Suggestions for sterner FDA warnings for acetaminophen

"FDA Wants Sterner Pain Reliever Warnings" - AP, 12/20/06

1. Extended use of this product will make your face stay that way.
2. Use as directed or you'll shoot your eye out.
3. Converting this package into a bong is prohibited by federal law.
4. For internal use only; do not insert product into ear or nose.
5. This product is not approved for use by squirrels.

Vitamin D may lower MS risk

A study published in JAMA says that white people with the highest blood levels of vitamin D are less likely to develop multiple sclerosis than people with low levels. The study looked at blood samples from 7 million members of the US military. Here's a link to a short piece in the WaPo.

I've been taking a daily vitamin D supplement for maybe a year, in part because I know I don't drink enough milk to get my RDA that way, but also because of some vague half-baked notion that it might help with MS. I know there's no evidence that it could work that way, i.e., that someone who already has MS could be helped by getting more vitamin D. Perhaps this reflects a little sparkle of optimism, some kernel of hope, from a place deep in the brain that is unburdened by logic.

It's easy to let the logical parts of the brain shout down that little sparkle. It's easy to sigh disapprovingly at bee venom, amalgam replacement, laetrile, and any other "therapy" for which there is no proof of effectiveness. It's really, really hard, though, to let yourself believe that things will get better, or even that they might get better.

What's in my grocery cart?

3 boxes (family size) Post Raisin Bran
3 boxes Quaker Corn Bran
4 bags Sunsweet Pitted Prunes
1 16 oz. bag golden raisins
1 8-pack Activia Yogurt (strawberry/blueberry)
2 5-lb. bags King Arthur Bread Flour
1 cucumber (Euro-type)
6 apples (Pink Lady)
3 liter bottles Naleczowianka mineral water (bubbly)
3 Freschetta frozen pizzas (cheese, pepperoni, supreme)
1/2 gal. skim milk (organic)
1 pint half and half (organic)
1 bottle chipotle/cheddar salad dressing
1 4-pack Sioux City birch beer

What's right with our relationship

We've been to see our therapist for a couple of joint sessions, and the really surprising thing is that it's helped us to see how good our relationship is, how our occasional fights really are occasional, and how most of the time, each of us feels great respect for the other and wants to look out for the other. In fact, I was thinking that much of the substance of our next meeting would be devoted to receiving instruction in meditation and mindfulness. I was thinking that until yesterday afternoon, when my wife called me to report that she'd been laid off.

It wasn't a total shock; there had been pretty painful warning signs over the last month, but it still made me want to inflict some sort of awful harm on the people responsible. Fortunately, we'll be fine in terms of finances and health insurance coverage. Some of my wife's colleagues will have a much harder time.

So we may end up spending some time with the therapist trying to sort this out. But it has been somehow comforting to notice how strongly each of us empathizes with the other, how deeply each of us feels the other's hurt, even though research suggests that this kind of empathy is less important to a relationship than our ability to genuinely share our partner's joy.

Crusty nirvana

I spend a lot of time in the kitchen, especially when the weather is cooler and invites warm, savory comfort food (braises, soups, stews, etc.) that pairs well with wine. I've dabbled with bread on and off, with mixed results, but for the last couple years I've been content to buy crusty bread when I had a hankering for it. But a few weeks ago, Mark Bittman's Minimalist column in the NYT offered a simple recipe for satisfying bread with no kneading, relying on a long, slow rise to develop gluten and baking partially inside a heavy pot to produce a hearty crust.

In the last few weeks, I've made maybe a half a dozen loaves of the stuff, and I love it: dense, chewy, with big irregular holes inside and a crisp, thick crust. Today, Bittman's column has some ideas for further refinements, additions, and substitutions. I'm anxious to try a rye version (up to 20% rye flour, plus caraway seeds) and maybe a baguette shape, if I can figure out what to put it in.

