Wal-Mart “competes” to eliminate Aldi

Wal-Mart Walton Store

Wal-Mart’s first five-and-dime in Bentonville, Arkansas

The great myth of big-box stores is that their prices are lower than local and small, efficiently run stores. Now, Wal-Mart wants to push Aldi out of business by actually lowering prices. Aldi is the only chain store in the nation that actually prices affordably. If Wal-Mart succeeds in crushing Aldi, it will only be followed by their inching prices up once again to profit shareholders. It’s a shell game that impacts neighborhoods for generations, directly and regressively impacting their bank accounts.

Wal-Mart can easily command higher prices by the same means that we say looks like healthy competitive activity: they will temporarily lower prices and create competitive promotions, something Aldi does not do. They can divert abundant reserves to invest in cannibalizing Aldi’s hard-won loyal customers and making them Wal-Mart customers. Then, with Aldi out of the way, customers will see prices rise again. We can imagine how our blithe, uninformed middle-class choice to shop at one store will force others to spend more money at that store when their preferred store closes. Supermarket business has the illusion of a truly competitive market, and the many hidden aspects of product branding and pricing make it look that way — until we start actully digging.
# # #
Whether a conscious minority loves Aldi and resists Wal-Mart is not going to affect this in the long run. In fact, they are going to be affected by Wal-Mart’s stockholders more than much else, no matter where they shop. Markets are a little complicated, and market economists tend to allow only for what is convenient to them. We can’t talk much about simple price competition. Aldi has a single product of each species, as well as fewer varieties of each type. One thing Wal-Mart and almost all other supermarkets do is create a “shelf competition” among brands, which also vaguely looks like real competition but actually is more like a price cartel for each, because each brand has secured a local niche based on brand loyalty and quality/price preferences. This has aspects of firm-on-firm competition, but it distracts customers from the external firm-on-firm price competition. The effect is that the identical product at Wal-Mart, does not have to compete with its peer at Aldi, and so its price is completely free of it. And so Wal-Mart does not have to compete with a store across the street on price for the same food basket. (When I say “identical product,” I mean it: I have found that products at Aldi come from the same assembly lines, even the packaging from the same printing presses, as the items in the supermarkets priced twice as high. Essentially a single company handles both products.)
 
The other anticompetitive aspect I have seen is location-based, where a supermarket commands a much larger region of customers and sucks the life out of smaller, more locally powered stores that don’t have or can’t invest as much power to resist. I think these local stores (10,000-40,000 sq. ft.) are large enough to be called profit centers themselves, but they are smaller fish eaten by the bigger fish. The new stores in turn killed the even smaller stores; seniors will remember stores from around the 1930’s to the 1960’s that were spaced about a half-mile apart. These disappeared by 1970 due to these dynamics. In fact, there were even several smaller corner stores in between those two. Just a few hundred feet of added distance between stores is an opportunity cost. Limiting choice due to distance is a major incentive for large stores to push smaller stores out of business.
Aldi doesn’t count as a local store, but its format (footprint, product mix, market niche and marketing strategy, internal economies) feel closer to the small local stores than to the national chain supermarkets. If you were to study shoppers you might find the same perception. An important aspect of this mix is the real estate realities of the urban landscape, where only the larger stores can squeeze favorable ground leases and incentives out of landowners and cities. They use their external capital and colossal reputation to achieve this. And so again, not only can’t two stores with similar products compete, but two identical products also will not compete in such an environment. Another problem with product mix on the shelves is that it creates such confusion that two identical products on the shelves will often never be identified by consumers as competitors. The shelf confusion coupled with the loss of local media has helped make it almost impossible for consumers to do their own comparisons, or tâtonnement.
 
It is not big news (I’m the only one ever to complain about it), but it is interesting that in around 2007, then-fledgling Chicago supermarket researcher Mari Gallagher both coined the term “food desert” (wearing the mantle of a progressive localist planner), and soon after was paid handsomely as a consultant for Wal-Mart making arguments for their new smaller neighborhood stores that would crush the real locals, and even cause external capital flight. I criticized her loudly about the fact that even her first “food desert” research completely excluded small, locally owned stores. But she didn’t have to pay attention. Why? Because she had already carved out her own captive market, among city officials and big supermarket business, and heard the green piper calling. The problem is that she forgot the people. Mari was able to change the market just using paper and what I gather was a compromised ethical attitude. Even “science” is affected by the market. This can’t be called a mere piece of trivia because trivia is about things that don’t matter: Mari’s pseudo-science is going to impact all of us in big ways, for generations. If Aldi packs up and heads back to Europe, can we really blame them?
Posted in Uncategorized | Leave a comment

Segregation, 2017

In our elite white corner of Chicago’s Black Belt, Peele’s “Get Out” is screened

At my age, I don’t go in much for horror films. Is it because the genre seems tailor-made for teenage dating? No man is too old to remember how, when the shock came, she gripped our hand tighter and welcomed our strong embrace. It was our modern urban proxy for walking in the woods.

In fact, Jordan Peele’s “Get Out” is not strictly a horror film. That wrapper is a clever conceit to freight in the much deeper problem of American black-white relations that Peele has been exploring for years in his satire. His idea of funny is actually a fat onion of anger, the raw kind, nearly impossible to peel with mere words, and not easy to peel with feelings and actions. I will not go into the details of the director’s career or really into any study of the film’s plot. This is about the wrapper inside the wrapper – about what happened during Universal Pictures’ free preview of the film at the University of Chicago campus during Black History Month 2017. Peele’s film, in this place and time, unwittingly offered up a perfect test-tube case study on the continuing segregation in 21st-century America.

This disturbing film – at its full depth, and parallel to the events of the evening – is really about how white America has mastered its relationship with black America. Within all of the interracial tension is the white American’s strange envy of the grim determination, melancholy humor, and creative strength of the black race. And this is why white America can be fascinated by the film. But Peele’s irony is that white America will continue to do what it does despite these truths, and, sadly, so must black America remain hypnotized. Inside the film are ideas as important as those explored in Spike Lee’s “Do the Right Thing.” In Lee’s case, America got it and, predictably, forgot it. In Peele’s case, it may be too subtle even for America’s future white leadership.

If University of Chicago undergrads want a truly “gripping” horror show, they need go no further than to step across Cottage Grove Avenue into the Black Belt. Hyde Park is surrounded by black in ways that make the Columbia-Harlem relationship seem trivial. The Black Belt here has scarcely changed, except for the worse, since it was the cradle of the migration. Many of Chicago’s great sociologists and economists cut their teeth on these neighborhoods and their datapoints. It is what gave the “Chicago schools” in both disciplines much of their study value. The Negro in ChicagoCharles Spurgeon Johnson’s seminal 1922 report on the Black Belt’s formative demographics and on the race riots – as well as Allan H. Spear’s 1967 bestseller Black Chicago were published by this college’s press.

My history has been inadvertently tied to this university since 1947, for three generations of my family. The circumstances behind the promotion of the movie bothered me. But it enabled me to see how the puzzle piece of the movie fits tightly together with the real life hypocrisy of white America.

Just across Cottage Grove are the homes and lives depicted in A Raisin in the Sun and Native Son. I do not mean this figuratively. The homestead of Lorraine Hansberry’s play still stands right there at the south end of Washington Park, and Native Son is actually set in the same neighborhood, as well as in parts of Hyde Park and Kenwood. Emmett Till’s boyhood home also still stands, not quite a three-minute walk from the old Hansberry house. That night in 1955 when they brought Emmett back to Chicago, Mr. Rayner, the undertaker, dressed his mangled form as Mamie Till declared she would let “all the world see what they did to my boy.” Few people know that Rayner’s little funeral home occupied part of the now-empty lot at 4141 S. Cottage Grove. But the place is just north of the Kenwood mansions where the fictitious Bigger Thomas carried out his murder.

