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World Edition - The Atlantic
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World Edition - The Atlantic
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Measles Don’t Care What Jessica Biel Believes
One morning in 1934, panicked passengers jumped from the deck of the SS Morro Castle as it sank just off the coast of New Jersey. The ocean liner had caught fire, and the passengers had rushed to grab personal flotation devices. But some improperly wrapped the life preservers around their necks. As they fell and hit the water, the torque snapped some of their spines.Personal flotation devices save exponentially more lives than they cost. Of the catastrophic boating accidents that occur daily, 84 percent of people who drown were not wearing one. But etch the details of this horrific wreck scene into one’s mind, and a person might become a life-preserver skeptic. Our basic tendency toward short-term thinking means we judge risk based on whatever is in front of us. We draw anxiety disproportionately from wherever we happen to be focusing our attention.The same psychology applies throughout public health. At the moment, much attention in the U.S. is on vaccines—rather than the diseases they cause. This week, the actor Jessica Biel drew fiery eyes for lobbying legislators in California to kill a bill that would standardize the process of exempting children from required vaccinations. Biel, perhaps best known for her leading role in 2006’s The Illusionist, expressed concern for the well-being of a friend’s child. She has responded to accusations of being “anti-vaxx” by contending in an Instagram post that she “believes in vaccinations,” but wants to protect personal freedom: “I believe in giving doctors and the families they treat the ability to decide what’s best for their patients.”Like life preservers and everything else, vaccines do come with some fleeting risk of unintended adverse outcomes: mostly rashes or fevers, and extremely rare cases of seizures. But these risks pale in comparison to those of the diseases vaccines prevent. Before the advent of vaccination, measles alone killed some 6,000 children in the United States every year.This year has already seen more measles cases than any other since the disease was declared eliminated two decades ago. The trend stems from low rates of vaccination, which are making exemptions from vaccine requirements a flash point. California has triggered a reckoning with why exemptions exist at all—and why belief came to factor so heavily into a question of science. When is a health issue a matter of belief, and when is it simply wrong? When is it so wrong that it’s neglect?No federal law requires vaccination. But every state mandates that in order to send a child to public school—to have that child sit in close quarters with other children all day, every day—parents must take preventive measures to ensure the child does not carry certain dangerous infections. Requirements are implicit in the legal precedent that withholding vaccination constitutes “medical neglect” of a child. Legally, for example, it’s considered neglect to let a cut on a child’s arm get infected and then refuse antibiotics. If that infection had been airborne, as with measles, declining treatment as a child gasps for air would also be textbook neglect. It has been deemed neglect in cases where infectious diseases could have been easily prevented, but wasn’t.Researchers at Ohio State recently reviewed cases across the country from 1905 to 2016 and found that a majority of the time, refusing vaccination was found to be neglect. There was a curious caveat, though. In states with “religious exemptions,” parents did not have to follow public-health mandates to vaccinate their children against measles and other diseases if the parents cited “genuine and sincere religious beliefs.” The Ohio State researchers found that in these states, vaccine refusal did not constitute neglect—or it was considered neglect only if someone’s belief was deemed insufficiently “sincere.”Religious exemptions have slowly expanded in the United States, to the point that now, in almost every state, parents can opt out of school requirements—and leave a child open to catching and spreading lethal disease to other children—if doing so is guided by what the state considers a sincere belief. In such cases, the same behavior is not neglect.[Read: Measles can be contained. Anti-Semitism cannot]Exemptions have expanded to include “personal or philosophical belief” exemptions, as well, which are currently offered in 17 states. When the standard is sincerity of belief, the thinking goes, it shouldn’t have to be drawn from a major religion (or even a minor one).Accordingly, the number of people taking up belief-based exemptions has been steadily increasing, and rates of vaccination declining. The constitutionality of vaccine requirements is well established, and courts have found states are not obligated to grant religious exemptions. Nevertheless, the overall effect of such respect for the concept of personal belief has been that, gradually, vaccine requirements have become requirements in name only.The return of measles, though, is forcing a breaking point. In 2015, a measles outbreak was traced back to a single child at Disneyland. California state health officials saw that the outbreak happened not simply because of one unvaccinated child, but because only 90 percent of kindergarteners in the state were fully immunized. To establish herd immunity for measles, a community needs 94 percent of people on board.This led the state to pass a law that eliminated personal-belief exemptions, making California the first state in recent history to do so, and only the third state in total. (Mississippi