Bittman reports that he prefers to bake in a smaller cast iron pot, maybe 3 or 4 quarts. I started out using an old Magnalite aluminum dutch oven of about that size, but have since decided I prefer to use my big (8-qt?) Calphalon soup pot. I found that in the smaller pot, the bread wouldn't develop much color at all until I took the cover off, and by the time it was finished it wasn't yet that beautiful dark mahogany that I associate with great artisanal bread (I've got a picture of my first loaf, which I'll post when Blogger cooperates). With the bigger pot, the larger volume decreases the concentration of steam that the bread is exposed to for the first half hour.

My favorite thing about the bread is that it's just as good toasted a few days after baking as it was right out of the oven.

What's a defect?

Today's NYT has a short essay on a journal article on parents using preimplantation genetics to ensure that their offspring, like them, express genetic traits like deafness or dwarfism. Usually, the technique is used to prevent the transmission of diseases like CF and Huntington's, but a survey of 190 fertility clinics indicated that 3% had used the technique to select for a disability. Snip:

In other words, some parents had the painful and expensive fertility procedure for the express purpose of having children with a defective gene. It turns out that some mothers and fathers don’t view certain genetic conditions as disabilities but as a way to enter into a rich, shared culture.

It’s tempting to see this practice as an alarming trend; for example, the online magazine Slate called it “the deliberate crippling of children.” Dr. Robert J. Stillman of the Shady Grove Fertility Center in Rockville, Md., has denied requests to use the process for selecting deafness and dwarfism. “In general, one of the prime dictates of parenting is to make a better world for our children,” he said in an interview. “Dwarfism and deafness are not the norm.” Dr. Yury Verlinsky of the Reproductive Genetics Institute in Chicago, who also refuses these requests, said, “If we make a diagnostic tool, the purpose is to avoid disease.” But both doctors said they would not oppose sending families to other doctors who might consent.

This really seems to cut to the heart of what it means to be disabled. In the case of deafness and dwarfism, there seems to be a culture that comes along with the physical difference such that those who have access to that culture (and perhaps not to elements of the larger culture that are available to the able) desire to share the culture with offspring.

It seems pretty obvious that MS lacks a culture of its own. Our physical differences are often undetectable, and move among the larger culture even though we may be able to take part in it fully. Given the prevalence of MS, we may encounter others with the same illness without even knowing it. If there is an MS culture, it probably exists only on the net; that's the only place where we're likely to encounter each other as members of the same gimpy tribe.

An investment of a sort

Tonight, she and I will be returning for a dual session with the therapist. We have, more than a few times, buried the hatchet in whatever conflict happened to make one or both of us furious and sworn that we really ought to see someone, i.e., marriage counselor, but we never really got anywhere until recently. The problem is that our insurance doesn't pay for family issues, so the question was: If we're going to pay out of pocket, who do we want to see? She managed to get a recommendation from a coworker for a guy who has some experience with MS couples, so we went last Monday for a session.

Of course, the first session doesn't really go anywhere, mostly just getting-to-know-you-and-your-marital-issues. I think C. even surprised herself when she was in tears after the first question, to wit: "So what do you hope to get out of counseling?" She went first, saying something about some suggestions for managing conflict, which went fine, but then I said something about how I wasn't really expecting to get advice, but just an opportunity to talk thru some things, especially since I really don't have many (any?) close relationships in which I'd feel comfortable bringing up marital stuff. And that was enough.

See, my wife has this extraordinary capacity for empathy, and what I said was enough to make her feel, all at once, all of the sudden, the isolation and loneliness that I've often felt not just with MS but even before as a guy who perceives himself to lack great social skills. And I sorta sat there for a while thinking about how it felt to feel her feel my pain. (The therapist seems to like to interact with one person at a time, leaving the other to listen and think.) Anyway, it seemed like we were done pretty quickly, and just that brief experience I think gave us enough empathy to have a week in which we really enjoyed each other's company.

