A woman in charge of a program for victims of human trafficking came to my clinic for a grand rounds talk recently. She discussed the nature and current definition of human trafficking, and she expressed skepticism about the notion of “sex work”, suggesting that all such work is inherently exploitive. In the lives of my disenfranchised patients, desperate in the midst of the demands of extreme poverty and addiction, “trafficking” is a framework that often fits better than “sex work”. I don’t see trades of sex for money working consistently well for the people on the sex side of the exchange. My clinic doesn't see a lot of creative writing majors getting some side money with genteel hotel gigs. And some of my patients have been involved in trafficking situations that are truly horrific, the unique contours of which are, frankly, worthy of more legislative and law enforcement attention than they get.
On the other hand, there are some exceptions. An easy example might be when strippers have organized into unions recognized by law as collective bargaining units. That’s “sex work” by any measure. (And the progenitor of “always look for the union label” jokes by sex worker advocates.) And there are independent sex workers who don't owe their earnings to anyone else but themselves: are they victims?
It’s sometimes tempting to think that sex workers who don’t use a "trafficking" frame are just fooling themselves—allowing their rhetoric to conceal the systems of exploitation (direct and indirect) around them; or, even more commonly in this debate perhaps, using empowerment rhetoric as a way of justifying their involvement in an economy that is inherently disempowering. It’s hard to argue against the idea that the economy of sex work is mostly built on attitudes that are inherently exploitive.
But I liked this article from The New Yorker, following some sex worker advocates at a protest recently. People using the “sex work” frame are angry that people using the “trafficking” frame have shut off one way that sex workers could regulate and control their economic lives and their physical safety, with laws that are aimed at internet trafficking.
I’d consider myself a feminist or at least an aspiring feminist, but I’m no feminist theorist. In this space, the tangles of political philosophy and difficult choices about regulation, safety, and societal values are deep and difficult. But being from San Francisco—where union strippers and others schooled me in a “sex work” frame—I can at least stay in the space of, its complicated. And I hope we can let the experiences of the people with whom we work—whether they are sex workers, victims of trafficking, or both—guide how we think about the economics of sex. I know of cases where the internet has been used as a tool of brutality. But I also have heard people's stories of getting into cars or trucks and finding themselves in mortal danger, where my inner reaction has been, maybe a web site might be a better way to do this? Some of the stories I’ve heard from street work have made me want to start internet skills classes for people who are "doing sex work" or "being trafficked", or both. Which is why I worry about whether a law to go after traffickers might instead be endangering the people whose bodies are actually on the line. I missed the SOSTA/FESTA debate until it was too late to make a difference. With a 97-2 vote in the Senate, clearly a lot of people missed it. Most of the people arguing against this approach were people who cared about the rights of tech companies and internet sites, not sex workers. But now we're left with the world we're left with, which, websites or no websites, continues to be violent against women. Websites or not, the system continues to be stacked more heavily against people who do sex work, or are trafficked, or both, than it is against the people whose money creates markets for sex. At least some of the people who are operating in a feminist philosophical framework but describing sex work as "trafficking" have a utopian end goal: the end of exploitation and of exploitive sexual and economic relationships. On larger goals like that, I am a pessimist. On small goals--like the idea that by slightly modifying elements of a terrible world, we can make it slightly less horrific--I am an optimist. I find that this inclination, more than any greater philosophical framework, gives me a particular sympathy for the "sex work" frame. And at the same time, where I actually work and live, my patients who find themselves in the sex economy (primarily because of their relationship to the drug economy) are, in fact, much more "trafficked" than employed. In my small corner of the world, I don't presently know any "sex workers", and I do know a number of "victims of trafficking." A change in jargon alone won't transform that brutal reality. Still... maybe a web skills class?
At its best, house music aspires to become the pop music of the beloved community
--an insistently multicultural and welcoming space.
After Chicago-born house music and its Detroit cousin, techno, had migrated to Europe, they merged into "electronic dance music" (EDM). Along the way house and techno were being shipped back to the United States for consumption by white kids. Big raves and festivals full of kids high on Ecstasy (MDMA) kept some of the utopian aspirations of original house music, but in the service of high-priced tickets sold in white areas of the country.