did so 35 years ago, and West Virginia never had such exemptions.) The crackdown seemed to work. By last year, kindergarten vaccination rates for the 10 required diseases were up to 95 percent.California is serving as a model of what could play out across the country—and a microcosm of other debates about science and belief. Several states now have bills in place to repeal non-medical exemptions. Last month, Maine repealed the personal-belief loophole and is currently considering a ban on religious exemptions, as is Connecticut. In New York, in the wake of hundreds of people contracting measles, Democratic lawmakers proposed a bill in May to make their state the fourth to ban religious exemptions. Republican Representative Anne Dauphinais told the AP in response that the religious exemption “is one thing you just don’t mess with.” But the move polled at an overwhelming 84-percent support, across religious lines. The bill passed on Thursday.Such moves stand to create a novel problem, though, and a test for the medical profession. There is still one way to get an exemption from required vaccinations: from a doctor. Indeed there are some immune disorders and other rare scenarios where a child cannot is not medically able to receive a vaccination, and so has no choice but to rely on herd immunity to be protected. But in the last two years, California has recently seen such medical exemptions triple. This has been accompanied by some doctors being identified as purveyors of exemptions, sometimes specifically marketing the service.Public-health officials have taken this to mean there is need for standardization of the process. The new bill, which Biel is protesting, would help the state identify practitioners who were writing dubious exemptions by having schools notify state health officials in suspicious cases. Patterns of invalid exemptions could be traced to certain providers, who could be penalized or educated as necessary to keep the state’s herd immunity strong.Overseeing standards of practice for doctors is not a novel concept. In the wake of the opioid epidemic and overuse of antibiotics, many health advocates believe oversight should happen more readily—if only to identify serious outliers. This could at least help ensure that no doctor is running an exemption mill, a phenomenon that does tend to happen whenever doctors in a private health-care system become the sole gatekeepers for various allowances or services. This has been an issue in cases like the psychiatric diagnoses that grant kids extra time on standardized tests, or the prescriptions that allow people legal access to marijuana or opioids. (In 2012, I got a medical-marijuana card on Venice Beach by paying $100 in cash to spend five minutes with a doctor. On the wall was a poster with a list of things I could say were bothering me that would warrant marijuana access. This was clearly not the spirit of the law.)Biel’s lobbying is against this sort of oversight that would prevent similar suspicious practices by doctors. The actor is stepping in to influence policy that could worsen outbreaks like measles because, as best she has publicly stated, it is what she believes. (Biel did not immediately respond to request for further comment.)In communal undertakings like eradicating infectious disease, the role of personal belief is limited—but not zero. It is exercised through a democratic process where elected officials (and their appointees) implement policies that keep communities safe and well. If public-health officials steer communities wrong, people rally and vote accordingly. The system falls apart, though, when individuals simply declare themselves exempt.
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World Edition - The Atlantic
The Family Weekly: How the American Dream Leads Straight to McMansion Hell
(Wernerimages 2018 / Shutterstock) Editor’s note: The Family Weekly will go on hiatus after this week while we figure out how to improve the newsletter. We’ll miss you while we’re gone, but you can continue to get Atlantic stories through The Atlantic Daily or our other newsletters by signing up here (at a frequency that works for you). Feedback fatigue is real, but we’d appreciate it if you could tell us in this brief survey which stories in each week’s newsletter you most look forward to. You can reach me directly here. I’d love to hear from you. —Shan Wang, newsletters editor This Week in FamilyKeeping up with the Joneses doesn’t make the average American family any happier with their quality of life, according to one new study. Owning a spacious and comfortable home can bring a homeowner joy, until a newer and bigger McMansion pops up in the neighborhood. But it’s not just comparing the size of a dream home that makes people unhappy: More space can sometimes mean more isolation from friends who live farther away and even from family members who can retreat to their own corner of the suburban castle.→ Read the restHighlights(Wenjia Tang) In this week’s installment of The Friendship Files, three friends are so close that when one of them needs a new kidney, a friend who’s a match donates his. They talk about their shared love of golf, which brought them together; the difficulties of dialysis; and the joy of recovering with some of your best friends.→ Read the restIt’s hard to negotiate effectively with a counterpart who responds with non sequiturs or a tantrum. Children aren’t the best negotiators, but it turns out most parents aren’t either. Yet there are some effective strategies for reasoning with kids. You can bargain, giving your child options or rewards for a desired outcome, or engage in a conversation instead of saying, “Because I said so.”