Beer face prophylaxis, part trois

Indian lamb saag with nan + beer. No pre-medication. Facial flushing, swelling, and mucous production within 30 minutes post-meal-start-time.

2009 Vogue Paris calendar

Here is the image that started this blog, originally found in Violet Blue. I mean, give me a freakin' break. This girl is nice-looking, but, in addition to any sociological issues, she is not even a sexy Sexy Nurse. How does Vogue magazine ruin sexy? The lingerie replacing the nurse's uniform undermines the fantasy of work-related shenanigans, and it isn't as aesthetically interesting as the iconic white dress (which is almost like a piece of fashion, as discussed in previous posts). Moreover, although she is posed in what I have called the Battleaxe-dominatrix theme, the photographer has completely failed to capture any malevolence--something else which the lingerie undermines--demonstrating a lack of understanding of this fetish.


Pathetic. It does, however, give us a chance to get acquainted with the reality of French nursing. Here's a real French nurse, Luc. He works in Africa:


Here's a real French nurse, Aude. Beautiful, and no high heels required, although she does apparenlty need a watch attached to her clothes:


And here's a real Quebecois nurse, Kathy, from French-speaking Quebec (btw, Montreal is the second-largest French-speaking city in the world, and, for as far north as it is, has its share of babes along with professionally-behaved nurses):

I must say, too, that if you do a Google image search for infirmière, you get a lot more photos and a lot more explicit photos, than if you do an English search.

There is more at The Sexy Nurse Report.

Beer face prophylaxis, part deux

I had Mexican food last night, again with beer (mostly to test my prophylactic concoction again). Another success!

After dinner, I logged in to my e-mail and discovered my 23andMe results were ready, and I spent most of the evening browsing through them. According to 23andMe, I have no facial flush from alcohol, and I am at high risk for Celiac disease. I have to look into these results more closely to find out if they have any plausible real connection to "beer face," but at least I think a good working hypothesis right now is that any flushing after drinking is more likely from a non-inebriation reaction.

Beer face prophylaxis

Last night, I may have solved my beer issue, which I like to call "beer face" or "beer head," i.e., flushing, swelling, muscous production, and congestion after drinking beer. (This lasts longer than the drunkenness and takes effect at beer doses below those required for me to get a "buzz.")

As John Durant at Hunter-Gatherer has noted in Beer and inflammation, some people react to beer drinking with less than desirable outcomes. Unlike Mr. Durant, I never drank beer in college because it used to give me intestinal cramping and diarrhea. I never connected this with wheat because I was eating a lot of bread, pizza, etc at the same time.

Then the family went on the Atkins Diet, and I basically haven't eaten bread since. Maybe once a week now, I will eat pizza or a breakfast item such as a "Dutch boy", but this is the extent of my bread intake.
When I do eat pizza, I like to have a beer with it because I don't drink Coke. Since doing Atkins years ago, I have not had so much of the cramping/gas with beer, but I have been experiencing the "beer face" described above.

Uppers and anti-inflammatories

So, last night we had pizza and beer, and I treated "beer face" prophylactically with over-the-counter medications. My OTC meds worked to prevent the flushing and congestion I get with beer nowadays. I have done this before as well, so I now have 3 successful outcomes, although only at an n=1 size.

The medications I used were
  • ASA (aka, aspirin)
  • ibuprofen (aka, Advil)
  • loratidine (aka, Claritin)
  • extended-release pseudeoephedrine (aka, 12-hour Sudafed)
This group constitutes two Non-Steroidal AntiInflammatory Drugs (NSAIDs), one antihistamine, and one sympathomimetic. Although Sudafed is often called an antihistamine in common parlance, it is not one and is more or less an upper like amphetamine. Sudafed works by constricting the blood vessels in your nasal passages, not by blocking H1 receptors, like Claritin.

Using this combo of OTC meds keeps my sinuses clear all night after a dinner with 1-2 beers.

Sexy nurse resuscitation: don't try it at home

Reflecting on the video I posted yesterday, it occurred to me that stripping in front of an unresponsive asystole patient may not be the right thing to do. Remember that sexual arousal is initiated by the pelvic splanchnic parasympathetic nervous system. You want to be pushing epi and working on the sympathetic system. So stripping is sort of working at cross purposes...
Cheers!

Coming back from the brink with sexy nurse

Two days ago, I posted a piece on the Sexy Nurse trope. Remember, my point was that the Sexy Nurse is not a stereotype, but an archetypal fantasy of male passivity. Here's a YouTube video that confirms my thesis, although on the surface it appears to do the opposite...



The plot of this commercial plays on the Angel-stereotype-accommodation-fantasy theme. The nurse is so selfless and altruistic that to bring her patient back from the brink of death she is willing to try anything, even stripping off her clothes.