A short stroll to the west is where Captain Walter Dyett taught jazz music and cultivated famous jazz musicians. Jazz and its older brother, the Blues, permeated Hyde Park and surrounding neighborhoods, until men from the university moved the industry out to the affluent white North Side, where it has thrived as a tourist attraction ever since. The Harlem Globetrotters did not get their start in Harlem: they began in Chicago’s Black Belt. Saul Alinsky’s community organizing for the Civil Rights Movement came substantially out of Woodlawn, immediately south. And there is so much more that one could see and say on the history if one could only walk through there without fear.

But the Black Belt is all more than history, because in social and economic terms it has all remained essentially where it was 75 years ago. The latent hope that it once promised is gone, and only poverty and deprivation remain. Englewood and surrounding areas are rife with boy-on-boy shootings. Yes, a large portion of the history of the death and life of black America is literally just across the street from the University of Chicago.

# # #

According to the Facebook event page, for the free preview promoting “Get Out” over 3,600 people had expressed interest and 1,300 had planned to attend. But the university’s Max Palevsky theater only seats 475. I watched with growing interest as the rules gradually changed. The printed Universal Pictures invitation that I’d received actually deviated from their norm for these college screenings. Perhaps in a nod to equity, it did not state that seating would be restricted to the school’s students. Later, the staff posted changes on Facebook, saying “only students with valid ID” would be admitted. People began responding with loud complaints, some (including me) alluding to the demographics. Soon after that, but only an hour before the show, the staff finally responded that any student with a valid ID from any school would be put in a priority line, and there would be a second line for non-students, to be admitted only after all students were seated. They were trying very hard to respond to our complaints and serve everyone as fairly as they knew how, but built into this was that the deck would have to be stacked to favor elite whites, no matter what they did, and each change they made only aggravated the situation for black people.

As a Ph.D. student, I was able to get into the student line at 103rd position. I would be guaranteed a seat. But I observed the two growing lines and confirmed what I’d feared would happen. By a rough estimate, the “student” line was about 80% white. Of the 20 or so students I polled, all were from U of C. The “non student” line, on the other hand, was about 80% black. And so the plan had turned into “a hot mess,” as one Facebook poster observed.

I was going to try to give my ticket up to a black person, and, perhaps foolishly, I felt I should also try to persuade others to do likewise. I asked someone to save my place, then stepped up onto a landing and in a loud voice got the attention of around 150 students below me. I gave a very brief history of the campus’ racial issues, the segregation of the two lines, and my intent to give my seat away. But these kids were so smart, or my talk was so boring, that before 30 or 40 seconds had elapsed they were already smirking and looking at each other and saying “what the fuck?” and had little by little returned to talking to one another and gazing into their phones. I was told by staff that I would not be allowed to give my seat to anyone.

The staff worked hard and claimed that all but about 10 visitors had been seated, but the full picture suggests that hundreds were no doubt disappointed. The two lines snaked through the large lobby and stretched out of both building entrances, perhaps well exceeding twice what the theater could hold. A young staffer was “counting” the two lines and openly reporting how many seats were left, which no doubt was being texted out to others. I had seen people walking away in frustration, and many others saying things like “hot mess” on Facebook. It stands to reason that a lot of people who had come from off campus must have left at some point, and many online (posters and non-posters alike) simply grew tired of the confusion and did not come, or, worse, turned back towards home in mid-travel.

At minimum, no white University of Chicago student was denied a free seat, while many more black men and women, being segregated into a separate category, enjoyed no such security. At maximum, hundreds of African-Americans were given a bait-and-switch favoring wealthy white American boys and girls, who got carte blanche to view an important new movie about black culture.

To be fair, there were black faces in the audience, but they were in the minority. It is a minor thing in the large scheme, but it came from the cryptic racial hypocrisy of our age, and the sum of the day-to-day effects of that hypocrisy is no minor thing.

# # #

Jesse Owens’ superhuman ability, and the white envy that it inflamed, anchor Peele’s diabolical plotline. Owens first saw true fame in 1933 in his debut at a national track meet. There, he astonished the world by winning the long jump, breaking the world record in the 220-yard dash, and tying the world record in the 100-yard dash. In fact, Owens accomplished these miracles at the University of Chicago’s own Stagg Field, less than a two-minute run (for him, at least) from where some of us were enjoying Peele’s film.

Where the astonishing mystique of black talent in 20th-century America actually came from no one can say for certain, but at least some of it no doubt came from struggle. Peele explains this in his devious anecdote. For all of the supposed genius on this campus, I fear that Peele’s deeper message was completely lost on the University of Chicago youth. This school is one of the top 10 learning institutions worldwide. A recent study by the Equality of Opportunity Project showed that more students from the wealthiest 1% of the population attend Ivy League colleges than those in the entire bottom 60%. The Black Belt, as we know, is still filled with this lower demographic. In Hyde Park, thanks to the University of Chicago, in 2000 about 18 in 20 residents age 25 and over had bachelors degrees, and around 6 in 10 finished graduate school. In the adjoining census tract, where Emmett Till grew up, only about 1 in 20 even finished college. In the 2000 census, the mean income around the campus was $90,625; just over the southwest border of campus it was $12,036. University of Chicago students have good socioeconomic reasons to be oblivious to these stark contrasts in their own backyard.

University of Chicago students are spoon-fed the core of dead white male history – the canon of justice of Socrates, Plato, Aristotle, Locke and Rousseau and Nietzsche and Durkheim, and on through the white male Chicago-school economists and sociologists. They can use this canon either to justify or to question a perpetuation of the order that supports them. But nobody in this batch were nodding their heads at me about the hypocrisy. By the time I was 30 seconds into my argument, they thought they’d got it, thought they’d got me. Many of them were giggling about what I was saying, and returning to their phones. They never even stopped to examine the truth.

It’s conceivable that I simply delivered my argument poorly. But presumably this campus is a place where ideas are respected and examined, not jeered at. Whatever the case, I was probably one of only a few to take the relationship between these black and white universes fully in the context of the film into real life. This may explain Peele’s use of Jesse Owens in the movie: the idea that it is a grave offense to steal the accomplishments of an individual from that individual. Yet, despite this, white America has often tried to congratulate itself for much of what black America has created, in spite of America’s centuries of continuing cruelty to that population. This applies to the skills of Jesse Owens and of other sports heroes; to the jazz and blues and house and rap and slams that they airlifted out of these neighborhoods; to the cotton empire, the cotton that Peele’s dusky hero rediscovered and used to his advantage.

And yet voicing problems like these is also why white America (and a lot of black America) stops listening whenever Ta-Nehisi Coates begins moving his lips, and why they may never see anything in Peele’s product but an amusing horror flick written by a rather special black man.

Perhaps it also explains in a kind of shorthand the motivations of Jabari Dean. In 2015, Dean – a black West Side college student angered by the police shooting of Laquan McDonald – threatened violence against whites on this campus. He was tracked down by the FBI, arrested, and branded a public fool. Dean’s mere words disturbed the peace at the University of Chicago, and he vanished without apparent incident, though perhaps with even less hope of finishing college. There is something about the University of Chicago in particular that seems obvious to many in the black community in this regard of stunning contradictions, but equally nonobvious to its white population.

I suppose that simply writing about an event like this can’t do much. Perhaps we can’t hope to chide these young elite thinkers into taking a harder look at race in America, rather than taking the easy road, arguing as people often do that at least things are gradually improving. For most black Americans, things are still unacceptably bad. In fact, things may be even worse than 80 years ago, when hope for a better life out of the South was at least able to help drive talent. Nobody white would let their children anywhere near this kind of life. The situation should have been treated decades ago, by our grandparents’ generation. These elite, they have the power to fix this. Will there ever be a generation that stands up and solves a problem like this?