→ Read the restOver the past few years, many parents have become accustomed to posting every cute, endearing, or embarrassing moment of their child’s life online. But as those kids start to push back—and are unlikely to sign up for their own Facebook account when they are older—are we facing another cultural shift around privacy and our digital identities?→ Read the restThank a dad for his dad jokes this Father’s Day—and don’t forget that your dentist appointment is at tooth-hurty. You might groan or roll your eyes, but the classic dad joke is meant to be warm and cozy—the perfect relief from the edgy and dark humor that fills most people’s social-media feeds. Why are dad jokes so bad, but so good? As one English professor tells Ashley Fetters, “Your kids are embarrassed by you anyway, so the next best thing [to them laughing in earnest at your jokes] is to level with that.”→ Read the restDear Therapist(Bianca Bagnarelli)Every Monday, the psychotherapist Lori Gottlieb answers readers’ questions about life’s trials and tribulations, big or small, in The Atlantic’s “Dear Therapist” column. This week, a woman asks for advice about her son who lives 15 minutes away, but won’t make time to visit her or let her see the grandkids. She doesn’t know what went wrong.Lori’s advice: It can be a painful experience for a parent to be rejected by a child, particularly if there doesn’t seem to be a major issue causing the tension. But it can be harder still for parents to hear their children express the reasons they need some distance. Taking the first step, and giving your child the opening for a conversation, might help bridge it. Meanwhile, you can send more enticing invitations. There’s a world of difference between “Will you be coming over for Easter?” (meaning: for our sake) and “Hey, we’d like to do something fun with you. Why don’t we take you all out for dinner at your favorite restaurant—or take the grandkids to the movies so you two can have some downtime?” → Read the restSend Lori your questions at dear.therapist@theatlantic.com.
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World Edition - The Atlantic
The White House Press Secretary Job Exists in Name Only
It may now seem quaint, but there was a time in recent history when White House press secretaries played a dual role: protecting the president’s image and advocating for the interests of a free press. The very layout of the West Wing suggests that’s the way it’s supposed to be. When they leave their office through the back door, the press secretary stands in a hallway equidistant from the Oval Office and the press briefing room.The geography symbolizes the balancing act a good press secretary must perform, said Mike McCurry, who held the job under former President Bill Clinton. “The press secretary has the job, internally, of being a whisperer for the White House press corps,” he told me. “Someone inside needs to defend the interests of a free, vigorous press even when it is uncomfortable and even when you know you will probably lose the argument.”These days, no one seems to be making the argument. The press secretary’s role has withered under successive presidents and, in the Donald Trump era, has been functionally obliterated. Sarah Sanders, whose resignation the president announced yesterday, operated primarily as a garden-variety senior adviser, much like her predecessor Sean Spicer. Obligations to the press and, through them, the American people, have been abandoned. Trump will eventually appoint someone to replace Sanders. But whoever comes in stands to be the latest caretaker of a job that exists in name only.[Read: Sarah Sanders broke the news]It would be easy to argue that it’s Trump who degraded the press-secretary position. The president has scorned the press, calling it the “enemy of the people” and subjecting individual reporters to personal abuse. But this has been building for some time. After serving as President George W. Bush’s press secretary, Scott McClellan wrote a book called What Happened in which he described himself as an unwitting tool for the dissemination of White House deceptions. Writing about his role in falsely denying that White House officials were involved in outing covert CIA official Valerie Plame, McClellan said: “I had allowed myself to be deceived into unknowingly passing along a falsehood. It would ultimately prove fatal to my ability to serve the president.”“Go out there and tell them nothing,” Bush had once advised his first press secretary, Ari Fleischer, before a press briefing.During Barack Obama’s presidency, press secretaries dutifully held regular news briefings, but they amounted to a regurgitation of pre-approved talking points. Even that has fallen away in Trump’s White House. Nearly 100 days have passed since Sanders gave her last official briefing in the White House press room. Her practice has instead been to talk to reporters informally on the White House driveway as she returns to the building from TV interviews with Fox News and other networks.In a case of the coach calling his own number, Trump has often tagged in for his press secretary, taking on the role of fielding day-to-day questions from the media. Martha Joynt Kumar, a presidential scholar and Towson University professor emeritus, says that, at this point in the term, Trump has held 419 short question-and-answer sessions with reporters—more than five times the number Obama held at a comparable point in his presidency. Trump, Kumar told me, “wants to be the person who communicates what he is thinking. He’s doing that through Twitter and he’s doing it with his short Q-and-As. He wants to be his own communications director and his own press secretary.”After her departure was announced by Trump in two tweets, Sanders spoke to reporters in her office, telling them it’s more important for Americans to “hear from him and his voice than to