From living in the Bay Area in the late 80s and early 90s, I remember both strains of this movement: the more-straight-than-not "rave" scene that eventually morphed into Burning Man and EDM festivals and dot-com money; and the gay clubs, spreading the original house music faith that had grown and flourished in the gay world without having to migrate to Europe and back.
But in San Francisco's gay world, during the time I was there, the sweet house music eventually morphed into something else as users' experience of MDMA was wearing off and some started migrating to crystal meth. The music became less hopeful.
Both the "rave" world and the house music of gay clubs kept an optimistic "love the world" vibe for a while, but utopian music doesn't translate to utopian economics. What I always heard, back in the days that I knew people who knew such things, was that if the club promoters weren't dealing drugs directly, they were taking a percentage from the dealers. Since there would be dealing in the club, some promoters reasoned, they might as well reduce conflict and unpredictability by granting a monopoly to a particular vendor, and getting some of the money back. Everyone wins, right? And whether in the gay world or the straight world, house music was never a liquor-heavy scene. So you either had to make money from high admission fees, or some other way.
MDMA lost its luster for people after repeated uses; and crystal was there as the next step. That's the economics of neurotransmitters. MDMA just wore off eventually, meaning that people developed a tolerance and couldn't keep getting pleasure from it. Most drugs do that. But a drug like crystal (aka methamphetamine) keeps some people going back to it, hungry for it. It starts owning people. And that means they keep paying, and paying, and paying. Financially, a club that's all about MDMA-fueled happy vibes isn't going to survive when the scene, and the money, has moved on. If the drug economy has moved on and you're getting a cut from the revenue, your DJs better follow suit.
I think about all of this when I listen to house classics like "Good Life" or "Where Love Lives", music that is so sweet, made for a dance floor that is happy and embracing. There were promoters, and drug dealers; like everywhere else, there was money changing hands. Every flowering utopia carries within it the seeds of its own harsh replacement.
But before that happened, there were people on a dance floor, happy. And you can't take that away from the music, or the DJs, or the people who were there.
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One of the things I adore about The Black Madonna is that her tatooed-librarian exterior extends to a nearly scholarly sensibility about house music and dance music generally. Check her Spotify playlist, "History of the World", for instance.
And listen to this late-eighties/early-nineties pair of house music classics; in my own personal history, this is what the clubs in San Francisco sounded like before meth hit. Before the darkness came.
As an HIV doc I’ve practiced in Ryan White funded clinics and clinics that weren’t. Ryan White clinics are better. Now @SenWarren is proposing a similar model for the opioid epidemic. Because in HIV and substance use, meds work, but they work much better with support. pic.twitter.com/Aa2ZL3XwpR
This was when Rickie Lee Jones decided to use hip-hop beats and tour with a DJ. The only time I saw Rickie Lee Jones in concert was when she was on the Ghostyhead tour, and most of her fans seemed like they were like, uh... huh? And my reaction was: holy crap! Rickie Lee Jones! I mean, I'd associated some of her songs with the coffee shop and then the used bookstore where I used to work, when growing up in the same neighborhood where Lady Bird works at her coffee shop in Sacramento. And she was always a wierdo--great used bookstore music, really--but on Ghostyhead she turned into a completely differently wierd and awesome experimenter. And Hilton Als, you look this up on the Internet and he says,
Sacrifice is a somewhat antiquated notion as it applies to the contemporary artist, but I use it defiantly in regard to Ms. Jones; she could not have recorded this album without having given something up and survived it, with wit.
I'm posting a response to Doleac and Mukherjee's paper on the moral hazard of naloxone. I think the paper is wrong, but I tried to be smarter about it on my second look at it than on my first. (Which inspired irrationally inflamed tweets; now I'm sticking to rational inflammation.)
Appendix: a brief discussion of the idea of "moral hazard" and why, even though it's a jargon term and not a description of a person, it still bugs me in this context.
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And because it would not be a Mu Receptor Mixtape post without a musical addition, I attach:
The homeless census was framed as a local event, but in truth, every city that gets federal money to shelter homeless people is obligated to do this kind of "point-in-time" count. Whatever the flaws of this approach, don't blame your mayor. There are better ways to count homeless people if you're concerned about estimating the number of actual homeless people. But it's the perfect policy for counting homeless people if your concern about homeless people starts with those who are visible to others.
