“The First Thing A Principle Does Is Kill Somebody”

Thus sayeth Lord Peter Wimsey in Dorothy Sayers’ Gaudy Night — and while it offers unmerited dignity to Gov. Mitch Daniels to accuse him of possessing a principled moral judgment, it is still true that his decision to defund Planned Parenthood will kill some number of Indianans Hoosiers [per MBL below.  Seeing as I’m a Gene Hackman fan, an embarassing lapse].

Given that he has foreknowledge (or should, by any reasonable standard) of this outcome; given that he is doing this intentionally — after all, he has committed himself to the affirmative action of signing the bill in question; given that the consequences of this choice are readily recognizable to any mature observer, I know how I would characterize this act. YMMV. The blunt fact remains that mortal harm is coming to some women in his state as a direct result of his actions.

What’s this all about?  Well, Kay here already noted the key fact:  Planned Parenthood in Indiana is a major supplier of healthcare to women in poverty; withdrawal of that care we lead directly to premature deaths.  That fact is implicit in what Kay wrote.  All I want to do here is to make it explicit, to leave no ambiguity in the demonstration that the approach to health care policy taken by Daniels — and Republicans in general — leads directly to the deaths of Americans.


From whence derive these –dare we call them murders?  Take a look at one of the most basic services Planned Parenthood provides its clients:  regular maternal and reproductive health care, including screening for one of the most preventable major diseases that afflict women, cervical cancer.  I’m going to do a bit of boring data dumping here, because I want to make the indictment of Daniels — and those who follow or admire him — as clear as possible

According to the CDC, about 12,000 women in the US were diagnosed with cervical cancer in 2007, the latest year for which I can find summary statistics. About 4,000 women died that year of the disease.  Many or most of those deaths were, or would soon be unnecessary, evidence of failures of public health, given that cervical cancer is preventable at very high rates.

For one route  vaccines exist that protects against infections by two of the most dangerous human papillomavirus strains implicated in the development of cervical cancers, and they are recommended by the CDC for girls and young women as early as possible (as young as 9) to protect against such viruses before risks of exposure mount.

Right wing opposition that to my jaundiced eye looks to oppose anything that might hint at independent sex lives for women has hindered the widespread application of one of the lowest cost, least invasive life saving medical interventions we now possess, one that could, as the raw numbers above suggest, save many thousands from the suffering involved in cancer treatment — and thousands again from dying unnecessarily from a wholly preventible disease.

The other path to prevention is, of course, the use of a screening test, the Pap smear, to catch the lesions that can proceed to full blown disease before they become malignant.

The US Preventative Services Task  Force (among many others) recommends that women begin a regular screening regimen within three years of the onset of sexual activity or their twenty first birthday, whichever comes first, to be repeated every three years until the age of 65, barring the presence of certain risk factors for the disease.

Such screening saves lives.  Lots of them.  Many sources report that a regular screening program with appropriate follow up reduces cancer incidence rates by up to 80%.  In the US that has corresponded to a drop in new cases from 14.2 per 100,000 in 1973 to rates about half that now, leading to 3 deaths per 100,000.  In Indiana itself, 2.4 white women per 100,000 were diagnosed with the disease in 20007; the number for African American women was 5.7 per 100,000.  That disparity may be due more to poor health services infrastructure and follow up for minority communities than to lack of access to screening itself; just about every source reminds the reader that the screening on its own can do nothing, unless action on the information thus gathered can occur.

All of this is background to this one datum: Planned Parenthood in Indiana delivers 500 Pap tests per week, and provides crucial health care support and services that allows the women it serves to do something about problems when detected.

Y’all know where this is going.  Pull 25,000 tests per year out of state health care system; do so for a population that is almost certain to include the most vulnerable and the least secure in their access to ongoing care, and you have a hot spot of cervical cancer cases waiting to happen.  If rates among that group revert to those comparable to countries with poor screening regimes – Romania in the late ‘90s, for example, with its Europe-high rate of 13.7 deaths per 100,000 – the back of my envelope tells three or four more women every year will die in Indiana unnecessarily – all for lack of access to the Planned Parenthood services that could have saved them.

I’ve been deliberately dull above, after my high-rev open.  The point I’m trying to make with this list of data and other people’s work is that there is not a political bone (or fibril) in the human papilloma virus.  HPV don’t care if you vote Republican or Democrat or The Rent Is Too Damn High.  It doesn’t judge you whether you have sex with one person….