But there is the small matter of the fee: $120 for an hour, which ain't exactly pocket change. For a couple days afterward, we talked about whether we felt like it was worth $120 an hour to go back for more sessions in the future. As an avowed cheapskate, I felt like maybe we could have found someone better, even though we'd only been to see this guy once. C. agreed that $120 would multiply rapidly, especially if it turned out that we wanted to keep coming back. So I called and left the therapist a message saying that we liked him but we didn't feel like we could afford his services, that we'd probably try to see therapists covered by our insurance on an individual basis, etc., etc. I was a little surprised when he called me back to so that he could offer us a discount, that he thought we would really benefit from couples work, etc., etc.

So we're going back tonite.

Is there a place for carrots and/or sticks in Medicaid?

Interesting piece in NYT on a West Virginia pilot program that will reward Medicaid beneficiaries who are "responsible patients" and deny some services to those who do not join weight-loss or antismoking programs, or who miss too many appointments. Snip:

Those signing and abiding by the agreement (or their children, who account for a majority of Medicaid patients here) will receive “enhanced benefits” including mental health counseling, long-term diabetes management and cardiac rehabilitation, and prescription drugs and home health visits as needed, as well as antismoking and antiobesity classes. Those who do not sign will get federally required basic services but be limited to four prescriptions a month, for example, and will not receive the other enhanced benefits.
....
No one questions that West Virginia, more than most other states, needs more healthful lifestyles and better primary and preventive care. But the new plan has stirred national debate about its fairness and medical ethics. A stinging editorial in The New England Journal of Medicine on Aug. 24 said it could punish patients for factors beyond their control, like lack of transportation; would penalize children for errors of their parents; would hold Medicaid patients to standards of compliance that are often not met by middle-class people; and would put doctors in untenable positions as enforcers.

“What if everyone at a major corporation were told they would lose benefits if they didn’t lose weight or drink less?” said a co-author of the editorial, Dr. Gene Bishop, a physician at Pennsylvania Hospital in Philadelphia.

I don't know if I like this or not. On one hand, I'm sympathetic to the NEJ's concerns about denying medical services on the basis of something that's beyond their reasonable control. On the other hand, there's John Johnson. Snip:

Speaking from the easy chair where he spends his days in a small wooden house near this small Appalachian town, his left trouser leg folded by a safety pin where a limb was lost to diabetes, he lighted another cigarette. Mr. Johnson, 61 and a former garbage collector, takes insulin and goes to a clinic once a month for diabetes checkups. Taxpayers foot the bill through Medicaid, the federal-state health coverage program for the poor. But when doctors urged him to mind his diet, “I told them I eat what I want to eat and the hell with them. I’ve been smoking for 50 years — why should I stop now?” he added for good measure. “This is supposed to be a free world.”

We're all paying for John Johnsons, both in Medicaid and in our HMOs and other insurance pools. And sure it's galling to have to pay for health services for a guy who doesn't care enough about his health to change obviously unhealthy behaviors. But I'm uncomfortable with giving the government a stick in this situation. It's not clear from the article to what extent the program involves the stick approach, but from a structural perspectice, the use of a stick requires a lot more due process protection to ensure only those who are truly stick-worthy get stuck. I'm much more comfortable with a carrot approach: if a beaurocracy makes a mistake in handing out carrots, nobody gets hurt. People might not get a carrot they're entitled to, but nobody gets hurt. And from a behavior-modification standpoint, doesn't science teach us that carrots reinforce good behavior much more effectively than sticks prevent bad behavior?

North Korea: Puzzling, fascinating

I'm probably not the only person who's curious about North Korea. Not just because of the news, but also because the gradual Wal-Martification of the rest of the world has made North Korea seem that much weirder. I recently read Guy Delisle's nifty Pyongyang, a graphic novel recounting the author's experiences working there, and today, Slate's "Today's Pictures" has a few tantalizing shots from North Korea. If you search on "Pyongyang" at Flickr, you can see some more glimpses into this frighteningly odd society.

Consumer-directed health plans: early reviews mixed

WaPo has an article about a study of people enrolled in so-called consumer-directed health plans. Basically, we're talking about people who are enrolled in high-deductible, low-premium health insurance plans and who pay their share of health costs with pre-tax money from health savings accounts.