Posted in Uncategorized | Leave a comment

Who are the real friends of the parks?

It is hardly surprising to see Juanita Irizarry and Friends of the Parks carrying the water for Chicago and opposing the Lucas Museum on the lakefront. What is surprising is that Father Michael Pfleger has pointedly asked who she is and what standing she and her group have to do this. I introduce my old friends Father Pfleger, Rev. Chris Griffin, and other leaders in the black community supporting the Northerly Island site to my old friend Juanita Irizarry. She also has advocacy roots, years in the trenches in the Latino community — just as the Griffin family, Pfleger, Apostolic Church, and others have done in the black community.

These leaders cannot always easily refuse requests for help. But they should question it, because it is part of the same kind of high-handed horse-trading with which these people and their populations have long been victimized in the other direction, passed up by the city powers, and it is the same kind of expected automatic response, and, not surprisingly, it is also what divides our ethnic communities. These leaders should wonder who their real allies are.

It is clear that someone, probably Mellody Hobson herself, explicitly asked black leaders to support the museum’s politically charged placement. In so doing, they deliberately turned the Lucas Museum into a race issue. This same tactic was used in 2008 when leaders used the Woodlawn Organization and Rev. Finney’s Apostolic Church as leverage to site the Children’s Museum in Grant Park. We are now in the golden age of using venerated civil-rights-era community power to help along downtown privatization efforts.

So, let it be a race issue. For a century, Chicago has directed where Black Chicago may exist. The black religious community should now be allowed to imagine for themselves where relevant points of interest like the Obama Library and the Lucas Museum should go.

Who says there must be a single, sprawling museum campus in Chicago? Who says that private museums must be sited on public land? Is this the limit of our city’s storied creativity? The new Green Line was once derisively called the “Watermelon Line” by hip-hop activist Bill “Upski” Wimsatt, in his sarcastic campaign against what he felt was its planned isolation from the rest of Chicago. The history of Black Chicago and Black America is not on the lakefront. It is true that the 1919 race riots were inaugurated in a dispute when a black youth was killed on 26th Street Beach for swimming into a whites-only beach — and yet that is perhaps the whole extent of Black Chicago’s historical affinity to the lakefront.

Black history comes to life, however, a mere few minutes’ walk from numerous Green Line stations. Lorraine Hansberry’s and Emmett Till’s homes, and Till’s resting place, are all a few minutes’ walk from 63rd and Cottage Grove. The site of Till’s open-casket funeral, and the heart of the Black Belt, is near 43rd Street station. The Du Sable Museum is five minutes from the 55th Street station, as is the fictitious site of the Kenwood mansion featured in Native Son. Rev. Griffin’s famous neighborhood has Ashland station near United Center, where Michael Jordan reigned supreme.

If Mellody Hobson truly understood Chicago, she might have recognized continuities linking these and other treasures and seen that the inner city itself is a living museum and starting point for narrative art for black and brown people.

Does she want revitalization, identity, real history? Why not rely on the Green Line as a backbone for a true rapid-transit-based museum campus. Put the Obama Library somewhere along Garfield Boulevard (but not in Washington Park). Let the Pink and Blue Lines anchor a similar Latino cultural network, with the Mexican Museum, Pilsen, and Little Village among the stops. Put the Lucas Museum where some of these lines meet, and make it the starting point for field trips to study and report on these and other historic places. Chicago is a transit town. The locations she wants would require special shuttles and parking lots.

Run special non-rush trains express to the most important stations, tied into the exhibit schedule at Lucas and the CTA Train Tracker, and link in topical multimedia audio and video — in the trains. Sell CTA day passes on this basis. See the revenue flow, see transit go, see the jobs and unexpected opportunities grow. It is actually easier to reach these West and South Side stations on rapid transit than to reach the Museum Campus. Urban transit links things together economically in astounding ways. Postmodern cities are only beginning to learn how best to exploit this fact.

The above is just one off-the-cuff example of many great ideas that would pour out of the heads of real Chicagoans who know and love the city — if only the planning process weren’t brokered exclusively by the arrogant and powerful.

Peter Zelchenko was co-organizer of Protect Our Parks and the Committee to Keep Lincoln Park Public (Latin School soccer field) and the Scammon Garden preservation campaign (Hyde Park, Gordon Parks Arts Hall)

Posted in Uncategorized | 2 Comments

Comment on today’s “Weakened Addition” on NPR

Scott Simon:

I’m a third-generation writer. My grandfather came to America in 1913 carrying three typewriters: English, Cyrillic, and Hebrew. My parents were newspaper and magazine editors, and my father was a senior editor at Chicago’s City News Bureau during its heyday. Incidentally, he is also the man who, on a fateful car trip, dissuaded Mike Royko from going into radio announcing, suggesting instead that he focus on his writing.

My brother is a medical copy editor. Aside from writing, I myself spent years in back rooms as a typographer as well as a news copy and slot editor, and it is in these places that I learned that careful copy and attentive typography elevate our language as well as any well-turned phrase. Do we aspire to live in air-raid shelters, or nice houses with smooth walls and solid finish-carpentry?

It should come as no surprise to you when I say that your comments, about those who care about punctuation are “cranky” people who lack “real lives,” are more than unwelcome. These comments are insulting to the many silent heroes in your own field. What started as a matter-of-fact academic study, you have chosen to import into the social fabric of your own adopted profession.


(Transcript)

Unfortunately, your attitude is typical of the stars in front of the mics and cameras, and under the bylines — those who enjoy the lion’s share of credit for the journalistic profession and yet fail to pay proper credit to the work behind the scenes. The craft of language is far more than just some self-important mouth at the microphone. Your attitude, if you persist in it, will serve to further dumb-down and cheapen journalism. I am sure that my family is at least as liberal as yours, and yet we believe that one can speak progressively without ignoring the beneficial aspects of ideas that protect something as important as language. I am younger than you, but I have lamented the gradual changes in public media that encourage commentary like yours, whose sole purpose, if not sincere, is to pander to a younger audience.

Sadly, your star status makes the least of your ideas much more persuasive than anything I could ever say, no matter how carefully I were to word it. Please don’t teach the new generation these asinine values.

Call me cranky, call me introverted — but your attitude has consequences. I am withholding my donation to public radio.

Posted in Uncategorized | Leave a comment

As with Chuy, black Chicago was Bernie’s to lose

It really would have been nice to see a progressive populist win here. It’s possible to do. Last year’s race between Jesus “Chuy” Garcia and Rahm “Sharp Elbows” Emanuel – the first runoff in Chicago mayoral election history – was as close as any progressive citywide candidate has ever come to upsetting established power here. Emanuel was downright “humbled” by the experience. Rahm will probably not survive to serve another term – he has been weakened by anger from the left, and now the stage is set for a right-centrist (i.e., a Chicago Democrat) to sweep in and defeat him. Rahm has no mysterious aura about him like the Daleys.

My 15-year-old son and I campaigned hard in South Side black wards for Garcia, walking the precincts door to door for two months, often in bitter cold winds. From such a vantage point, you can see what is being distributed door to door, and you can hear exactly how people feel, you learn what the arguments are, and you learn how to answer them. Both of the campaigns knew the black vote was crucial. Rahm won primarily by lying to black voters in Chicago. His well-paid media experts and strategists exploited the historical division between African-American and Hispanic political blocs in Chicago.

Rahm’s geniuses hit upon the idea that, since Chuy was opposed to the University of Chicago’s bid to site the Obama Library on Chicago’s scarce public parkland, they could claim that Chuy didn’t want the library anywhere in Chicago, and that therefore Chuy didn’t like black people. These constituted a huge distortion, this pair of lies: Chuy has been a leader on the right side of black issues in Chicago for 25 years, and he has never deviated. Still, they printed the exact opposite on millions of pieces of literature that they scattered on the South and West Sides, and they stated the same thing in TV commercials. The strategy worked. We had people slamming doors in our face. The lies moved black voters the few percent needed to ensure victory.

