thoughts on a snowy evening

Recently I have been struck by one of K's favorite quotes from J.R. Tolkein: "All that glitters is not gold; not all that wander are lost." Watching television tonight, I was appalled at the thin actresses who cry after putting on a fat suit (they wanted to "empathize" with those who are overweight). And this is what entertains America? I browsed through the New Yorker and read an editorial/article asking what kind of values are Americans setting up for themeselves? Menand has an interesting point in that

"We are ourselves products of the culture whose products we consume, and we can't help taking it, for the most part, on its own terms."

The social constructs which we create are immensely powerful. Menand referred to literary prizes as valuable only in the recognition that society bestows upon the award. K just wrote about the consumerism craziness that overtakes all good sense during the holiday season. Tolkein may be right in that some who wander are not lost, but right now, society is a bit lost.

The Economist has a thought-provoking article on the differences between the poor in Appalachia and those in the Congo. What is happiness and what is not happiness is a matter of opinion. Yet if happiness is universal, then is it merely the emotion that is shared? Happiness economists would suggest that the level of one's happiness is relative to the level of material goods of others around one's self. Moreover, when "an individual who becomes richer becomes happier; but when society as a whole grows richer, nobody seems any more content (7 Aug 2005, The Economist).

Perhaps the American dream fits both sides. Its retains the flavor that a better life is just over the horizon but that this "good life" is attainable. F. Scott Fitzgerald wrote in Majesty (short story):

The extraordinary thing is not that people in a lifetime turn out worse or better than we had prophesied; particularly in America that is to be expected. The extraordinary thing is how people keep their levels, fulfill their promises, seem actually buoyed up by an inevitable destiny.

It may be that a new year is approaching or that I realize that the year will bring many changes to my life. I have not been this content for a long while. A good friend of mine once said that when you're not looking for it, what you want will happen. Now I've paraphrased this generously and it was originally referrring to relationships, but I think he's right (as he often is).

Happy New Year's.

so this is Christmas

It's easy to say that Christmas (for those who celebrate it) is over-commercialized. Each year, K and I venture into the four shopping malls that permeate our lives in the hope of bestowing some measure of happiness to those on the receiving end. We practically learned how to drive years ago when we would do our December shopping on the weekends. Then, as now, I find the process overwhelming. No one seems happy when they shop at these times of year since no one either has the time or can find the perfect gift. I mean, is the special edition of Office Space or boxed set of eight different fragrances from Victoria's Secret going to change the life of the average middle class American?

I like to think that, in the vein of Charlie Brown, that it is the spirit of Christmas that counts. Certainly, there are moments on Christmas Eve and Christmas Day when I believe this to be true. Glancing at the parking lot of Target is not one of them.

For many, Christmas is a huge expense. In 2004, sales grew by 6.7 percent. This year, according to the Washington Post,

The NRF has been among the most bullish, forecasting sales growth of 6
percent, to $439.53 billion. Other groups, like the International Council of
Shopping Centers, expect a more modest increase of 3 percent to 3.5
percent.

[To put it into perspective, the The International AIDS Vaccines Initiative estimates that the total annual spending on an AIDS vaccine is $682 million.]

Maybe it's good that Christmas comes but once per year.

Life as we know it

Life is changing a bit too quickly these days. Coming back from San Francisco, I had a layover in Vegas and tried my first slot machines. For $3, I could occupy my 20 minutes before boarding a plane. Apparently, slot machines are made for right-handed people and take less skill (but about as much luck) as I anticipated. Also, the lights and pyramids and glitter of the hotel-casino complexes are astounding from an airplane.

Perhaps more importantly, while hovering over Vegas, I realized that I probably won't be in the Midwest next year. I'm looking at six cities, only one of them being in the Midwest. Tis a bit scary, to be flying around the country and never having the chance to explore a city in which I may be living next year.

San Francisco reminds me of Cape Town for some reason.

High society

The fact that I'm back from Philly means that I'm over halfway done with my tour of the major US cities and also not any closer to a decision. However, I will say that I have started to have a clearer picture as to what I want and need for the future.

The highlight of this trip was of course, the New York Philharmonic, featuring the pianist Andre Watts. What I love about music was exemplified in the technical splendor of Watts on Saint Saens or the divine, exposed lonely notes in "Prelude and Liebestod from Tristan and Isolde."

Alerted by the AJOB blog to an opinion article on HIV testing in the New England Journal of Medicine. The World Health Organization lists voluntary counseling and HIV testing (VCT) as a “crucial entry point into the care and treatment programmes” (WHO 2001). VCT is considered an integral part of HIV prevention or treatment program, as it “enables uninfected people to remain so and enable those infected with HIV to plan for the future and prevent HIV transmission to others” (ibid).

The argument in the NEJM article is whether the HIV/AIDS epidemic should be treated as a viral epidemic, subject to the control of standard public health measures, or as a social disease, one in which the social mores and dangers of stigmatism of the individual are of primary concern. Certainly, it would be easier, and perhaps more cost-effective, to monitor the disease in the US with standard notification of partners and track progression of the disease epidemiologically:

"Using the current CDC estimate of 40,000 new HIV infections per year, the potential to prevent half to two thirds of these infections, and the current average lifetime cost of care for a patient with HIV infection of $200,000,²⁹ more effective epidemic control would save between $4 billion and $5.4 billion per year. Widespread availability of condoms, syringe-exchange programs, public health notification of the partners of infected persons, and improvement of case management and monitoring systems would be unlikely to cost more than an additional $1 billion to $2 billion per year nationally — two to three times the current CDC funding for HIV prevention."