According to the study, these folks are indeed paying more attention to their cost of care, just as advocates for such plans predicted. On the other hand, they tend to be healthier, whiter, and richer than those who in traditional plans, just as critics predicted. Bottom line: half of those in consumer-directed plans would switch to a traditional plan if they could; about a third of those in traditional plans say they would switch to consumer-directed plans. Snip:

In contrast with other plans that typically require $15 or $20 co-payments for visits to the doctor, the new plans can require consumers to shell out hundreds or thousands of dollars of their own money for medications, physicians' services and hospital care before most coverage kicks in. The plans have high annual deductibles, but their premiums tend to be lower.
....
"It's a cultural shift," said Devon Herrick, a health economist at the National Center for Policy Analysis in Dallas. "When you go to Wal-Mart you don't have to ask about price -- it's right there next to the good or service you are buying. Health care is not there yet, but it's getting that way. This is the early stages. We have the incentives to get people more responsible and asking about price."

Link.

Young man, don't sit up straight

Interesting item in the ChiTrib today about sitting and posture. Turns out that sitting up straight, with your back at a 90-degree angle to the floor, is more likely to lead to back pain than leaning back. Specifically, a 135-degree angle is ideal. In fact, that big-ass recliner in front of the TV would be perfect, if you could get it into your cubicle. Snip:

"Really the best position is what you get in a La-Z-Boy, although that wouldn't work well for someone using a computer," said Dr. Waseem Amir Bashir, who led a study conducted at Woodend Hospital in Aberdeen, Scotland.

Bashir's findings, which confirm what experts in ergonomics have believed, were presented at the McCormick Place meeting of the Radiological Society of North America. His conclusions come from getting a different view of the spine, using a newly designed magnetic resonance imaging machine that allows for a full view of the back while sitting.
....
Assuming any position for a long period is a bad practice, said Judy Lesse, an ergonomics consultant for Herman Miller. "We design our chairs so that people can change positions regularly," she said. "You may find it difficult to lean back while using a computer, but you can lean back while talking on the phone."

Dave Trippany, corporate ergonomist for Steelcase Inc., a Grand Rapids, Mich., maker of office furniture, said that "flexibility is the key. People should move around to increase circulation. Reclining is part of that."

Link.

Anti-inflammatory plant stuff

This morning's WaPo has a gee-whiz article about research into the anti-inflammtory properties of a plant from the ginger family called Afromomum melagueta. In the wild, gorillas have apparently long been savvy to this stuff's benefits, but unfortunately lacked the marketing skills to properly exploit its commercial potential. Thank goodness Avon got ahold of some; it plans to market skin-care products containing Afromomum. Others speculate about its use as a substitute for anti-inflammatory pharmaceuticals like Vioxx and Bextra. Snip:

A clear vial filled with amber fluid rests on scientist Ilya Raskin's desk, glinting in the autumn sunlight streaming through his office window. The container, a small glass bottle with a plain white screw-top, contains a substance Raskin calls 006. "Double-zero-six" is potentially more precious than the rarest topaz.

Raskin is a biochemist at Rutgers University's Biotechnology Center. The golden liquid on his desk may prove to be one of the most powerful anti-inflammatory substances ever discovered. "It contains a derivative of a plant known as grains of paradise, or Aframomum melegueta, a member of the ginger family," said Raskin. The compound works in a similar way to the well-known anti-inflammatory drugs Vioxx, Celebrex and Bextra but, it is hoped, without their side effects, said Raskin and other scientists.

Link.

Stupid brain tricks

As a person whose brain is kinda, well, broken, I sometimes lose sight of what a wacky gizmo the brain is. Frinstance, there's a little article in the NYT about a rare condition called lexical-gustatory synaesthesia, in which the brain tastes words. Snip:

One subject, Dr. Simner said, hates driving, because the road signs flood his mouth with everything from pistachio ice cream to ear wax. And Dr. Simner has yet to figure out any logical pattern. For example, the word “mince” makes one subject taste mincemeat, but so do rhymes like “prince.” Words with a soft “g,” as in “roger” or “edge,” make him taste sausage. But another subject, hearing “castanets,” tastes tuna fish. Another can taste only proper names: John is his cornbread, William his potatoes.