Hilary Clinton’s Chicago people (some of the same people, in fact) appear simply to have taken the 2015 mayoral election playbook and rerun it. It’s a popular concern when black candidates for major offices are so few. The idea was to characterize centrist Hilary as the choice for black voters, rather than the true progressive. Clinton’s geniuses included all of the right ingredients in their expensive commercials: Black-and-white photos, slow-panning, suggesting Civil Rights history. The stentorian Southern accent of the narrator. The long, low double-bowed string bass indicating the timeless struggles of history. Noble black faces aplenty. The full recipe.

“I have moved precincts to 75% wins, sometimes even higher, partly with the help of carefully crafted, targeted, methodically placed media like this.”

Clinton took Chicago by only around 30,000 votes – and she won the whole state of Illinois by less than 40,000 votes.

This map shows that Hilary had strong margins in the same Black South and West Side battleground wards that were of interest in the Emanuel-Garcia race a few months before. And so, again, Chicago’s African-American vote proved highly volatile, a force that could easily move centrist or progressive depending on how deceptive the messaging could be. Some feel that Bernie lost the black vote with a faux pas during the Flint debate, when he appeared to associate being black too closely with being poor. But with nearly one in three African-Americans below the poverty line, there were enough poor voters in Chicago’s black precincts, at least, to “feel the Bern.” And yet Hilary’s money beat Bernie’s in that market, giving the impression that she is the Civil Rights candidate, that she is the progressive – a claim that is impossible to support.

Reasoning will not fit easily in a 30-second blurb. Distortion will.

bernie-segregation-fullsize-680x384

I hate to say that I anticipated this potential problem in the Sanders strategy, and although I was tempted to try to persuade them how to solve it, I didn’t do it. I thought they would know this, because it was as plain as the nose on your face, and I assumed they knew what they were doing. However, they failed. Illinois, it has been argued, spelled the beginning or the end of Sanders as a serious threat to Clinton. And so this was an important loss.

I also didn’t contact the Sanders campaign because big campaigns have little imagination, as I learned with the Garcia group. During that 2015 election cycle, I was also teaching the CivicLab training course on basic campaign operations for the aldermanic candidates. One of my favorite cheap guerrilla media tools is the plain-vanilla neighbor-to-neighbor merge letter. It is not just a mass-printed letter. I described it to the candidates: One or two days before the election, amid all of the four-color-printed trash littering the vestibules, a very personal letter will be found by every undecided voter, taped carefully to their front door. The letter is neatly typed on plain white paper, signed by hand, sealed in a handwritten envelope.

Neighbor-to-Neighbor Letter – GENERIC – 03-25-2015Letter Template

In the letter, in three or four paragraphs, a neighbor identifies herself, tells you she lives right around the corner, expresses anger about the lies, answers the lies, and calls on decent and intelligent voters to ignore the innuendo and vote the right way on Tuesday. She signs the letter, in actual color ink. She circulates only a few dozen of these letters. It is that simple. I have moved precincts to 75% wins, and even higher, partly with the help of carefully crafted, targeted, methodical media like this.

Reasoning will not fit in a 30-second blurb, but people still trust letters from neighbors sooner than any anonymous four-color mailer.

When I was told how the polling in black areas was leaning for Emanuel, and when I saw the nasty lies being circulated, I knew that the letter was one way to score. But the campaign had relied primarily on union management. Union organizers are brilliant at persuasion, but they know union halls and phone banks, not sidewalks and doorbells. With two weeks to spare, I sent an e-mail to Garcia’s campaign leaders, Andrew Sharp and Clem Balanoff. I explained that a door-to-door approach was needed for the campaign. I’d already told Clem earlier that we should bus all of the best campaigners into the South and West Sides to knock on doors there. We had enough people, but they were working in neighborhoods that were already convinced.

I explained that we should distribute 24,000 letters to households in our 15 battleground wards on the South and West Sides, very close to the election. I included a sample letter and precinct data. I described how to extract the target data from the database, how to merge and print it, and how to identify and solicit volunteers and others to sponsor, approve, sign, seal, and deliver the letters. I said that with two or three coordinators, one fast laser printer, and a lot of paper and envelopes and tape, I could have the entire project started and finished in four or five days. I said that this could be done with $600 in paper, printing, and envelopes. I gave them this proposal two weeks before the election.

They didn’t even respond. Knowing how busy they were, I gave them plenty of time, but at the last possible minute I called, exasperated. Clem explained that he had dealt with the battleground wards by paying 120 workers to do literature drops there. That was all.

In fact, it seemed as if they were afraid even to ask our volunteers to go out and brave the cold. Volunteers were glad to come in for an hour or two and do phone-banking, but nobody was pressing them hard to get out on the street. If you create a culture of willingness to get out there and knock on doors, everyone will do it. If you create a culture of hanging out in the campaign office and sitting at a phone, everyone will do that. I’m not saying they weren’t working hard, but strangers persuading strangers is much more difficult over the phone.

When Andrew and Clem passed on the letter idea, I decided to test it in one precinct anyway. I picked a representative precinct where we had a willing volunteer, and she signed 120 letters to go to all of the undecided voters in her precinct. My son and I taped them to doors the day before the election.

Excel File – Post-Runoff Analysis – Neighbor Letter – Ward 8 Precinct 52 04-08-2015

After the election, I studied the numbers. The first election and the runoff results had very consistent correlations from precinct to precinct in the best and worst few precincts of both campaigns. Judging from results from the first election, our test precinct should have been Garcia’s 13th-best precinct of all in the runoff. However, it turned out to be the 8th-best in the runoff. All other precincts stayed amazingly consistent from the previous election. The only thing that was different was our letter.

That may not sound significant. But I calculated that the letter appears to have moved one in four voters in our test precinct. Done throughout the 12 battleground wards, as would have been my plan, this should have closed the margin enough for Garcia to have come very close to winning. Along with some more aggressive door-to-door persuasion in the same area, it would have been hard to lose.

Emanuel-GarciaClinton-Sanders

The results of the Emanuel-Garcia election on the South and West Sides look eerily like those seen in the Clinton-Sanders race in many ways. The most important aspect, to me, is that both teams had Chicago in their hands if they wanted it, but instead of asking volunteers to head outside of their neighborhoods and brave the cold, instead of trying to reach voters more intimately, they thought they could beat the establishment with its own techniques – robocalls, phonebanking, color direct mail, TV commercials, radio spots. Bernie Sanders could conceivably have won Illinois from Hilary Clinton with more door-to-door campaigning in the right places. He also could have changed history with a laser printer and less than $1,000 in printing.

It is hard to win a grassroots campaign. It takes more effort, and it won’t be done without the intimacy that comes from people coming in contact with people. Getting on the streets, or at least getting something into people’s hands that looks a little different, looks like it came from a human being, can make a huge impact. These are media befitting grassroots politics. I hope that the next time an opportunity like this rolls around, someone will surprise us for a change and try the obvious.


Peter has participated in progressive politics since he was eight years old, starting with Dawn Clark Netsch’s first campaign. In 2003, he wrote the book It Happened Four Years Ago, a documentary exposé of a stolen election, a popular text in political science classes here. He has trained Chicago candidates and election volunteers for many years for the League of Women Voters, Project LEAP, CivicLab, and other organizations. He was a co-founder of Design for Democracy. He also sued the Chicago Board of Elections twice in Federal Court, after twice exposing major data vulnerabilities. But politics is a sideline, a necessary evil, and he does not enjoy it.

Posted in Uncategorized | Leave a comment

Lisa Morrison Butler: Help! Fix the DFSS Helpline!