The authors argue that in an age of openness and multiple anti-retroviral drugs, that it's a travesty that 2/3 of those with newly identified HIV-positive serostatuses do not inform their partners. I agree with that assessment. However, the problem of partner notification is the question whether proclaiming one's status is considered as socially acceptable as the researchers. If it is socially acceptable, then HIV testing and prevention methods (condom distribution, decrease in number of partners, careful monitoring of existing viral load) is working. In that case, HIV might well be managed as a chronic disease. However, if it is not, then the stigma attached to HIV (and even to STI's in general)

The downside is that routine notification of partners may have an adverse effect on the utilization of health care services. Could knowing that one's partner would be notified translate into a lack of willingness to access health services?

Tradition

David Cameron, age 39, has been been given a mandate by the Conservative Party in Britain to lead them back to Downing Street. Having the "energy of youth" and the willingness to talk about the issues (such as the environment) that the Tories previously have avoided is a huge start. Interestingly, he appears more open to Blair's social policies, just as Blair embraced some of Margaret Thatcher's economic policies.

Commentators have been bringing up Cameron's sudden rise to the party's leadership forefront. It will be worthwhile to see how Cameron talks about family values and his position on national security in the coming months. Bill Clinton lead the Democratic Party to victory in the 1990s after promising to inspire greater trust in the government and moving the party to a center position on the ideological spectrum. Tony Blair captured the swing voters in 1997 and brought his party to a "New Labour" stance.

How will a strong Tory leader affect British politics and the "Special Alliance" between the United States and Great Britain? Much of that answer will lie in Cameron, but it will also lie in the future of the Republican Party. Cameron has opportunities on the basis that he is a new leader with a vision of Britain that is unlike that of his predecessor, Michael Howard. Cameron is more willing to work with the current system than to change it completely and does not appear to endorse the reactionary responses seemingly favored by Howard. The 2004 election became more centered on the presidential candidates than the platforms themselves. Who will be the face of the Republican Party after Bush? Who will become the face of the Labour party after Blair? With the parliamentary system in Britain, the governmental party has greater influence over policy than what occurs in the United States. Therefore, the process will be important for the future as well as which leaders the British goverment will be contacting.

Separation

From Arundhati Roy's "The God of Small Things" (p.214-215)

"Promise me you'll always love each other," she'd [the mother Ammu]
say, as she drew her children to her.

"Promise," Estha and Rahel would say. Not finding words with which to tell her that for them there was no Each, no Other.

Sleepless in Sudan

My roommate alerted me to this great blog. Certainly, fans of Kristof's NY Times articles will find it worthwhile.

World AIDS Day

I haven't posted anything on World AIDS Day yet. One year ago was my last day at the Motherwell clinic and to this day, I'm torn over whether the battle against HIV/AIDS is one of hope or one of promises yet unmet. It's tough to see that the rash of articles this year focuses on the failure of goals to be met and the rising tolls of infection and death, even in the wake of the G8 summit this past summer. The 3 x 5 goal will not be met. The goal was to place 3 million on antiretroviral therapy by the end of 2005, but less than 1/3 of that goal will be met. That the new G8 goals is to place all infected individuals on ARVs by the year 2010 thus seems optimistic to the point of being overly naive.

In a BBC articlet:

South African Health Minister Manto Tshabalala-Msimang, who has long been lukewarm over the usefulness of anti-retroviral drugs, refused to back their use.

Many African countries encourage abstinence to avoid infection

In an interview, she said that anti-retrovirals offered no cure, and that she might use food supplements or traditional medicines if she became infected.

One asks (or at least, I ask myself this all-too-frequently), what can be done? On a policy level, certainly dialogue and discourse between the UN, nations, those who implement such policies, and those who receive the benefits/drawbacks of such policies must be examined.

What is perhaps equally important (and just as naively understood) is the active support of the wider first-world community. Kar just wrote about generosity of individuals. However, the wider generosity of individuals (Gates Foundation) vs. nations (US PEPFAR) must play a role as well. The movie "The Girl in the Cafe" was actually commissioned to "celebrate Africa in 2005." It's actually written by Richard Curtis, the same person who did Love Actually, so fans of that movie might celebrate.

Behavior change comes at the level of the individual, but the motivations to push initiatives forward have to come from a larger audience more than once a year.

Generosity

Richard Schulze has given Mayo Clinic an impressive $48.9 million for a cancer treatment, both on the patient and therapy development.

I'm amazed at the generosity at these large donors. Yet I also wonder, who are these people who have such wealth that they are able to afford such a donation. The average American with a bachelor's degree will earn an average of $2.1 million over his or her respective lifetime. Those with a professional degree will earn an average of $4.4 million in lifetime earnings. An average high school graduate earns a paltry $1.2 million in a lifetime today.

A song from the first Shrek soundtrack also comes to mind. The song "Stay Home," speaks about the desire for a simple life and being happy.

" A simple life's my cup of tea
I don't need nobody but me...

...I wanna be a millionaire someday
And know what it feels like to give it away
Watch me march to the beat of my own drum"

It is interesting to think about what the pursuit of material goods and wealth may ultimately bring. The opportunity for a better life of one's children and fewer worries of financial hardships are legitimate reasons for wanting a career with a comfortable income.

Andrew Carnegie once said, "The man who dies rich, dies disgraced." This quotation may be an exaggeration, but it certainly speaks to the idea of accumulated wealth. In 1994, money accounted for a greater proportion of total giving by Americans than Scandinavia, France, or Britain. The article (linked above) suggests that this trend is influenced by tax breaks and other incentives, not found in other countries.

Though this post has become more jumbled than originally intended, I conclude with a few points to ponder:
1. Who is in a position to give?
2. Is it just as valuable to give time as money?
3. How will this rising feeling of philanthropy influence giving within first world and to third world nations?