Sunday, July 17, 2016

Sunday Reading

Mike Pence vs. Women — Joan Walsh in The Nation on Trump’s VP pick.

It looks like Donald Trump blinked.

After a 13-month battle with the Republican establishment in which he won most every skirmish, Trump appears to be acting responsibly, as his campaign confirmed the news that he’d chosen mild-mannered Indiana Governor Mike Pence to be his vice-presidential nominee. It was hard to believe that was Trump’s first choice. There had been lots of reporting that he wanted Newt Gingrich (why not, God, why not?) and, despite New Jersey Governor Chris Christie’s legal baggage (plus Trump’s son-in-law Jared Kushner’s mortal grudge against Christie for sending his father to jail), it seemed like Trump found in Christie a kindred soul/bully as well. But he was by most accounts scheduled to introduce the white-haired establishment favorite, Mike Pence, at an event in Trump Tower on Friday.

Then came the horrific attack in Nice, France, and late Thursday Trump announced he would postpone his VP announcement, presumably out of respect for the victims. (By the way, the Tour de France went on.) Then he said he’d take the weekend to continue mulling his choice, before tweeting official confirmation of his selection on Friday morning. If this is how Donald Trump makes decisions in real time, he is not looking terribly presidential.

Putting aside the drama of the past 24 hours, it’s worth looking closely at Pence, because he tells us a few things, too—about what counts as “establishment” in today’s GOP.

If Trump thinks he’s getting a running mate who can appeal to the center and swing voters, he’s wrong about that. Pence is so far right when it comes to women’s and LGBT issues, he makes Trump look like a Democrat. Frankly, he’s a smooth-talking Todd Akin.

In Congress, Pence co-sponsored a bill that would have redefined rape and limited federal funding for abortion to women who suffered “forcible rape”—what Akin famously described as “legitimate rape” when he doomed his 2012 Senate bill. Pence is also the guy who began the GOP’s ugly and so far unsuccessful crusade to defund Planned Parenthood, back in 2007. “He’s the only one I know of who has been so completely obsessed with Planned Parenthood,” Planned Parenthood president Cecile Richards said back then. “This just seems to be an enormous focus of his.” Of course, Pence got more company in the Tea Party Congress of 2011, and that year he threatened to shut down the government over continued Planned Parenthood funding.

Since becoming governor in 2013, Pence has signed various anti-abortion bills and succeeded in defunding Planned Parenthood in his state. That helped lead to a devastating resurgence of HIV/AIDS, since Planned Parenthood was one of a few providers of HIV testing in the state.

Unfortunately, there’s not much daylight between Trump and Pence on the issue of Planned Parenthood. Although daughter Ivanka reportedly got Trump to say nice things about the group’s women’s-health work earlier this year, both he and Pence have said that if Planned Parenthood wants to continue providing primary care for women, and crucial screenings for breast and cervical cancers, it should stop providing abortions.

“If Planned Parenthood wants to be involved in providing counseling services and HIV testing, they ought not be in the business of providing abortions,” Pence told a Vox reporter. “As long as they aspire to do that, I’ll be after them.” Sounds like Trump: “Millions of women have been helped by Planned Parenthood. But we’re not going to allow, and we’re not going to fund, as long as you have the abortion going on at Planned Parenthood, and we understand that and I’ve said it loud and clear.”

Also, Trump has promised to punish women for getting abortions (and then flip-flopped); Pence has actually done so. In Indianapolis, 30-year-old Purvi Patel was prosecuted for using the pills doctors prescribe for early pregnancy termination allegedly later in her term. Her conviction is being appealed.

Of course, Pence is probably best known nationally for supporting one of the nation’s toughest so-called “Religious Freedom” laws, and then backing down when big businesses from Apple to SalesForce to Angie’s List said they’d curtail commerce in his state. Pence says he “fixed” the law, but LGBT advocates don’t entirely buy it. Conservatives do, however, and they consider Pence a traitor for bowing to business.

Pence is an odd choice, for many reasons: He’s got low approval ratings in his home state and faces a tough reelection battle. He supports free trade and opposes Trump’s Muslim ban. The Indiana governor endorsed Texas Senator Ted Cruz just before the state’s crucial primary in May, but said wishy-washy nice things about Trump, too. When Trump crushed Cruz in Indiana, Pence got on the Trump train. He was ready to move up front and sit alongside the leader. But now he’s sitting in a New York hotel waiting for an announcement that may never come.

