, a history of the French Revolution, getting half of it wrong, but the essential point – that what started in glory ended in chaos, and what began in a declaration of all the rights of man ended in a denial of every one; but that the articulation of what was right was either no help at all or a constant source of hope – was there. It depends on how you see it. Brillat-Savarin’s eternal point was that at some level it didn’t matter, that the hub-bub of the Palais Royal created a series of values – of which the restaurant we were sitting in now was a modest but real microcosm – that endured whatever squalid mess the politicians made of things, and that that was the right point to make.



How was the food? The food was fine. Sixty years ago it would have seemed very good. Seventy years ago, Decour’s time, it would have seemed like the best food in the world. We had filets of beef with green peppercorn sauce, and sautéed potatoes – they used to do pommes soufflees at these places, but no more. I know why – and green beans. The deserts were really good. Luke said that the profiterole were the best he ever had. I had an old classic, apple sorbet doused with Calvados, the kind of thing that’s so hard to find these days. With the tastes of Barcelona still sharp on my lips –gingered scampi and smoked ell and brains – I knew it was old fashioned. Still, it was the fashion that I, too, had loved of old.



I reread Decour’s last letter when I got home to Paris, and I realized then that I had missed something essential. In a way, as Huck Finn would say, I missed the whole blame point, missed it a thousand miles. Decour was a communist, a Marxist, and buried in the letter is the clear cool claim that he is talking about food because he refuses to talk about God. “You know that I’ve been waiting for two months for what’s going to happen to me this morning, and that I have had time to prepare myself, but, as I have no religion, I have no fallen into a meditation on death; I consider myself a little leaf who falls from the tree to make the soil. The quality of the soil depends on that of the leaves.” It is a non-believer’s claim, quietly defiant. As I have no religion, I don’t think of death. The questions of food rise from that context.


I don’t believe in a good God, and I don’t believe, as Decour must have, in History. But I believe in the inn of the four seasons: that Decour went there with the girl he loved, that he left her the menu when he knew the Nazis were going to kill him, that it has moved, and not moved, been rebuilt and is still the same, so that we can eat there now. They could walk in now and be happy again in the garden. It would all be different but they would still be at home. We walked under the sign, and contemplated the connections. He had thought about that in his last moments. That the table came last to his mind is another way in which the table always comes first.



The Table Comes First by Adam Gopnik