I really thought it was going to be easy. I have a friend I’ve known nearly all of our lives. My friend is a hard-working court reporter. He has worked very hard all of his adult life at this difficult hourly job, and for the past few years has also had to care for his dying mother.

Last year, he had to pay off his mother’s massive credit-card debt by taking out a mortgage on her home, and he then lost the home in a short sale because he couldn’t make the payments. Today, he is being financially abused by a relative in Chicago’s crime- and poverty-ridden Auburn Gresham and is now facing homelessness. After speaking with one of his cousins in New Jersey, we calculated that since he will turn 63 in March, it’s a good time to start helping him find the services he needs. He’s certainly earned them.

With homelessness and freezing temperatures up in Chicago, why is it so hard to get basic help from city servants?

Lisa Morrison Butler is Mayor Emanuel’s newly appointed Commissioner of the Department of Family and Support Services, coming from a successful few years at CityYear. Her department is supposed to help people help themselves. But if you can’t reach them, there’s no way. I also need to find ways to help my friends that are not going to cost me my whole day. DFSS’s customer-facing is going to have to improve for anyone to be able to do that. So far, I’ve invested more than an hour just finding out that I had the wrong number, and now I’m totally lost in the woods.

Yesterday (Sunday), I called their front-end helpline, 312-744-4016, and dutifully pressed the button for referrals. A message said that I would have to call back tomorrow because today is Sunday. I called back in the morning and was simply told the following by a machine: “Your call is very important to us. However, we are experiencing an extremely high call volume. Please call back later.”

No telling me what days and times are best to call, no telling me how many minutes I’ll have to wait, and certainly no inviting me to press some button to leave a phone number.

Around 11:45 a.m., I tried again. At least this time I got past that message, which made me assume that they did not have “an extremely high call volume.” But after 47 and a half minutes of patiently waiting through , I finally was able to speak to Christina. Christina stopped me after 30 seconds and told me that DFSS helps only with homemaker services, Meals on Wheels, and adult daycare. My friend qualifies for none of that. I need to look into Section 8 or senior housing, in addition to other possible services, and I was hoping simply to get him connected to a caseworker. No dice.

Why would it take over 45 minutes on hold and three trips to the Internet just to be told I had the wrong number? Do you know, while I had the phone to my ear, I was able to put on my coat and walk in the cold to my son’s school, sign a release form, and walk back, just to continue to wait on hold. How’s that for multitasking?

Where is the City on multitasking? Amid recent City Council complaints of dismal services for the homeless, the department needs to make sure that when it has an opportunity to capture a client, they don’t lose them to their technological black hole. One extraordinarily simple way to do that is to allow them to leave a message with a phone number and to be called back when it is convenient. Another is to give the customer some accurate idea of the wait time. A third is to offer these possibilities even when the office is closed. These are basic services that human receptionists used to offer. Today, the caller is always left holding the bag, and in this case there is neither any predictive information given nor some avenue of recourse.

The inconveniences offered by this city tend to begin with the initial phone call. Many people give up after the first try. Lisa Morrison Butler has the power to change the little things in people’s lives, starting with this.

Posted in Uncategorized | Leave a comment

The True Danger of the Epi-Pen

The morning after Christmas Day, we found ourselves in some suburban Chicago emergency room. My teenage son had thrown up after ingesting some pine nuts, and his throat and stomach still felt bad after an hour and two Benadryls, so we went to wait in the ER to be safe. However, I opted just to sit in the waiting room and not to check in unless his condition worsened. He said he felt safer there, and frankly so did I. About an hour later — three hours after the incident — we were contemplating leaving. I called the allergist to be safe, and got an earful. “You should have used the Epi-Pen immediately,” she said, “and gone straight to the hospital.”

I asked why, and she gave me an astonishing figure: she claimed that around four in ten allergic reactions result in a worse reaction sometime within six hours after symptoms appear to dissipate.

“That much?” I asked. “Can you repeat that? I’d like to look into it.” It sounded improbably high. It did not jibe with my 50 years’ experience with my own peanut and egg allergies, nor with my son’s history, nor with the experience of many friends I know. I’d never heard of an allergic reaction spiking a second time: they all went downhill. Though we were on the phone only four minutes, I had the vague feeling that she was spouting just enough high-quality nonsense to be able to hang up on this jerk and get back to her holidays. Although my son was feeling better after three hours, the allergist instructed me to get him checked in, to get him an epinephrine injection and steroids. And so, despite the fact that he was almost back to normal, we were stuck there for three more hours while my son sat through a hypodermic injection, three catheterizations (two had collapsed), the hour of shivering that results from an increased adrenaline rush, repeated prodding and poking, and a generally bizarre, disorienting environment.

The ER doctor was very good. I complained to her that we’ve all been trained many times in the use of the Epi-Pen, and while the mechanical aspects of its use have always been repeatedly made crystal clear to us, up until now we have not had a clear indication of the scenarios calling for its use. We and most other Epi-Pen owners, it appears, believe that it is only in life-and-death situations that we should administer it, and yet we were just told by the allergist that anytime there is even mild discomfort, even a minimal sensation in the throat, the device should be used. The ER doctor concurred.

The implication, and the source of the confusion, is that doctors seemingly want us to consider every allergic reaction due to ingestion to be a life-and-death moment. The ER doctor said that skin rash would not be a concern, but whenever irritation affects the “core” (throat, chest, stomach, lungs, vomiting), the airway is at potential risk and we should always administer epinephrine and then follow up with a visit to the emergency room. In effect, the Epi-Pen gives us an hour or so to get there. If we had two Epi-Pens, we would effectively have twice as much time.

I interpreted this to mean that using the Epi-Pen, which is to say, taking a shot of epinephrine, should not be viewed as responding to an existing moment of clear and present danger, only a precautionary step to forestall potential danger and gain time to reach a hospital. We should have a more liberal sense of it, and far from being afraid of the Epi-Pen, we should use it whenever in doubt. But we should also realize that in doing so we must then hurry to an emergency room immediately.

The nurse, for his part, was one of those wonderfully smart, gregarious, heavy-set types with a big mouth. I do not see a lot of doctors like him. Even the best doctors always have their minds on the next patient’s chart or on their own personal lives, and most display mild annoyance the moment your effort for them to justify their position surpasses a certain low threshold. Like other unsung heroes, there is far less arrogance in many nurses: even as they are wiping up our shit or vomit and changing our sheets, and although they are thinking about the next chart as much as the doctors, nurses seem to have much more spirit to listen, open up, and explain. There was some of this in the ER doctor as well, but she would not admit what I was pressing for.

The nurse said a little too much. He told me that the 30% to 40% figure of our allergist had to be wrong. He pointed out that what our allergist probably meant was that the risk shoots up when you use epinephrine and then don’t administer any buffering medications soon afterward. He explained that this is probably what the “rebound effect” refers to (technically called biphasic anaphylaxis).

But, then, we hadn’t used any epinephrine when we called the allergist, and of course the allergist was well aware of this because I had told her.

This is the crucial point. The upshot is that if you do not use epinephrine, there is far less possibility of a rebound within six hours; the risk usually decays naturally over time as the body’s own immune system defuses the allergen. Apparently (see the Ellis articles below), rebound or biphasic anaphylaxis can occur in some cases when insufficient epinephrine or steroid are administered. But the nurse suggested it may be the epinephrine followed by steroids that in fact creates the increased risk of rebound. Either our allergist was deliberately equivocating and making us stay in order to discipline me, or she was innocently mistaken — both of which are dangerous things. Or the nurse is all wrong. One thing is certain, and that is that nobody is sure of anything.

As you will see, I am not arguing here that we should never resort to epinephrine.