hear from me and mine. No one elected me to anything.” Not yet, anyway. Sanders is moving back home to Arkansas and isn’t ruling out a run for governor—a job once held by her father, Mike Huckabee, and for which Trump already endorsed her run.With no obligation to hold press briefings—a time-consuming process that involves hours of daily preparation with White House officials—what would Trump’s next press secretary actually do? Over time, Sanders had become one of the president’s fiercest defenders; it’s fair to assume Trump would expect similar loyalty from the next person to hold the job.In one memorable exchange at the White House last August, CNN correspondent Jim Acosta invited Sanders to repudiate Trump’s contention that the press is the “enemy of the people.” She wouldn’t do it. “I’m here to speak on behalf of the president,” she said, “and he’s made his comments clear.” Joe Lockhart, another former Clinton press secretary, told me that she “played a huge role in demonizing the press as the enemy of the people.”Trump pulled her into his inner circle and came to rely on her counsel. At the summit meeting last year in Singapore with North Korean leader Kim Jong-un, Trump complained privately to aides about all the TV attention paid to Kim’s unexpected walking tour downtown. Trump worried that the press coverage might give Kim an edge in the negotiations. He told aides he wanted his handshake greeting with Kim moved up so that the networks would stop airing the footage, a former White House official told me yesterday, speaking on the condition of anonymity in order to discuss internal conversations. Changing the timing of the handshake posed logistical difficulties, and top aides, including then-Chief of Staff John Kelly, tried to talk the president out of it.Trump dug in—until he heard from Sanders. She told him that if they altered the timing, the historic greeting would not unfold in primetime back in the U.S., the official said.Don’t give up that coveted primetime slot, she told him. Trump relented.“She thinks the world of him,” the ex-official told me. “She understood her role as that of an adviser, supporter, and confidant, and his as the president who made the decisions. She’s very respectful to him.”[Read: The deep Republican roots of Trump’s media bashing]Once Trump leaves the scene, will the press secretary’s traditional role be revived? It’s possible that the norm-shattering 45th president may have killed off the job for good. Past presidents disliked the press and tried to manipulate the media, but they recognized it was in their interest to accommodate reporters as best they could. In his book Washington, author Ron Chernow writes that in 1792, the nation’s first president complained that newspaper coverage was “an evil which must be placed in opposition to the infinite benefits resulting from a free press.” Nearly two centuries later, former Democratic President Jimmy Carter wrote in his memoirs about a meeting with advisers in which they told him relations with the press corps were “especially bad” and “unlikely to improve.” They cautioned, though, that “I could not win a war with the press.”In the social-media era, presidents may conclude they can indeed win that war. They may see no reason to empower press secretaries with divided loyalties. Presidents now have abundant new tools to marginalize the press and present themselves in the most favorable light. Obama’s White House would limit press access to the president, and instead distribute official photos that professional news photographers likened to propaganda. Trump’s Twitter and Facebook audience numbers in the tens of millions, giving him a megaphone outstripping that of many news outlets.The title may live on; the cozy West Wing office with the fireplace may endure. But when future press secretaries exit through that back door, their attention is likely to be firmly fixed on the Oval Office to their right—not the press briefing room to their left.
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World Edition - The Atlantic
The Books Briefing: Books From Our Fathers
This Sunday, families in the United States will celebrate fatherhood—a role that, like motherhood, carries the weight of personal and cultural legacies both poignant and fraught. In Laila Lalami’s novel The Other Americans, a young woman wrestles with complex feelings of grief, fear, and resentment after her father, a Moroccan immigrant, is killed in a hit-and-run. A short story by Saul Bellow examines a son’s relationship with a father who both trained and betrayed him.The writer David Giffels’s father didn’t often speak about emotional topics—but near the end of his life, an unlikely project gave Giffels the chance to get to know him better. In editing a collection of essays about fatherhood, Brian Gresko found a wide range of experiences that challenged the preconceptions he once had about parenting and art. And the sociologist Scott Melzer’s research on traditional ideals of masculinity introduced him to a group of dads whose choices are expanding what those ideals can mean. Each week in the Books Briefing, we thread together Atlantic stories on books that share similar ideas, and ask you for recommendations of what our list left out. Check out past issues here. Know other book lovers who might like this guide? Forward them this email. What We’re ReadingMy last project with my dad was building my own coffin“All my life, that workshop was the place I understood my father best, a room seasoned with the vinegary smell of sawdust and sweet machine oil and the mystery of the man. My proposal to build a casket was mainly an excuse to be in his dust, to learn from him, to spend time together.”
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World Edition - The Atlantic