Reportedly, Trump was angered by the leaks about Pence on Thursday and believed they came from the Indiana camp. For a while on Thursday, Newt Gingrich apparently still thought he was in the race; he came out last night with a proposal to “deport” all Muslims from the United States if they won’t denounce Sharia law—perhaps to remind Trump that Pence opposes such restrictions on Muslims.

Of course, journalists hoped Trump would pick either the voluble Gingrich or the combative Christie, to make the race more fun. I don’t think Hillary Clinton much cares which of the men Trump chooses; they will all send women voters into the Democratic camp even faster than they’ve been running from Trump.

Turkey’s Purge — Dexter Filkins in The New Yorker.

The coup in Turkey is over, and now the purge begins.

On Saturday, Turkish soldiers and police—those who had remained loyal to President Recep Tayyip Erdoğan during the uncertain hours of the previous day—were rounding up their enemies across the security services, reportedly arresting thousands. There will be thousands more. In the high-stakes world of Turkish politics—nominally democratic but played with authoritarian ferocity—justice for the losers will be swift and brutal.

The remarkable thing about Friday’s coup attempt is not that it failed, but that, after years of Erdoğan’s relentless purging of his opposition, there was a faction inside the Turkish military strong enough to mount one at all.

The confrontation was a long time coming. When Erdoğan first became Prime Minister, in 2003, he was the Islamic world’s great democratic hope, a leader of enormous vitality who would show the world that an avowedly Islamist politician could lead a stable democracy and carry on as a member of NATO, too.

Those hopes evaporated quickly. Erdoğan, who was elected Turkey’s president in 2014, has taken a page from Vladimir Putin’s playbook, using democratic institutions to legitimize his rule while crushing his opponents, with an eye to ultimately smothering democracy itself. Over the past decade, Erdoğan has silenced, marginalized, or crushed nearly anyone in the country who might oppose him, including newspaper editors, university professors, aid workers, and dissident politicians. (What an irony that Erdoğan, who has imprisoned so many journalists, and gone to great lengths to censor Twitter, Facebook and YouTube, may have saved his Presidency by using FaceTime to make an early Saturday appearance on a Turkish television news channel.) President Obama and other Western leaders, seeing Erdoğan as a bulwark against chaos, largely gave him a pass. In his most recent grab for authoritarian powers, Erdoğan pushed through a law that stripped members of parliament of immunity from prosecution, a measure that his critics fear, with good reason, that he will use to remove the few remaining lawmakers who still oppose him.

Then there’s the military. Since the Turkish republic was founded, in 1923, the county’s generals have imagined themselves the ultimate arbiters of the its politics, stepping into power—sometimes savagely—whenever they felt the government had become either too leftist or too Islamic. (After the military overthrew a democratically elected government in 1960, the generals executed the Prime Minister.) The military has had a special contempt for Erdoğan, whom they regarded as a dangerous Islamist—but they have proven no match for him.

In 2007, Erdoğan’s henchmen initiated a series of show trials, known collectively as Sledgehammer, in which fabricated evidence was used to remove the top tier of the Turkish officer corps. Hundreds were sent to prison, and the military itself seemed banished from politics forever. Indeed, Erdoğan must have been surprised that there was still a dissident faction of the armed forces large enough to try to bring him down. On Friday, the coup’s organizers didn’t even have the sense to detain the man they were trying to overthrow, and they apparently never seriously contemplated shooting their way into the palace. (After a coup in 1980, the military killed and imprisoned tens of thousands.) In the wake of their failure, the military will be soon be under Erdoğan’s total control, like virtually every other institution in the country.

In his dramatic appearance at Istanbul’s Atatürk Airport on Friday night, Erdoğan blamed the insurrection on the exiled cleric Fatullah Gulen, a reclusive figure who lives in the Poconos. “I have a message for Pennsylvania,’’ Erdoğan said, a reference that must have baffled many non-Turks. “You have engaged in enough treason against this nation. If you dare, come back to your country.”