"Homelessness", as an idea for folks who aren't poor, mostly amounts to a category that translates to the visibly desperate, the obviously impoverished. I hear this when I explain what I do for a living in well-to-do social settings. There is sometimes this strange fumbling on the part of the person I'm talking to, where they end up blurting out some story like "I talked to a homeless person once" or "I bought a guy a sandwich" or "I see people with signs on my drive home from work." That's OK. I understand that when I say the word "homeless" that this pokes right into an until-then-healed-over confusion and anxiety that people feel when they actually see other people's desperation. What they feel in that moment when somehow the desperation connects to them, and they know that it's both simple and complicated at the same time.
Homelessness isn't just the man sleeping in a doorway in a wealthy neighborhood. The "homeless lady" who is seen in the park with her bags and her inner voices. This is mostly who people at parties I go to are thinking of. And those are important people too. But, I learned from my boss when I started doing this job, you can get all kinds of answers when you ask, what are the causes of homelessness?--and you can offer a very simple response in return. Homelessness is caused when the cost of having a home exceeds the ability of people to pay that cost. The rest--that's just details.
And this might remind you that there are some other homeless people you'll never count, people whose suffering is immense but not visible, not recalled as a "social problem" because it doesn't enter into the social urban space:
A woman who regularly must inhabit a treacherous ever-shifting zone between a man's simply selfish sex and his outright rapes in order to stay in an apartment.
A man who is sleeping in a storage unit, in a warehouse storage facility.
A woman and her child who won't leave her boyfriend's house because he really might kill them if they do.
A transgender woman who gets one kind of abuse in women's shelters and another in men's, and so stays outside to avoid both.
A man who has to stay out of his sister's house a few nights each week so she doesn't lose her housing for having people stay in her apartment.
A man, just out of prison, taken in by a woman who wants to fix him, to save him, and he's not sure that he's fixable or that he wants to be saved, but he knows he wants to be inside.
And there are so many more.
Even, almost, a small group of women in an ATM vestibule in a corner of the city I won't identify, women we didn't see at first, looking wary. We did count them, luckily. But we didn't count any of the others. And if it was easy to get an affordable place to live, all of them would have their lives changed. If we made housing a priority. If we thought it was what our fellow human beings deserved. If we could count them all, and they all counted.
I was getting in a fight on some doctors' group on Facebook about Medicaid work requirements and some dude was being so irritating that he apparently provoked me into starting a sentence with, "Despite not being an Ayn Rand superhero anonymized troll-boy like yourself..." Which is a sure sign I need to not be on Facebook right now. In this time of desperation--DACA still not fixed, CHIP still not fixed, Puerto Rico still devastated, no Puerto Rico Medicaid fix, no community health center funding renewal, and now they're going to ask impoverished people to work to keep their medical care because, I don't know why exactly, and it feels like in health policy and in many other places in policy, nothing nothing is working like it's supposed to... well, I am perhaps more easily provoked than usual.
Desperate times require desperate beauty: Pharoah Sanders' 1982 performance of the Coltrane song Olé is not for everyone--it is 23 minutes of rough, raw, ecstatic, on-the-edge jazz--but since I heard this at some point in my early 20s, I am still not over its propulsive ferocious magic.
Yeah, still no CHIP fix, no community health center fiscal cliff fix, no Puerto Rico Medicaid fix, merry Christmas, y'all.
Meanwhile, there was this time in my life where I was living in Washington, DC. Nothing policy-wonky; as a matter of fact I was a mouse-killer. I lived in a seventh floor studio apartment; it was mostly a pretty lonely year. I was buying music to pass the time, and somehow got into this one song on one French house music compilation (Respect is Burning, Part 2). "Casa Campo", by Clement, somehow grabbed me, and I've had a soft spot for that track ever since. And it wasn't like I was going to clubs or meeting people at that point. I was sitting in this seventh floor apartment, watching planes in the distance flying into National, listening to house music for no especially good reason. This is music for dancing and having sex and taking drugs, not sitting around your apartment being a stone-cold-sober mope-tastic pre-med. So, I can't explain why I was buying that kind of record, or why on that kind of record, it was this particular song at that time.
