“The First Thing A Principle Does Is Kill Somebody”
Thus sayeth Lord Peter Wimsey in Dorothy Sayers’ Gaudy Night — and while it offers unmerited dignity to Gov. Mitch Daniels to accuse him of possessing a principled moral judgment, it is still true that his decision to defund Planned Parenthood will kill some number of Indianans.
Given that he has foreknowledge (or should, by any reasonable standard) of this outcome; given that he is doing this intentionally — after all, he has committed himself to the affirmative action of signing the bill in question; given that the consequences of this choice are readily recognizable to any mature observer, I know how I would characterize this act. YMMV. The blunt fact remains that mortal harm is coming to some women in his state as a direct result of his actions.
What’s this all about? Well, Kay here already noted the key fact: Planned Parenthood in Indiana is a major supplier of healthcare to women in poverty; withdrawal of that care we lead directly to premature deaths. That fact is implicit in what Kay wrote. All I want to do here is to make it explicit, to leave no ambiguity in the demonstration that the approach to health care policy taken by Daniels — and Republicans in general — leads directly to the deaths of Americans.
From whence derive these –dare we call them murders? Take a look at one of the most basic services Planned Parenthood provides its clients: regular maternal and reproductive health care, including screening for one of the most preventable major diseases that afflict women, cervical cancer. I’m going to do a bit of boring data dumping here, because I want to make the indictment of Daniels — and those who follow or admire him — as clear as possible
According to the CDC, about 12,000 women in the US were diagnosed with cervical cancer in 2007, the latest year for which I can find summary statistics. About 4,000 women died that year of the disease. Many or most of those deaths were, or would soon be unnecessary, evidence of failures of public health, given that cervical cancer is preventable at very high rates.
For one route vaccines exist that protects against infections by two of the most dangerous human papillomavirus strains implicated in the development of cervical cancers, and they are recommended by the CDC for girls and young women as early as possible (as young as 9) to protect against such viruses before risks of exposure mount.
Right wing opposition that to my jaundiced eye looks to oppose anything that might hint at independent sex lives for women has hindered the widespread application of one of the lowest cost, least invasive life saving medical interventions we now possess, one that could, as the raw numbers above suggest, save many thousands from the suffering involved in cancer treatment — and thousands again from dying unnecessarily from a wholly preventible disease.
The other path to prevention is, of course, the use of a screening test, the Pap smear, to catch the lesions that can proceed to full blown disease before they become malignant.
The US Preventative Services Task Force (among many others) recommends that women begin a regular screening regimen within three years of the onset of sexual activity or their twenty first birthday, whichever comes first, to be repeated every three years until the age of 65, barring the presence of certain risk factors for the disease.
Such screening saves lives. Lots of them. Many sources report that a regular screening program with appropriate follow up reduces cancer incidence rates by up to 80%. In the US that has corresponded to a drop in new cases from 14.2 per 100,000 in 1973 to rates about half that now, leading to 3 deaths per 100,000. In Indiana itself, 2.4 white women per 100,000 were diagnosed with the disease in 20007; the number for African American women was 5.7 per 100,000. That disparity may be due more to poor health services infrastructure and follow up for minority communities than to lack of access to screening itself; just about every source reminds the reader that the screening on its own can do nothing, unless action on the information thus gathered can occur.
All of this is background to this one datum: Planned Parenthood in Indiana delivers 500 Pap tests per week, and provides crucial health care support and services that allows the women it serves to do something about problems when detected.
Y’all know where this is going. Pull 25,000 tests per year out of state health care system; do so for a population that is almost certain to include the most vulnerable and the least secure in their access to ongoing care, and you have a hot spot of cervical cancer cases waiting to happen. If rates among that group revert to those comparable to countries with poor screening regimes – Romania in the late ‘90s, for example, with its Europe-high rate of 13.7 deaths per 100,000 – the back of my envelope tells three or four more women every year will die in Indiana unnecessarily – all for lack of access to the Planned Parenthood services that could have saved them.
I’ve been deliberately dull above, after my high-rev open. The point I’m trying to make with this list of data and other people’s work is that there is not a political bone (or fibril) in the human papilloma virus. HPV don’t care if you vote Republican or Democrat or The Rent Is Too Damn High. It doesn’t judge you whether you have sex with one person….
…or if you like to do it like they do on the Discovery Channel. It could give a viral sh*t what you think of the PDF of Obama’s birth certificate. It shows up, gets nice and comfortable. And then some women get sick, and some die.
And can I say again that those deaths are in principle wholly preventable?
Planned Parenthood does lots more than screen for gynecological cancers, of course. This is just one example of the real commitment to saving lives, to life, that marks that organization. But this story makes the point well enough: when you cut poor and vulnerable people’s access to health care real harm results.
Which means that Mitch Daniels is presenting his bonafides to the Republican electorate with an action that will lead directly to the deaths of women whom he doesn’t know – whom he and we cannot know. That anonymity, the statistical nature of the crime, means that Daniels will almost certainly never pay any price, let alone a criminal one, for his role in their deaths. But they will be on his hands, and should be on his conscience.
And to go larger than just one politician whose ambition has swamped his capacity for moral reasoning, this is why we must work for more than just an individual electoral defeat for today’s Republican party. Mitch Daniels may indeed by the best they’ve got over there. That’s as damning an indictment as I can imagine.
Factio Grandaeva Delenda Est.
Images: Egon Schiele, Death and the Woman, 1915.
Albrecht Dürer, The Flight to Egypt, 1494-1497.