Gulen, an aging cleric who heads one of the world’s largest Islamic orders, fled Turkey in 1999, when it appeared that the military was going to arrest him. For years, he was one of Erdoğan’s closest allies, helping him in his rise to power. While Gulen preaches a message of love and tolerance, there has often been something mysterious about him and his followers, who do not readily advertise either their affiliation or their intentions. Over the years, Gulen’s followers quietly found positions within many Turkish institutions, particularly the courts and police. (It was the Gulenists who led the show trials against the generals and the press.) In 2008, James Jeffrey, the American ambassador, wrote a memo about the Gulenist infiltration of the Turkish National Police. “The assertion that the T.N.P is controlled by the Gulenists is impossible to confirm, but we have found no one who disputes it,” Jeffrey said.

Then, in 2013, Gulen and Erdoğan split, in what appears to be part of a naked struggle for power. In the years since, Erdoğan has purged the courts and police of thousands of men and women presumed to be Gulen loyalists. It’s hard to know whether Gulen was behind Friday’s attempted putsch, but at this point it seems unlikely. While Gulen’s followers predominated in the security services, they were not generally believed to be a large force inside the military. It seems more likely that the officers who led the revolt represented the remnant of the military’s old secular order. Now they’re finished.

During his speech last night at the Istanbul airport, Erdoğan referred to the attempted coup as a “gift from God.” Erdoğan is usually a precise speaker, but in this case, perhaps in his excitement, he showed his cards. With the coup attempt thwarted, he will no doubt seize the moment. In recent months, Erdogan has made little secret of his desire to rewrite the constitution to give himself near total power. There will be no stopping him now.

Listen Up — Paula Span on new technology to help those of you with hearing issues.

An estimated one zillion older people have a problem like mine.

First: We notice age-related hearing loss. A much-anticipated report on hearing health from the National Academies of Sciences, Engineering and Medicine last month put the prevalence at more than 45 percent of those aged 70 to 74, and more than 80 percent among those over 85.

Then: We do little or nothing about it. Fewer than 20 percent of those with hearing loss use hearing aids.

I’ve written before about the reasons. High prices ($2,500 and up for a decent hearing aid, and most people need two). Lack of Medicare reimbursement, because the original 1965 law creating Medicare prohibits coverage. Time and hassle. Stigma.

Both the National Academies and the influential President’s Council of Advisors on Science and Technologyhave proposed pragmatic steps to make hearing technology more accessible and affordable.

But until there’s progress on those, many of us with mild to moderate hearing loss may consider a relatively inexpensive alternative: personal sound amplification products, or P.S.A.P.s. They offer some promise — and some perils, too.

Unlike for a hearing aid, you don’t need an audiologist to obtain a P.S.A.P. You see these gizmos advertised on the back pages of magazines or on sale at drugstore chains. You can buy them online.

But they go virtually unregulated by the Food and Drug Administration. That leaves them “without the design control requirements, performance standards, technical standards or labeling requirements that apply to devices,” the National Academies report said. By law, manufacturers can’t even label or advertise P.S.A.P.s as intended to help with hearing loss.

The lack of regulation may foster faster innovation — F.D.A. approvals take time — but also creates consumer chaos.

New digital features — some P.S.A.P.s use Bluetooth technology to customize devices, and some will actually test your hearing — are sprouting like dandelions. Yet you can spend $70 or $700 on a pair with no simple way to tell helpful products from the worse-than-useless.

“The current market is pretty much a free-for-all,” said Dr. Frank Lin, an otolaryngologist at the Johns Hopkins School of Medicine and a member of the National Academies committee.

“Some P.S.A.P. companies are very good, founded by former hearing aid executives and engineers,” Dr. Lin said. “The devices you see in Walmart for 40 bucks are terrible.”

Which P.S.A.P.s are the good ones? A Johns Hopkins audiologist, Nicholas Reed, has run electroacoustical tests on several devices marketed online, measuring their output or gain (translation: volume), frequency ranges and clarity, the three factors most important in helping people hear.

He has also tested them with users with mild to moderate hearing loss. (These devices won’t help people with severe hearing loss.)

Placing people in hearing booths with some background noise, he compared their hearing with various P.S.A.P.s to how well they could hear with no hearing device and with a midpriced $2,500 hearing aid.