…or if you like to do it like they do on the Discovery Channel.  It could give a viral sh*t what you think of the PDF of Obama’s birth certificate.  It shows up, gets nice and comfortable.  And then some women get sick, and some die.

And can I say again that those deaths are in principle wholly preventable?

Planned Parenthood does lots more than screen for gynecological cancers, of course.  This is just one example of the real commitment to saving lives, to life, that marks that organization.  But this story makes the point well enough:  when you cut poor and vulnerable people’s access to health care real harm results.

Which means that Mitch Daniels is presenting his bonafides to the Republican electorate with an action that will lead directly to the deaths of women whom he doesn’t know – whom he and we cannot know.  That anonymity, the statistical nature of the crime, means that Daniels will almost certainly never pay any price, let alone a criminal one, for his role in their deaths.  But they will be on his hands, and should be on his conscience.

And to go larger than just one politician whose ambition has swamped his capacity for moral reasoning, this is why we must work for more than just an individual electoral defeat for today’s Republican party.  Mitch Daniels may indeed by the best they’ve got over there.  That’s as damning an indictment as I can imagine.

Factio Grandaeva Delenda Est.

Images:  Egon Schiele, Death and the Woman, 1915.

Albrecht Dürer, The Flight to Egypt, 1494-1497.

22 replies
  1. 1
    an MIT alum says:

    Tom—I read this, recognized the data-driven style with a just a dash of snark, and then checked the byline to be sure. Keep up the good work.

  2. 2
    JCT says:

    Elegant, Tom.

    The question now presents itself — how should this be presented? Can this display of pure ambition over the health of young women in need be (excuse the term) hung around his neck?

    He’s on record as saying his own “analysis” shows that no one will be “affected” by this. Whatever the fuck his “analysis” was… probably just asked the local Republican operative if it would sufficiently buck up his bonafides.

  3. 3
    Maude says:

    Daniels is trying to re live the glory days of Reagan.
    In Indiana, will coat hangers have a different meaning for men and women?
    Daniels is dangerous to women.

  4. 4
    I Don't Get It says:

    I don’t get it. Is it so hard for you to provide pap smears from a group that doesn’t do abortion?

    Just start another organization called Schmanned Schmarenthood and do all the non-abortion stuff through there.

  5. 5
    JCT says:

    @I Don’t Get It: What an apt screen name.

    The “abortion” issue is a fucking *smokescreen* — otherwise they would SUPPORT Planned Parenthood because it decreases unwanted pregnancies by making contraception available. But this is about controlling women via the “sex is dirty” meme.

    And yes, that makes perfect sense — let’s dismantle this highly effective program that has improved the lives of women all over this country because Mitch Daniels and his band of misogynists has decided that it’s a great way to beef up their poll numbers.

  6. 6
    lamh34 says:

    Anybody have any idea what’s going on? Why is POTUS giving a previously unannounced statement.
    BTW, the statement WILL pre-empt The Apprentice…BAM!!!

  7. 7
    Lolis says:

    @I Don’t Get It:

    Why should we have to? No federal money is used for abortions anyway.

  8. 8
    The Dangerman says:

    I don’t see how the Republicans get out of that quandary that in order to win the nomination, you have to go way, WAY Right; sure, he can win the nomination with such acts, but he can’t win the General. Same applies to anyone having to go the Dick Van Troglodyte route.

  9. 9
    DairyStateMom says:

    Planned Parenthood already completely separates out abortion services. No abortions occur with taxpayer dollars. The clinics that do abortions are free-standing and separately funded. Daniels is defunding an organization that provides health care services to make a political point, not a real point about abortion. Right-wing asshats (unfortunately virtually indinguishable from mainstream GOP these days) are at best disingenuous on this point and at worst lying piles of … well, you get the idea.

  10. 10
    Donut says:

    We cannot be afraid to say what Tom is saying here: decisions like this one will cause women to die. Period. My wife is sitting here next to me now because of an attentive OBGYN who insisted on aggressive testing that falls outside of the guidelines. We are lucky. I shudder to think – to know – that I would be a single dad and my son never born, and we are lucky – we have been fortunate to always have insurance. So many women are not so lucky. They’ll never have the chance to meet a health care prof who gives a shot and goes the extra mile, let alone who just follows protocols.