However, in the end, we see that the patient is manipulating his bedside EKG monitor in order to entice the nurse into removing her clothes. This would seem to contradict my contention that in the Sexy Nurse fantasy, the patient is a passive sexual agent. I submit that there is no contradiction. Consider that this commercial is humorous. Without the plot twist at the end, it would simply be the start of an erotic fantasy, not a funny. The joke is that we identify with the patient and laugh at the ridiculousness of our mutual fantasy. After getting the nurse to strip, the patient re-takes a passive role, laying still and letting the nurse stroke his head. This is his fantasy, not taking advantage of the nurse. The commercial is, in fact, a confirmation of my thesis.

'A hard man is good to find': conceptual origins of the sexy nurse

For an explanation of this post, see The Sexy Nurse Report series.

Where does the sexy nurse stereotype come from, and, if it's wrong (it is), what is the typical nurse like?

In other posts, I've described the origin of The Sexy Nurse (that is, the portrayal of promiscuous nurses in short, white skirts, high heels, and little caps with bouffant hair, pouting lips, etc) as a psychological phenomenon: men who fantasize about a nurse who, essentially, provides sexual favors as part of a continuum of accommodation and caregiving for the man while he is laid up in a hospital bed. As a male who never had this fantasy, even before entertaining the notion of actually working in health care, it's hard for me to see it as anything than an expression of laziness. It is as though the fantasy for these men is that, finally, they have an excuse to lie in bed and be passive while receiving sexual gratification at the same time. Ugh.

However, this psychological explanation of The Sexy Nurse fantasy doesn't provide a conceptual explanation for its basis. Why do men fantasize about nurses in this particular way?


defining the Sexy Nurse fantasy

Let's be clear: there is a fantasy. If you troll through some Internet pr0n trying to figure out how men fantasize about nurses, you will find three main themes on which variations arise: (1) the accommodating nurse, (2) the dominatrix nurse, and (3) lesbian nurses. If you go the Kristen Archive of erotic stories (definitely NSFW... in fact, maybe also not safe for home in some states!) or the Fleshbot blog (NSFW) and look for narratives about nurses, these are the three themes you'll find*.

(1) The accommodating nurse: An accommodation fantasy is one in which a nurse's typical duties in providing comfort and care morph into sexual involvement with a male patient. The implication seems to be that any physical contact can turn into sexual intimacy. In Donna the Night Nurse, the author of this erotic story has cleverly created a fantasy within a fantasy. An injured man is laid up in the hospital and cannot perform Activities of Daily Living such as feeding himself. His nurse is not a stereotypical Sexy Nurse, but as he is laying in his bed, he does fantasize about her being nude except for a white nurse's cap. Later in real life, after bathing him, she finds him aroused and begins providing him with sexual favors:
As the weeks passed, I was healing nicely and thoroughly enjoying my hospital stay. Donna was giving me extra treatments almost every night and was surprising me with things like double chocolate cake and nights when she would slip into my bed after she had removed her uniform.
Two points that are important to note here are that the author describes his job on an oil rig, and the nurse takes the active role in initiating sexual contact. Although one should probably take authors' autobiographical comments in erotica with a grain of salt, it is still significant that the author identifies as a worker, someone who doesn't usually get to spend time in bed.

(2) The dominatrix nurse: Dominatrix might not quite be the correct term. Disturbingly, in these erotic stories, there are a number that contain outright rape of incapacitated patients. In visual pornography, rape seems to be replaced with BDSM (bondage/sado-masochism). And these fantasies seem usually to be lesbian in focus. In the film Nurse Alexis, one nurse ties another down with tape:

It's sterile, easy to use, and handy when you need a tourniquet in a flash. Or if you need some bondage in a flash. When you think about it, the nurse and the dominatrix can learn much from each other.

India Summer doesn't have anything to learn though—she knows all about bondage and control and power. She's just letting Emy Reyes use her. How else will Emy become a good nurse?
(3) The lesbian nurse: Lesbianism, or actually WSW, is a common male fantasy, likely to arise in any context. Home health nurses make an appearance in the story "A Burning Fever":
It was a nurse, but dressed like no nurse I had ever seen before. She wore a white nurse's uniform, but the skirt was very short, barely covering her thighs, and the neckline plunged down to the top of her breasts in a deep vee. She was extremely attractive - funny, it must have been the fever; I didn't normally think of other women as attractive...
What's missing? The common element in all these Sexy Nurse fantasies is the absence of either a proactive or dominant male patient*. In no accommodation fantasy does the patient rouse himself into taking advantage of the nurse or even initiating sex a la an old movie slap slap kiss, as in On the Waterfront...