Dr. Reed has tested just 29 participants so far, he cautioned, and real-world results will vary. Still, he and his colleagues were impressed with three P.S.A.P.s.

The Soundhawk, which operates with a smartphone, performed almost as well as the hearing aid, with a list price of $399. The CS50+, made by Soundworld Solutions, and the Bean T-Coil, from Etymotic, worked nearly as well and list for about $350.

The researchers also tested the MSA 30X, available at drugstores for $30, and found it actually increased distortion. “A pure waste of your money,” Dr. Reed said.

Dr. Lin’s research group is conducting two pilot studies that fit patients with P.S.A.P.s, and “we’re seeing very positive results,” he said.

Dr. Reed will present his findings at the International Hearing Aid Research Conference next month.

Ultimately, both the President’s Council and the National Academies committee recommend that regulators establish a new product category for these over-the-counter devices, sometimes called “hearables.” They’ve urged the F.D.A. to set specifications that ensure safety and effectiveness, and to require that devices meet certain manufacturing standards.

Then consumers can buy them with greater confidence, avoiding the “bundling” system, buttressed by state and federal laws, that makes hearing aids available only through audiologists.

(The exception: You can already buy some hearing aids online, but sometimes the only difference between them and the same devices marketed as P.S.A.P.s is their labeling.)

Industry groups have objected to changing the current setup. But the proposal resembles the way many consumers now buy eyeglasses: Get a prescription from an optician or ophthalmologist, then comparison-shop in stores or online for prices and styles.

Hearing devices require more customization and instruction than glasses. And while glasses can correct vision, no device fully restores normal hearing.

But while F.D.A.-approved hearing aids fitted by audiologists may remain the gold standard for treating hearing loss, P.S.A.P.s may have a place. “Let the consumer find the device online, and then let the audiologist charge an hourly rate to fit it,” Dr. Reed said.

Already, he added, “a lot of savvy people are doing this for themselves,” patching together systems that use over-the-counter electronics and audio equipment.

Richard Einhorn, a Manhattan composer, suddenly lost most of his hearing because of a virus in 2010. He owns high-end hearing aids, but like many users, still struggles in noisy environments like restaurants.

His solution: He removes his hearing aids and turns to his iPhone. “The iPhone has fantastic audio specifications, on par with some professional gear,” said Mr. Einhorn, 63, a board member of the Hearing Loss Association of America.

He relies on an F.D.A.-certified hearing app, the Jacoti ListenApp; a plug-in directional microphone (he uses the Shure Motiv MV88); and quality earphones. (Disclosure: He serves as a consultant for Jacoti.)

Thus equipped, “you can hear really well in situations where even a hearing aid doesn’t work so well,” Mr. Einhorn said.

You’d hope that Medicare would eventually reconsider its policy on covering hearing devices, a step the National Academies report also urged.

The aging of the population means many more Americans will confront age-related hearing loss, and researchers have shown that it contributes not only to social isolation, but to increased risks of falls, poor health and hospitalization, cognitive decline and dementia.

Yet treating hearing loss has been largely an all-or-nothing proposition. You pay an audiologist lots of money, or you blast your TV and ask friends to repeat themselves. A third option, F.D.A.-regulated P.S.A.P.s, might represent a simpler, cheaper solution.

“Do you have to put in a hearing device that’s 100 percent perfect?” Dr. Reed said. “Maybe 85 percent is enough to improve your life.”

Doonesbury — Wear this to remind yourself and others.

One bark on “Sunday Reading

  1. Hearing aids: if you really really need them, paying for the audiologist’s expensive ones are worth it. You don’t think twice about buying a new car or even a used one. $5,000 for hearing assistance that will allow you to hear the wren twittering outside or your partner speaking behind you will enhance your life more than a new set of wheels. As for hearing in a restaurant, my 5 year old Widex’s have a “comfort” ap that covers noise outside of close range so you can concentrate on what the person across the table is saying. There’s also a “phone” ap that, like the comfort one, turns on with the little switch on the microphone. There’s a subtlety to the performance of the doctor prescribed aids that are missing in the cheapies. Louder is necessarily better in all cases.

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