So let's give thanks for brains, even broken brains, for connecting us with the world. Hold the ear wax.

Is this anything? I don't think so.

I've seen a few articles on this particular "story" since Monday or so: the nation's leasing health insurance trade group has come out with a "plan" for covering the millions of Americans who lack health insurance. Snip from a Chicago Trib article:

The organization called on the federal government to spend an additional $300 billion over 10 years to expand public health programs for poor Americans, offer subsidies to working families to buy medical coverage, and support state health reform efforts. But there are no specifics on how the proposals would be financed or provisions for taming rapidly escalating costs.

The first priority should be providing insurance protection to almost all of the nation's children in three years, Ignagni said. Then the focus should turn to programs that will aid adults, including new tax-advantaged accounts for people who purchase insurance on their own.

With the Democrats taking charge of Congress after last week's elections, the industry plan helps set the stage for action on health reform. Democrats have long considered health care a priority and signaled a keen interest in expanding medical coverage.

Is it just me, or is everything in the insurance industry's courageous proposal completely consistent with the industry's interests? It's kinda like the auto industry calling for all Americans to have access to a car.

The articles I've seen characterize the industry's release as a sharp counterpoint to the Harry-and-Louise ads that tanked the Clinton plan a dozen years ago. I could never figure out why it was that the industry opposed the Clinton plan. If I remember right, the plan would have essentially pushed for more employers to offer coverage to their employees, meaning it would have pushed more customers into the waiting arms of the insurance industry.

The only thing that seems not obviously in the industry's interest is the expansion of Medicare and Medicaid. But even there, the industry stands to reap a substantial benefit: more sick people get access to care before they get so sick that they end up in the ER. Right now, the compulsory ER "charity care" is paid for by jacking up the charges to those who have coverage. If you can stop or at least slow down the stampede of poor people through the ER, you can slow down the growth in premiums that's led so many employers (and some employees) to drop their health coverage.

Wake me up when the insurance industry puts out the press release explaining how to pay for the expansion in coverage.

How dry I am

A week and a half into my latest med change, I'm feeling slightly improved but dry as a Mormon barbecue. Since last Friday, I'm taking (for the pain-sleeping-peeing stuff) 40 mg Cymbalta in the morning, then 20 mg amitriptylene, 250 mg Serzone, and 0.8 mg Flomax at night. I think the pain might be a little better: yesterday, I was able to wear a pair of woolly trousers to work with only minimal itching. Sleeping has improved, too: I haven't had the foot-twitching clonus in bed for a few days, and I think I only got up to pee twice last nite. And I actually went two nights without waking up in a puddle.

But it's definitely starting to be the time of year for dry, itchy skin and hangnails, especially after spending some time in the pool. I'm moisturizing my hands twice a day, using only Cetaphil bar soap in the shower, and drinking as much water as I can choke down, but I'm still feeling shriveled. Also, I seem to have regressed back into chronic constipation, so back on the glycolax, I guess. This sucks, because the last time I got the glycolax filled, it was from a different generic manufacturer. The stuff tastes bitter and yucky and never seems to dissolve fully, unlike the last two batches I had. Yuck.

Making a case

Last Friday, I got a visit from a friend. T's not somebody I feel I know well, mostly because he lives elsewhere, but a guy who's a little older and a little smarter than me, the kind of guy I wish I knew more of. Anyway, T came over Friday evening and we had a lovely meal with some really nice wines he brought with him, and a couple neighbors popped in for a glass, and it was really great. I made a squash bisque and roasted a couple chickens and we had a little fancy chocolate tasting after the meal. Nice.