The point is not that a male display of dominance would be a more "normal" sexual coupling but that in the context of sickness/disability and the nurse-patient relationship, "normal" male wooing is not plausible, leaving a display of dominance as the only avenue for a fantasy involving a proactive male partner. And yet, these are not the fantasies that men have. In fact, the incompatibility of The Sexy Nurse fantasy and the dominant male is even made explicit in one erotic story that begins
I have since recovered from my earlier submissiveness and, in fact, assumed the opposite role to some extent. But I have never forgotten my earlier years and the education I received from... Nurse Adrian.
Needless to say, a male patient does not take a dominant role in the dominatrix or lesbian fantasies either.


the Sexy Nurse: stereotype vs. fantasy

I note that The Sexy Nurse is usually considered a stereotype. The Center for Nursing Advocacy called it "an enduring stereotype of workplace sexual availability that contributes to the global nursing crisis." This statement is made in response to a Dentyne Ice gum commercial that shows a nurse becoming attracted to a patient when he starts chewing Dentyne. Hmmm. Far be it from me to disadvocate (is that a word?) for nurses, but this might be overstatement. I seriously doubt that many women are disuaded from entering nursing because of an advertisement for Dentyne gum that shows nurses as sex symbols. (Is our lack of community fashion shows due to the negative impression women have of runway models?) The idea that nursing is competing for labor with medicine, academia, etc, is rather naive. And frankly, the women who are going to be turned off by being objectified are either religious in outlook or career- and status-driven overachievers who aren't going to consider nursing anyhow.

And anyhow, what about this stereotype business? As anyone who actually works in the hospital will tell you, there are in fact male patients who will cop a feel as well as cads who will actually ask for sexual favors. What are we to make of these men? Are they blank slates who have been brainwashed by media imagery into believing that female health care workers are in the habit of jacking off male patients? Or are they simply the same boors and cads who would be engaging in grab ass in a local pub? I am inclined to think the latter, because... now pay very close attention to what's next...

We have already examined the Sexy Nurse fantasies of men as presented in erotica and found that the thing that ties them together seems to be the active role of the Sexy Nurse and the passive role of the male patient in initiating and carrying out sexual contact. Therefore, a male patient who steals a kiss, grabs ass, or requests a handjob from female staff (all things that have happened while I've been working) is NOT acting out on a Sexy Nurse fantasy! He is simply a middle-aged cad who meets a pretty young woman who is treating him nicely. He would probably grab ass or make comments to a waitress who was very attentive to him as well. This is not a problem of media creating stereotypes out of male fantasies.


belief vs. desire

I would like to distinguish between stereotypes and archetypal fantasies. A stereotype is a predisposition--a belief--about a category of people. A fantasy is an expression or narrative of sexual desire. And from Jung, we have the idea of archetypes, or "instinctive trends" that help to provide meaning. The relationship between these terms is difficult to define, I think.

To say that (heterosexual) women desire sex with men is a stereotype. It is a stereotype that is probably held by a very large percentage of the population, and it is probably accurate when applied to a very large percentage of (heterosexual) women.

Nobody is really bothered by this stereotype about women because it is held by and applicable to large enough percentages of the population that it simply exists in people's minds as an assumption about life, a truth. But it is in fact a stereotype. This is important to recognize. People go through life using stereotypes to tell them how things and people should or will act. Nobody questions stereotypes when they have large enough universal applicability.

That women desire sex with men with large penises is also a stereotype. It is probably held by a large, but smaller, percentage of the population, and is probably accurate when applied to a large, but smaller, percentage of women.

That women desire sex with black men with enormous penises is also a stereotype. It is probably held by a somewhat smaller percentage of the population, and is probably accurate when applied to a somewhat smaller percentage of women.

Somewhere between "women desire men" and "women desire well-hung black men" a truth that anyone can say in public elides into a pejorative "stereotype" that will at the least make people uneasy if you say it. This exact point of ellision is controlled in large part by the surface areas of the circles that describe this Venn diagram--"women", "women who desire men", and "women who desire well-hung black men". The exact calculation I wouldn't know how to make.

If one looks at the content of erotic fantasies, as represented in a site such as the Kristen Archives or EroticStories.com, it is clear that while people spin their own personalized fantasies of sex, fantasies also trend toward certain themes--eg, differences in age, adultery, multiple partners, etc. Whether these themes are themselves archetypal or in fact represent a variegation of detail on yet deeper sexual archetypes** I don't know. And it doesn't matter. For the purpose of this essay, it need only be recognized that there are archetypal erotic fantasies.