1304951748in550The problem of risk here appears to be a semantic one involving statistics and time. Some fevers or infections can become life-threatening, in some limited cases, if left completely untreated for too long. An allergic reaction also has certain signs and symptoms that should be monitored. It might be better to say that most allergic reactions, even ones in which there is some core effect, begin with almost zero risk of actual danger; in limited instances, the risk rises, and if treated improperly (such as in cases after taking epinephrine without following up with buffering) it could react at higher levels. Discomfort and swelling of the esophagus with an allergic reaction is a natural and routine response, and yet only in the rarest instances does the constriction become so extreme as to truly endanger life. Nobody wants anyone to stop breathing, but today we have emergency provisions for essentially every moment of allergic discomfort — not because there is a warranted risk of death, but primarily because doctors would rather not have a mess on their hands if something bad were to happen.

It would be proper to point out here the upshot of these facts: while avoiding epinephrine will almost never increase the risk of life-threatening anaphylaxis, taking epinephrine in fact almost always will increase the risk, due to the danger of rebound. But this is not what the allergist represented to me. Doctors hate to explain risk curves and factors, perhaps because they fear being misinterpreted, perhaps because they have no patience. Occasionally, they may lie outright. The allergists I have spoken to over the years have never bothered to make any of this very clear. I’d not heard of the rebound effect until that day when my ex told me to ask about it.

This is to point up the dilemma that most allergic reactions — even ones affecting the core — are never emergencies, and yet more often than not we all must now get to the emergency room, thanks to the Epi-Pen.

Both ER doctor and nurse emphasized that epinephrine is not usually a dangerous drug. It is artificial adrenaline, naturally produced in our adrenal glands. It is chemically identical, so the pharmaceutical industry can legally call it adrenaline, and the dosage is what we manufacture in our bodies every now and then whenever we experience a sudden fight-or-flight situation. Almost hit by a car? Threatened by a superior? Running for your departure gate? Fell down some stairs? If one of these things were to happen right after you ingested something you were allergic to, oddly enough, it could conceivably save your life. Epinephrine greatly increases our metabolism and as a result encourages a stronger histamine response. Though we may have the fear that we are in danger of asphyxiation, causing that necessary increase in adrenaline, in rare instances a body may not generate enough of it naturally to cause the throat swelling to go down. Because this has happened a few times to a few people, we administer epinephrine all the time to all of the people; because we cannot be trusted with syringes, it must be packaged in a very costly delivery system; and when we use this delivery system we must also go to the emergency room for further antihistamines and steroids.

If we were to use an Epi-Pen accidentally, as the ER doctor said she sometimes sees, it is arguably of no greater concern than if we accidentally cut ourselves with a kitchen knife, a common enough occurrence. But even accidentally taking epinephrine, at least in our world, still necessitates going to the emergency room. In the case of no allergic reaction, this would not truly be necessary. In the case of an allergic reaction, it is due to the danger of the rebound effect.

Part of the problem here, it seems to me, is the very fact of the emergency room. In addition to the adrenaline, what my son was given there were fluids, antihistamines, and steroids. Like adrenaline, all are generally safe things that we can, and often do, administer ourselves. Naturally, as this was a hospital, they did everything through a mainline catheter in fluid form, which offers better control over dosage (eliminating such variables as throwing up some unknown amount of the antihistamine or steroid), and so it could take effect more rapidly (eliminating such variables as the contents of the stomach that could slow down uptake of the antihistamine or steroid).

Inserting a venous catheter is probably not something everyone should need to know how to do. But taking these things in pill or liquid form after epinephrine would have a similar effect; it would merely take somewhat longer, and in case of vomiting or full/empty stomach, one would have to take into account dosage. There is, apparently, no medical danger in taking these things together. It would not endanger anyone to take a shot of epinephrine and chase it with reasonable doses of Benadryl and steroid pills. In fact, it would be exactly what one could and should do after taking epinephrine following an allergic reaction.

This is to say that in another universe, or a different America, it would be considered safe to do all of this at home, and it would be safe — and even advisable — to have all of these things available more or less over the counter. In another universe, our doctors would be more readily available over the phone without the pomp and circumstance, or perhaps we might be told by some doctors that we don’t even need them at that moment. If we knew what we were doing, in most cases it would be only for our peace of mind.

In the case of a real emergency, naturally we would jump in the car or call 911 and get to an emergency room. But how much less often in our world would that need occur, if we only had such things in our medicine cabinets? In the event of even a strong allergic reaction, could it ever happen? How many of today’s simple procedures could be safely done at home if the world were just a little different?

A tiny number of people are saved from the brink of death with the Epi-Pen. It can be argued that many more, likely thousands upon thousands of times a year, are put at unnecessary risk due to doctors’ overeagerness to protect us from ourselves by giving us the wrong sense that every allergic reaction is, ipso facto, a life-or-death situation. The truth is that most unmedicated allergic reactions are probably no more risky than crossing the street, and yet a microscopic minority are as risky as crawling across a busy highway. Closer to the point, most are similar in terms of risk to having a fever, and yet a vanishingly small number are as risky as, say, a gunshot wound to the torso. This is the case whether we go the epinephrine route or not.

I am in a logical quandary in my mind whether the “rebound” risk makes taking epinephrine perhaps more dangerous than just relaxing, throwing up a few times, going through the motions of discomfort, letting it pass, as billions of humans did in the millennia up until the 1970’s. (Naturally, we have epinephrine on hand just in case.) I say this because it seems allergy doctrine insists that epinephrine must always be followed by a three-hour stay in an emergency room for the additional drugs and observation — and this involves additional risks, not the least of which are the major threats to our autonomy.

1304951748in550There is an infantilizing aspect to our doctors’ tone of voice. Much has been said about bedside manner. Patients are full of layers of questions, and doctors are full of complicated answers, including misinformed ones. In most cases, not enough is said, because the harried doctor simply wants to get the discussion over with. I can understand that it would be impossible for a doctor or nurse to sit patiently over the phone or in a clinic and give a two-hour interactive discussion at a sixth-grade literacy level, on the pharmacological history of autoimmunity and justification for emergency procedure. However, many doctors wish simply to pat us on the head and tell us not to fret about our bodies. The bold ones encourage us to look it up online. And yet I have browbeaten dentists, orthopedic surgeons, allergists, and others over the years to justify, at least in capsule form, the crap they seem to be spewing, and more often than not I have found grave equivocations at the bottom of it all. This tends to happen when I research a doctor’s claims after his or her patronizing lecture and exasperated exit from the examining room. I am tempted to feel that some doctors are such busy, vicious, money-grubbing people they don’t even realize where their words are coming from.

I believe that the self interest has been institutionally channeled into a reflexive response, a kind of easy self-administering drug, a soma. This response is constructed through the regulatory morass created by big medicine. The architectural revisions are based on decades-deep layers of often conflicting medical research. Every malpractice suit helped build the edifice, and so every allegedly or truly negligent move made by every doctor through history was a stone in the huge ziggurat listed on maps as medical paraonia. I must admit that every irresponsible patient through history provided a the mortar, and that the AMA and insurance lobby have done their part by securing landmark status for the structure.

While they’re all taken care of and have left the neighborhood as millionaires, ordinary people like us have been forced to keep up the property taxes on the ziggurat all these decades, in the form of bloated insurance provisions and perversely overcautious medical procedures.

I’m sorry. I didn’t mean “vicious, money-grubbing” above in a hostile way. I meant to indicate that the doctor’s immune response described above has become a vice, a kind of drug addiction; the fact that this response happens to result in significantly greater revenue for the medical industry may simply be called a salutary side-effect of the paranoia. If there were not greater victims than the doctors, and if the doctors did not truly have their reward, I might have pity on them.