T. spent the night, and we were both up and about at 7:30 or so the next morning, and we got into this kinda long conversation about me and MS. T's a lawyer, too, has a fabulous analytical mind and a very easy-going manner, and he started out with an open-ended question like "So how's your health?" or something like that. I gave him the sort of autopilot answer that I give without thinking, something like, "Oh, not too bad, I guess" or something like that. I don't remember exactly how it went from there, but he just started to ask a few more questions that made it clear that he really wanted to know how things were going.

T wasn't so much interested in any of the history, but really seemed interested in a pretty deep account of where I'm at are now. It's been a long time since I had a conversation like that. I don't have a very large social circle, just a few close friends and assorted medical professionals; these people either know the whole story, because they've participated in it, or they don't, because they haven't asked or because I'm kinda tight-lipped.

Anyway, the theme, I guess, was coping: How do you do it? Why do you do it? What makes some people able to do it, but not others? T's got a pretty close friend with MS (also a lawyer) and he talked about his admiration for those of us who manage to retain some level of control over our situations and his dismay at his inability to understand others who seem unable to cope, particularly a couple of members of his family who've lost or are losing battles with alcoholism.

I don't remember much about what we said, although we went on for an hour or so. But I remember feeling strangely satisfied that I'd stated my case, that I'd been called on to give an account of my experience of my illness--how it feels, and how I live with it--and had been judged worthy. I guess I like to think of myself as a person who doesn't like to feel like he owes anyone. I want to make do for myself, meet life on my terms, but I know that I often feel a contradictory urge to prove that independence. Saturday morning, I had the feeling that I'd made a persuasive argument.

Booze news you can use

Whatever your political leanings, tonight will almost certainly be cause for celebration or lamentation. Champagne glasses will be raised in triumph, and bourbon will be slugged in bitter defeat. According to the NYT, if you're gonna be drinking tonight, you might feel better in the morning if you nix the cheap brandy in favor of some high quality vodka. Snip:

Experts say that the type of alcohol you drink does make a difference, but for various reasons. Among the most important is the amount of congeners (pronounced CON-juh-nurz) — complex organic molecules, like methanol — in a particular drink. Impurities in poorly refined spirits like cheap vodka can also play a role, but congeners, which are common in darker liquors, seem to have the greatest effect.

According to one report in The British Medical Journal, which looked at the effects of different types of alcohol, the drink that produced the most hangover symptoms was brandy, followed by red wine, rum, whiskey, white wine, gin and vodka. Another study showed that bourbon was twice as likely to cause sickness as the same amount of vodka.

I voted this morning and hope to find some way to forget the whole deal until tomorrow morning. As a moderate lib, I'd like to see control of the House shift, but I've got no illusions about what little impact that would have on the issues that matter to me. It just means that we return to being a country where it's hard to change the law, which is how it ought to be.

About time

A week and a half after my last visit, the pain clinic finally called with my new med instructions. Apparently, they'd been playing phone tag with another of my posse of health professionals. I was pretty sure that was the problem, but I resent that nobody saw fit to tell me that. I called them a half a dozen times, but couldn't get a status report until just this morning. In my profession, if I told a client I was going to take a specific course of action, but failed to do so and failed to explain that to the client, I would be subject to professional discipline.

Anyway, the plan is this: 1) stay on 40 mg Cymbalta, but try taking in the morning instead of bedtime; 2) add 10 mg of amitriptyline at bedtime, increasing by 10 mg/week up to 30 mg; and 3) decrease to 300 mg of Serzone now, then drop by 50 mg per week until I get down to 200 mg. This is all to get me better-quality sleep at night (the amitriptyline is supposed to help with bladder stuff) and to ensure that I don't develop serotonin syndrome. If it goes well, then we can talk about increasing the Cymbalta to further reduce the pain.

Initially, I thought, Wait, this plan looks like gives more weight to helping me sleep than it does to actual pain relief. But then I remembered how last nite I got up to pee 8 times and how, when the alarm went off a 6:15, I just about cried. So I think maybe it's just fine if we're focusing on sleep first. It certainly seems at this point like it might be the easier problem to solve.