But even though now I can't find the CD in my stuff, every now and then I go find the song on the internet. I've never known anything about the person who made it--though you can look that up these days--and I can't even say why this la-de-da chill-out kinda song makes me happy. Especially with the little guitar bit at 0:27, it starts like something that should be playing at the pool bar in some kind of boutique hotel where probably nothing good ever happens and a lot of money changes hands to make those nothing-goods happen.
But, the pleasures of music can't always be explained, and the moment where a little synthesizer riff starts dancing around at about 3:33, with the bass kicking in a few seconds later, makes me inexplicably happy, moving my shoulders at my desk, as if somehow I was like, some Parisian getting ready to go to le discotheque.
Which is probably at least as inexplicable as, why there's still no CHIP fix, but there you have it.
"if she’s dance music’s mom, she’s a rad, weird and decidedly cool mom" -- MixMag
The New York Times described her in passing as "warm left-field disco"; but I gotta say, I just had to write down the first time I heard her song "He is the voice I hear" because I feel like it might later turn out to be an important moment. The first time The Black Madonna entered my headphones. And yeah, I realize I'm like a year or many years late to the party as usual, though I want to say in my defense I found this song from Spotify not from the Times. I mean, I have never and will never hear this in a club, but I'm not such a looo-zah that I'm getting dance music recommendations from Paul Krugman or whatever.
But anyway, during my twenties, if I had the cool and the common sense to be in the back of the club with the DJ instead of up at the front handing out condoms and public health information, "He is the voice I hear" is the kind of music I would have dreamed of producing as a result. Smart, propulsive, genre-mixing, obscure-sampling, and somehow, intellectual about being emotional. But no, due to my misspent youth in public health, I go to work and write prescriptions instead of dropping beats at a Barcelona music festival. Instead, I'm a doctor, telling you that
we still need the Children's Health Insurance Program fully funded,
and we still gotta fix the Puerto Rico Medicaid cliff,
and may our dance music be welcoming and warm, always.
Because, wow, Holy Record Store Nerd, Batman!--check it, from 2012: Alright this morning
I stayed up late re-watching Arrival. I decided that I love that movie.
I was thinking about Arrival today while folding laundry, the morning after I'd stayed up late to re-watch it, wondering why this movie speaks to me so much. I often connect strongly to moody cerebral science fiction movies, so maybe it was inevitable. But more deeply, on watching the movie this second time, I connected strongly to the particular combination of fear and wonder, of feeling intellectually challenged and emotionally overwhelmed, that Amy Adams conveys for much of the movie. She is haunted but enlivened by what haunts her. She walks towards the fear, the dread. In doing so she embodies a quiet, kind power; a form of strength that incorporates curiosity and love as part of its structure. This is the emotional quality I seek in my work and my life. The heroic version of this quality looks easier in the movies than it is in real life, and I'm not even using advanced linguistic theory to bridge the gap between alien civilizations across time and space. I'm just trying to help people stay alive. I don't compare this experience to trying to communicate with aliens; these are my people. It's less the experience of the aliens as it is another part of the story, about grief, that I think I connected to most strongly. The idea of going towards love even if grief lives in the same room. And yet, these aren't my deaths to grieve. I haven't lost the people I'm closest to. I remember a moment when I was doing AIDS work and I saw this movie Fearlessin 1993, at a time when everything seemed like it was just going to keep getting worse. And I remember losing it at this movie. Crying my eyes out for reasons I didn't totally understand, for deaths that hadn't yet occurred, for grief that wasn't really mine to grieve. And yet, was. I think I'd been getting numb for the weeks preceding seeing the movie, and then cried much more than I normally would have. Some guy's story came back to me, some horrible story that I don't remember now, and it was like I'd shut myself down after hearing his story, and then after the movie, for some reason opened myself back up to the world, to pain, to other people's stories. Arrival wasn't that for me last night. It was just a very evocative sinking into the deep spare melancholy of the world; of the universe. And how this connects to who I am right now, I feel like I'm still working out. But I do know there is something about Amy Adams' character that I identified with, that I found in common with how I am feeling. When I figure that out, maybe I will be able to read some alien alphabet of time and physics. Or maybe I'll just know my own language better.