One might also call this the money problem in medicine. I don’t mean this simplistically. I mean the wool over the eyes business. I mean the thin, gluey, transparent membrane that doctors freely escape through whenever they speak to us, but that neither we nor they can easily see or comprehend. They use it whenever a patient asks a little more than they are entitled to ask or than doctors are comfortable hearing. It is in their patient tone of voice that is actually impatience, in the standing there in a relaxed posture by your bed that really means they want to get the hell over to the next room. The billed value for this expert and his body language typically far exceeds the time actually expended.

In shorthand, the money problem is in the extraordinarily bounteous compensation for an often less-than-extraordinary human mind and spirit. The field of medicine attracts generous people, but it also attracts selfish people. The fact is that that we can never tell anymore which doctors have entered this field primarily to save lives and which to make money hand over fist. Are they communicating their mandates to us out of tender concern and a Hippocratic duty to human life, or for the serious green? It is a psycho-social condition, but impossible to diagnose. It presents in these doctor-patients in exactly the same way whether they are social or selfish, and we can only treat their suffering symptomatically, by just shutting the fuck up and letting them go.

1304951748in550I don’t want to lose sight of the 150 lives per year ended prematurely by the tragedy of untreated anaphylactic shock. In fact, in a way I am arguing that, paradoxically, many if not all of these people lost their lives not when they failed to have an Epi-Pen or get help in time, but because of the Epi-Pen’s very existence as the modern world’s only available way to mitigate the risk. And of course when I say Epi-Pen I mean not only the little plastic spring-loaded stick but all of the mechanisms and assumptions surrounding it, spreading out as far as the eye can see, but touching nowhere near that remote provincial settlement known as autonomous care.

Something here makes me very angry: The medical priesthood is persuading me that epinephrine is a good thing, and I can certainly see great value in it. What irritates me is not the debate about epinephrine, nor even the emergency room quandary, but that the care community feels it has done its duty by giving us this little technological curiosity called the Epi-Pen. The fact is, the Epi-Pen is not epinephrine in a syringe. The Epi-Pen all on its own is a Rube Goldberg device eminently prone to failure and human error. The Epi-Pen and the complex surrounding it are not to be trusted on their own to save lives.

Doctors tell us that an Epi-Pen is good, and that two are even better. The fine print is that we are trusting the lives of our loved ones to these extremely dubious, expensive, and hard-to-find devices. They should be in our medicine cabinets, but often they are not. Or they have expired. Or there was some other mishap. This solitary device could save our lives. If that one packaged, mechanized hope should fail, we are alone, facing premature death.

From this fact screams a great hypocrisy in industrial medicine. Either it is fully committed to saving lives, or else it has failed in its duty. The Epi-Pen, not being as cheap, ubiquitous, and reliable as a disposable toothbrush, is inadequate alone in our medicine cabinets to solve the anaphylactic shock problem. In fact, because we can afford only one or at most two a year, it puts our loved ones at risk to have only that many available. After that, our child is only moments from death. Perhaps it failed, or it fired improperly. Perhaps it wasn’t where it should have been. Who can tell who was to blame? A misplaced phone, a too-late call, a wrong address, a traffic jam, a slow ambulance, and our child is lifeless. All of the life-saving epinephrine in the world is three miles away, safely locked up in a hospital or pharmacy.

We should therefore be very angry at the Epi-Pen. We should be clamoring for the right of access to the hypodermic needle, proper training in its use, and several vials of cheap, ubiquitous manmade adrenaline in every home and every neighbor’s home. Our allergists and pediatricians should be fighting for this kind of world, not the kind that now exists.

1304951748in550Up until now in similar arguments, people (other than the specialists I am indicting) tend to nod and agree with me. However, when I get down to the real nitty-gritty of the philosophy, I do start getting the bizarre sidelong looks, even from more or less reasonable people. You can practice that look, too, right here. Here is my outlandish thought, my prescription.

I feel that somewhere a few decades ago we lost a fundamental human right, the right to the personal power of self-determination, of personal risk. We abandoned it to the ziggurat. This risk-protection appears in the tyvek-wrapped individual candy packets for Halloween and other events, objects that tell us that we shouldn’t cook for ourselves or pass out apples to strangers or trust our neighbors anymore. It appears in all of the disposable medical packaging and its waste laws. It has drifted into the Changing of the Disposable Gloves two or three times whenever we order a Potbelly sandwich. It appears hundreds of times a day in similar things, most prevalently beginning in hermetic sealing and ending in poorly redeemable waste, but also beginning in filling a form for something we need and ending in crickets, or beginning in a nice day and ending in some numbing frustration due to yet another wayward, worthless appliance once thought of as a convenience. We are so numb to this world that we do not even notice as it hits us square in the face a hundred or a thousand times a day.

It also appears in the notion that a mere mortal can’t be trusted with a needle any more than he or she can with a gun. There is also that lock-in at the registration desk in an emergency room: if you announce your presence, though you may have a simple headache, you or your insurance (which ultimately comes back to you) are in for a bare minimum of $500. If you stay outside and take care of yourself, you are defying all of that physical and moral packaging industry. But it is relatively cold and lonely out there. Our Christmas trip for the allergic reaction billed over $4,000.

Finally, it appears with clear and present danger in the story of the medical industry’s faith in the Epi-Pen and its mechanical distrust of patients.

These are all examples of the controlled individuated processing of man’s everyday life. It begins with any given basic idea (getting lunch, parking a car, seeking medical attention), proceeds with unit necessities within those procedures (packets to microwave, transactions to swipe, forms and fields to complete, disposable catheters to tear open, brochures to feed to patients), and ends in waste, externalized byproduct, and death. All of this has evolved not for man’s benefit, only to reduce risk and increase profit. Wherever it appears to redound to mankind’s benefit, one can identify social and environmental externalities, as well as basic system losses, all of which negate most and probably all of the gross gains.

The neat little logical Russian nesting dolls that the medical industry (and every other industry) has created, where we can’t know what we can’t know, are a big part of this. What doctors and nurses were telling me yesterday without actually telling me, you see, is that the world would actually be much better off if we all learned to load a needle. Epi-Pens are too costly and too specialized. Having only one around is highly risky, and often there isn’t even one. Beyond basic first aid — an undeniable good — we really should have some other essential medical skills for things that have the potential to spiral into life-and-death situations but that in actuality are not, things that couldn’t spiral if we only knew and could do just a bit more. Doctors will violently shake their heads here and say that I’m insane, perhaps even bring me up on charges of some kind of terrorism — but sooner or later they will have to come back and admit that parts of this idea are quite sound.

Aside from what the Red Cross currently teaches, I wonder if every middle schooler might have a few hours of class time to be taught and drilled in the use of the hypodermic needle — both subcutaneous or intramuscular, what diabetes patients are taught, and intravenous, what drug abusers are taught. They should be taught how to identify situations of low blood sugar or anaphylaxis or any of the half-dozen other things that call for an injection. They should be taught not to be afraid, and such skills should feel as righteous and rewarding as driving a car. Every refrigerator should have a few vials of insulin and adrenaline, and every medicine cabinet should have a few sterile syringes. (I’ll concede that the syringes should be single-use.) In an urgent situation, one should be able to call a neighbor and get backup materials and skills in seconds. One should know how to equip a medical kit for such things. These things should be encouraged in carry-on luggage.

You can see a glimpse of the pride of having arcane knowledge in popular culture. In a dystopian movie, out in the desperate wasteland, we are often treated to an aggrandizing heroic device: the rough-and-ready protagonist is busy, sewing perfect sutures with whisky as anesthetic; administering a curative injection; or displaying other field surgical skills, often on himself (or, even better, herself). It inspires us, makes us want to be more like them — it even looks like something we could vaguely do and be proud of, like baking bread — but of course we cannot do it in the real world, because our doctor and culture forbid us, warning us that it is too dangerous. It remains, ironically, locked inside the fantasy world of the dystopian, far from utopia. But in these furtive wishes lies the frustration of mankind’s subjection to unreasonable technical controls, wishing to escape through Freudian dreams.