    This decision of Daniels’ breaks my heart in so many ways. Those three women who will die for Daniels’ ambitions are, like my wife, likely already someone’s mom. They will be sisters, partners, spouses, best friends. The pain of their deaths will needlessly hurt so many more than just a few women here and there.

    Fuck, what a lousy bastard this man Daniels is.

  11. 11
    MBL says:

    There’s no such thing as an “Indianan.”

    The word you’re looking for is “Hoosier.”

  12. 12
    Tom Levenson says:

    @MBL: Fixt. See above.

    @an MIT alum: @JCT: Thanks for the props. Some snark is needed to anneal the rage.

  13. 13
    Ruckus says:

    In a reliably functioning society calling this man a murderer would not just be appropriate, it would be called for, demanded even.
    Not only do we have the technology to give women better health, basic human responsibilities demand that we give health care not only to the women but to all citizens.
    But there is the rub. The conservatives don’t want any one other than white christians to be citizens.
    Assholes. All of them. Every last one.
    Now some will accuse me of being inflexible and hard line. And they are right. For the last 60 years I have watched conservatives fuck up everything they touched.
    I hope that they have made the decision that this is their finest hour and that they need to strike everywhere and with such force to overwhelm any resistance. I hope that is true because I see that this will be the only thing to expose them as the incompetent assholes that they are.
    Most of the programs they are trying to eliminate have relatively little advantage to them at huge costs to everyone else. What is the motivation? What/how much are they actually selling out their humanity for? I’ll bet it isn’t all that much.

  14. 14
    JCJ says:

    Tom, as I’ve posted before the first pap smears I ever did was at a planned parenthood clinic while I was in medical school. It just so happens that was while I was in my second year of medical school in Bloomington at Indiana University. This is an outrage.
    Also HPV is associated with cancers of the oropharynx as well. Recent reports have stated that HPV is the most common cause of these cancers now in men (tobacco use is the other cause.)

    ETA: Oropharyngeal cancers are often referred to as “throat cancers.”

  15. 15
    Wag says:

    Based on our analysis, I see no reason not to call Mitch Daniels a “net pro-life candidate.” Sure, a few women will die under his watch on Indiana, but that will be more than balanced out by the increased number of unintended pregnancies caused by the inability to access reliable birth control, as well as the abortions prevented.

    All in all, a win for the pro-life community. A loss for anyone interested in promoting anything not aligned with the GOP.

  16. 16
    Yutsano says:

    @Tom Levenson: First painting is exquisite Tom. And the ratfuckers are just out to keep their wimmins barefoot and pregnant. Plus ca change and all that.

  17. 17
    SiubhanDuinne says:

    What everyone else said. And how nice to see a favourite line from my favourite book by my favourite writer used as the thread title. Thank you.

  18. 18
    something fabulous says:

    @SiubhanDuinne: I just came by to say almost the exact same thing! Harriet fans, unite!

  19. 19
    Riggsveda says:

    My daughter, who has lived hand-to-mouth for much of her life, gets all of her gyno-care from PP, and it really made a difference.

    BTW, Daniels did a nice job on privatizing the Welfare system in Indiana, too. Just ask IBM. I wonder who he could get to sue the US government if they made him president?

  20. 20
    WereBear says:

    So we save money by not providing this vital test; and then spend it when the woman is dying in intensive care.

    More expensive AND more suffering! Republican Health Care.

  21. 21
    Jan says:

    We’re discussing this from a distance. Are Hoosiers OK enough with this to approve it/acquiesce?

    I was born in 1948. While I was a college student, the pill came on the market and abortion was legalized just after I graduated. My college roommate was the first female student “allowed” to major in physics in our college’s history. Law and medical schools were just beginning to open up to more than “token” women students. For the first time in our town, banks began letting women get car loans without a co-signer. (Not mortgages, though and it was still OK to ask “Yes, but what did she do?” if a man “roughed up” his wife. Those changes took another decade or so.) I’m watching all of this start to unravel….

    Re. Dorothy Sayers: What’s the story behind the quote? My favorites are Gaudy Night and The Nine Tailors. Her books are dated in the best possible way — one can learn a lot about the ’20’s and ’30’s from her novels.

  22. 22
    gaderson says:

    @Yutsano: Yes, really enjoyed the Schiele, need to rewatch my Aeon Flux (the animator Peter Chung has noted Schiele was the model for that animation.).
    As for the text, what do the ‘journalist’ think would happen if they actual call someone like Daniels on his draconian measures? Or do they not even think of it?

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