* * *
Addendum: Maybe something in this territory: From Chris Plante in The Verge: "Arrivaltells the story of one woman who chooses a life of grief to save the world. I find her so painfully relatable. As I get older, the emotional struggle of life — the one I couldn’t see when I was a child — has revealed itself. Friends and family die. Unexpected tragedies interrupt banal work weeks. To live and to love is to court inevitable grief, and we make the choice to move on. I’ve attended many funerals over the past few years, and I thought about each of them on the drive home from my screening. I don’t have the advantage of knowing my future, but I do have the memory of my past. I know the pain that comes with emotional investment, and it does not hobble me, or at least I try my best not to let it. I found Arrival’s bigger themes of communication and trust compelling. But what will stick with me is its defense of choosing life in the face of profound grief."
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Don't worry: I haven't forgotten the musical note:
It seems like a good ecologic/musicologic question to ask whether the Arrival soundtrack would've sounded even a little bit the way that it did if no one had ever recorded humpback whales. I mean that as a compliment. I like listening to humpback whales. An accidental discovery leads me to recommend playing these two links by clicking them in rapid sequence to play in different browser tabs. If you make that happen, the soundtrack becomes a backing track to the whales (or vice versa?):
Admittedly it's a little late on Saturday night and I'm listening on headphones so as not to wake anyone up. And I'm in a mood, and might have descended a little more deeply into the humpback song / Icelandic film score mash-up zone than others might choose. Still, you might consider playing them both, from the beginning, starting at the same time.
There is also a very non-whale-ish piece of music, "On the Nature of Daylight", that is not a part of the movie's score, but serves as the underpinning of a key portion of the movie. (Written by Max Richter, who wrote the score for The Leftovers, speaking of haunting science fiction.) I recommend this also via YouTube link:
Look, whatever I thought I might do in giving updates on Medicaid issues, is pointless. I think I thought only a few desperate people crying in the dark would defend Medicaid, and... it hasn't been quite so bad. Not good, mind you. From the point of view of this blog, though, the bigger point is that the job of keeping you posted on a daily level is being done really well right here:
"I don't care who you are, what you done, or who you done it to. If you're here, so am I."
"Ain't no shame in holding on to grief. As long as you make room for other things too."
It's been one of my professional ambitions to be Bubbles' doctor. I mean, not Bubbles himself. He's a fictional character from The Wire. (Sort of.) But people like Bubbles.
And I'd sort of forgotten about that until I was talking today about 12-step. For a lot of my patients on buprenorphine, the 12-step movement is a mixed blessing. There's wisdom there, but also judgment. But some folks find a way to put the two together. They find the help of a medication, and they find the wisdom of a community.
I can't tell you how many times I say, "One day at a time" as part of a sentence, and I really really mean it. Every day. Sometimes multiple times a day.
And there are none of my patients where I see them and I go, dude, that guy's just like Bubbles. They are each their own person. But I do see Bubbles now, and say, that guy's a lot like my patients.
Sara Rosenbaum, a Jedi-level health policy wonk, breaks down the details of the draft plan as it stood last week, highlighting a number of its problems. The same Commonwealth Fund blog brings us up to date this week with this explainer which emphasizes a key problem: in the House plan, in 2020 once you are out of Medicaid, you're out for good. But many of the working poor, particularly those who work seasonally, go in and out of eligibility. Basically the plan stalls until 2020, when it stealthily, steadily, and irrevocably culls the ranks of Medicaid expansion beneficiaries. It does this by booting current beneficiaries as soon as they work too much and lose eligibility for Medicaid, (while making a lot of noise about work requirements, personal responsibility, etc, etc); then allowing no new beneficiaries; and, most of all, never explicitly admitting to the goal of reducing the number of beneficiaries.
So, in summary, it starts as an incoherent mish-mash of modifications and quietly morphs into the "I didn't end your coverage, you ended your coverage" Medicaid destruction plan.
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Nothing like a single mom song to get the blood boiling on the contraction of Medicaid expansion.