We are only what we are capable of. When we know nothing, we are nobodies. Whenever we surrender even more knowledge to the pushbutton, we lose a little more of our self-confidence, which is in fact our sense of self. But this pervades our world far beyond first aid and medicine. In first aid, today we are warned never, ever to tie a tourniquet, tie off and suction a snakebite wound, or move a victim with any back injury — techniques that until 30 years ago were taught to youth. It is not that this knowledge is no longer valuable, it is that in a few remote cases a few people have inadvertently caused more harm than good due to a lack of data or knowledge, and so specialists have instructed us simply to stay away from them entirely and not even to think of them. But even in the city, relinquishing this responsibility is not universally a good thing, since in many cases proper training and readiness could save a good deal of trouble and reduce risk.

These notions of the erosion of technical self-sufficiency are everywhere in our world, not only in the first-aid business. To once again become human, we must somehow venture back to that visceral world, at least know it and re-experience it somehow every now and then. There are connections here in industries as diverse as food, camping, transportation, education, dental hygiene. It is why bicycles are considered toys in most states and also why we’re morbidly obese. It rears its head when we are afraid to lift the hood of our car or even change a tire, and so we call AAA instead. We see it in the meat section of the American supermarket, since modern butchers know that we couldn’t possibly stomach the sight of a chicken or cow or pig head, much less slaughter our own meat. In fact, there are connections here to all modern human activity: it pervades our world. These restrictions pull out our self-determination and wrap it in convenient opaque packaging that would sooner suffocate us than empower us.

1304951748in550My New Year’s resolution is to get out there and renew my Red Cross certification. I can already hear the applause from doctors: “Yes, that’s quite charming and noble; everyone should learn how to treat for shock.” But for me this will be to build confidence for feeling bolder about the above things. What brave doctor or national medical association will risk admitting that every American should know a great deal more than CPR and how to treat for shock? Doctors should not be reading this and benignantly nodding down at me in that avuncular way that they do; they should feel threatened by it. The AMA has its standard response for dangerous nonsense like this, and I expect to be treated to it.

These instincts do not originate from isolated concerns about the medical industry: I come at this from a critical view of the entire world of technique. But it so happens that my childhood pediatrician was none other than Robert Mendelson, the so-called “medical heretic.” This is the Chicago doctor who in the 1960’s was roundly criticized by the AMA and others for saying similar things. Mendelson’s bestsellers argued that we should keep our distance from doctors and hospitals, that the only time we should ever see one is when we are keeling over.

Like Mendelson, I feel the relationship with medicine should be much more open and collegial, like a true partnership. As much as doctors claim it is, today’s medicine is only a twisted version of this. I’d really like to be able to stop in and chat for a few minutes with my neighborhood nurse or physican’s assistant, perhaps see her or him standing outside a simple storefront between the shoe-repair man and the dry cleaner. I would also have the nurse’s cell phone number, and the numbers for one or two others within a couple blocks’ walk from my house in case the nearest one is unavailable.

If I had questions about injecting my son with epinephrine and observation while buffering its effects, the nurse or PA would be just around the corner and we could practice with saline. She would certify my authorization to purchase epinephrine, syringes, steroids, and other such supplies. I’d need to stay in her good graces and out of trouble to renew these rights. And she would offer the same opportunity to all of my neighbors as well, and many neighbors would take her up on it, and we’d all know who had done so. That wouldn’t put epinephrine in every medicine cabinet, it wouldn’t free us entirely, but it would be a safe first step toward truly ubiquitous epinephrine and other life-saving remedies.

1304951748in550

Bock SA, Munoz-Furlong A,Sampson HA. “Further fatalities caused by anaphylactic reactions to food, 2001–2006.” J Allergy Clin Immunol 2007;119:1016–8.

Ellis, A.K. “Incidence and characteristics of biphasic anaphylaxis: A prospective evaluation of 103 patients.” Ann Allergy Asthma Immunol. 2007 Jan;98(1):64-9. (Suggests correlation between too little epinephrine P = 0.048 and/or corticosteroid P = 0.06 with biphasic anaphylaxis.)

Ellis, A.K. “Priority role of epinephrine in anaphylaxis further underscored – the impact on biphasic anaphylaxis.” Ann Allergy Asthma Immunol. 2015 115(3):65. (Can’t see the abstract or article on this for some reason.)

Greenberger PA, Rotskoff BD, Lifschultz B. “Fatal anaphylaxis: postmortem findings and associated comorbid diseases.” Ann Allergy Asthma Immunol2007; 98:252–7.

Guerlain S, Hugine A, Wang, L. “A comparison of 4 epinephrine autoinjector delivery systems: usability and patient preference.” Ann Allergy Asthma Immunol. 2010 Feb; 104(2): 172–177.

Lee, JK; Vadas, P (July 2011). “Anaphylaxis: mechanisms and management.” Clinical and Experimental Allergy 41 (7): 923–38. PMID 21668816http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2222.2011.03779.x/full

Lee, JK; Vadas, P (July 2011). “Anaphylaxis: mechanisms and management.” Clinical and Experimental Allergy 41 (7): 923–38. doi:10.1111/j.1365-2222.2011.03779.xPMID 21668816.

Luckhurst HM, Tuthill D, Brown J, Spear E, Pitcher J. “G86 Anapen, EpiPen and Jext Auto-Injectors; Assessment of Successful Use After Current Training Package.” http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2954079/ (Only 28% of participants were able to perform the individual device’s 10 steps correctly. Overall the trainer devices fired in 88%, with a failure rate of 2 to 30%; a clinically and statistically significant result. The Epipen’s swing and hit delivery method may affect its successful delivery compared to the Jext and Anapen’s methods.)

Marx, John (2010). Rosen’s emergency medicine: concepts and clinical practice 7th edition. Philadelphia, PA: Mosby/Elsevier. p. 15111528.ISBN 978-0-323-05472-0.

Neugut AI, Ghatak AT, Miller RL. “Anaphylaxis in the United States: an investigation into its epidemiology.” Arch Intern Med 2001; 161:15–21. (Estimated 500–1,000 deaths per year (2.4 per million) in the United States.)

Pumphrey R. “Anaphylaxis: Can we tell who is at risk of a fatal reaction?” Curr Opin Allergy Clin Immunol 2004;4:285–90. (Death from anaphylaxis is most commonly triggered by medications??? doesn’t show in this article despite in Wiki?)

Pumphrey RS. “Fatal anaphylaxis in the UK, 1992–2001.” Novartis Found Symp 2004; 257:116–28, discussion 128–132, 157–160, 276–185.

Pumphrey RS. “Lessons for management of anaphylaxis from a study of fatal reactions.” Clin Exp Allergy 2000; 30:1144–50.

Sampson HA, Mendelson L, Rosen JP. “Fatal and near-fatal anaphylactic reactions to food in children and adolescents.” N Engl J Med 1992;327:380–4. (Early administration of epinephrine within 30 min of allergen ingestion is key to preventing fatal anaphylaxis. A delay in access to epinephrine is also a prominent and consistent risk factor in fatal anaphylaxis as it seen in 80–87% of fatalities.)

Triggiani, M; Patella, V; Staiano, RI; Granata, F; Marone, G (September 2008). “Allergy and the cardiovascular system”. Clinical and Experimental Immunology. 153 Suppl 1 (s1): 7–11.doi:10.1111/j.1365-2249.2008.03714.x. PMC 2515352.PMID 18721322.

Wikipedia, Anaphylaxis article. (Approximately 2.4 per million Americans annually die from anaphylaxis episodes. Estimated 0.7-20% of anaphylactic reactions do cause death. A second dose of epinephrine rebound is required in 16% to 35% of episodes [some of these, but perhaps not all, must be rebounds].)

Posted in Uncategorized | Leave a comment