Less miffed, less grumpy

Last Friday, I was feeling miffed and grumpy because the pain clinic wasn't getting back to me about the med changes we discussed at my appointment last Tuesday. I'd felt really positive about the appointment: the nurse practitioner had listened very carefully to me, and talked about some med changes and physical therapy stuff, and I thought I would be adjusting my meds that nite after dropping in at Walgreen's. I think it was something like cutting the Cymbalta down to 30mg/day to reduce my need to get up and pee half a dozen times every night, and add a little bit of amitryptaline to help me sleep. There was, however, a question about whether I would be getting too much serotonin, whether I'd have to change my dose of Serzone, and they'd need to get in touch with the psychiatrist who prescribes the Serzone.

When I went to the pharmacy, though, they said they didn't get a call from the pain clinic. So I called, and they said they hadn't gotten ahold of the psychiatrist. That was Wednesday. By Friday, I still hadn't heard, so I called and got the same repsonse. And while it seemed completely plausible that they were having trouble reaching the psychiatrist (who is only part-time at my HMO), I really felt like I needed to be doing something different.

When I got home on Friday, there was our friend L., who has lymphoma that hasn't responded to treatment (2 autologous stem-cell transplants and god knows what else). She'd been at the hospital that day getting fluids, because her gut wasn't working properly, and needed to have somebody look after her. She was pretty miserable, rushed to the bathroom every 15 minutes, and winced whenever she sat down. She ended up back at the hospital yesterday (getting fluids topped off), and my wife spent the day there with her.

Today, I'd really like to hear from the pain clinic. But I'm feeling a lot less miffed and grumpy, even though I had another night of intermittent, unsatisfying sleep.

Are democrats exploiting Michael J. Fox?

You've probably seen or heard about the ads: Michael J. Fox bobs and weaves while talking about a republican candidate's opposition to stem cell research. I guess there's one running in my state, now, too. Initially, Rush Limbaugh claimed Fox was gimping it up in the ads, either by skipping his meds or by simply faking up his Parkinson's symptoms. Later, apparently, he "apologized," but charged that "Michael J. Fox is allowing his illness to be exploited and in the process is shilling for a Democrat politician." Now, a hastily-produced response ad featuring some B-list celebrities is responding, urging that Missouri reject a ballot initiative on stem cell research (main points: initiative creates constitutional protection for stem cell research, poor women will be trapped into donating eggs for money, usable stem cell treatments still 15 years away).

I think the Fox ad is extremely effective, in a way that can't be neutralized by trotting out some pro-life athlete or actor. See, the public has already decided this one: whether they understand the science, whether they understand the work that remains to be done, they're in favor of helping sick people, and just as with in vitro fertilization, they're not as concerned with what happens to the embryos are they are with what happens to Michael J. Fox, because they are not of equal moral worth. And the ad just reminds them of this, in a memorable way. It's silly to think that they only feel this way because Michael J. Fox told them to.

But is Rush right? Is he being exploited? No. I doubt very much that Fox believes that he will benefit from stem cell research. I doubt he's getting paid scale. I doubt he's being held in the chair against his will until he finishes shooting a dozen spots. Is he a shill? Well, no more than anybody else who lends their name and image to endorse a product/service/cause/candidate.

Look, I know there a thousands of sick people who would be happy stand in for Fox; we'd love to tell the folks out there in TV-land about our illnesses, how our lives have changed as a result, and to talk about why it's so important that the government not squelch this research by closing the federal purse. I'm happy, though, that Fox is doing it, because everyone knows who he is, or was; because everybody knows his story; and because he's so darned cute.

And if Fox was exaggerating his symptoms, if he was gimping it up? Fine. I hereby grant to Michael J. Fox the right to supplement his symptoms with my symptoms: he's free to add a couple stutters, wobbles, and tremors, and, if he wants, he should feel free to wet his pants on my behalf, too, because nobody asked me to appear in an ad. If that's the worst distortion or deception that happens in a political ad this season, we can all rejoice.

Link to short NYT piece about the Fox ads.