The relationship of stereotypes to archetypal fantasies, I do not know, but there must be one. For people who believed that women had an instinctive aversion to black men and no preference in penis size, the very large number of erotic stories and pr0n films depicting interracial sex would seem not only non-erotic, but ludicrous.

Is the opposite true? Do men who are aroused by interracial erotica necessarily have a stereotype that women desire well-hung black men? I'm not sure, but it seems very likely to me. Of course, as with all things psychological, the specifics are very murky. Perhaps a man who likes interracial erotica stereotypes women as cheaters, or stereotypes women as prefering large penises, or stereotypes women as prefering dominant personalities, or perhaps all three. But these stereotypes do not have equal claim to believability. The stereotype that women are born cheaters is much harder to hold in the face of lived facts than a stereotype that women prefer dominant men. Both may, in fact, have equal truth value, but they are not equally as observable.

This is far from the final word on stereotypes and fantasy. Consider that two men might both believe women are born cheaters while one eats up cuckolding erotica and the other gets sick to his stomach whenever his wife leaves the house. A fantasy is not simply a re-telling of a stereotype, it is an integration of stereotypes that provides meaning, meaning in this case being erotic salience.

So how does my Blacks-on-Blondes commentary relate to the Dentyne Ice commercial?

I think it should by now be obvious that The Sexy Nurse is not a stereotype, although she may be a fantasy. In the face of lived facts--trips to the hospital, TV shows, meeting neighbors, etc--it would be too difficult for anyone to actually believe that The Sexy Nurse was characteristic of today's nursing profession. And the Dentyne Ice commercial confirms this:
The 30-second spot shows two male patients in beds in a semi-private hospital room. One is a young hottie with a long leg cast, the other an overweight elderly gentleman. Hottie grins mischievously and presses call the button. Then he hobbles to a rolling table across the room, picks up a package of Dentyne Ice, puts one in his mouth, and hobbles back to bed, groaning.

An attractive young female nurse enters, wearing a short-sleeved white nursing dress. We can't see the dress length, but the neckline is unzipped to reveal some cleavage. The nurse asks, casually: "Did you call?" The patient responds smugly, knowing he's about to score: "Hi...I'm Derek." The nurse sits on his bed and moves very close, staring at him with obvious erotic intent: "Tanya...hi." The two are about to kiss when they remember the other patient and look over. The elderly man looks at them expectantly. The nurse quickly draws the blue curtain to separate the two halves of the room.

So the elderly man puts a piece of Dentyne Ice in his mouth. Instantly a second female nurse of roughly his age and comparable physical attributes appears. She smiles and says "Hi!" and she seems about to sit on his bed. The spot cuts to the closing image of the product package, with the tag line delivered by a young woman in voice over: "Dentyne...Get Fresh."

The joke is on us, the viewer! As we get sucked into the fantasy, some of our stereotypes such as nurses as young women and young people as sexually adventursome come into play and are suddenly overturned by the appearance of an older woman. Furthermore, our desire and our suspension of disbelief that makes fantasy possible is revealed to us when we reject interest in the older woman dressing in the same counter-factual Sexy Nurse clothing with plunging neckline.

However, although the Sexy Nurse fantasy may not be a stereotype, it may be based on other stereotypes that are harder to contradict based on people's lived experience.


nurse stereotypes; sexy nurse stereotypes

Wikipedia has a list of nurse stereotypes:
* 1.1 Angel
* 1.2 Battleaxe
* 1.3 Handmaiden
* 1.4 Homosexual male
* 1.5 Matron
* 1.6 Nymphomaniac
* 1.7 People who weren't accepted to medical school
Some of these don't apply to The Sexy Nurse. The gay male may be a stereotype of male nurses, but it doesn't apply to stereotyping female nurses. People who weren't accepted to medical school doesn't apply (and I don't believe this is a widespread stereotype of nurses, either).

Of the remainder--Angel, Battleaxe, Handmaiden, Matron, Nymphomaniac--I see all as having differing relationships to The Sexy Nurse and to each other. For example, one could conceptualize them all as different manifestations of the Virgin-whore dichotomy, inhabiting different poles in the characteristics of compassion and sexuality (two characteristics themselves seen as mutually exclusive aspects of personality), as shown in the following diagram:
However, I don't think this diagram in fact captures the relationships accurately.

The Nymphomaniac stereotype essentially is equal to The Sexy Nurse, and as I stated above, I don't believe it is a true stereotype of nurses. The sociologically-minded may insist on pointing out that in "the old days" nurses were culled from the ranks of prostitutes, and this could be the origin of a stereotype of nurses as whores. However, this knowledge is confined today to the very few people who know anything about the history of nursing. Most people today make no association between health care professionals and sex workers.

Keep in mind that we are referring here to public perceptions, and not the medical diagnosis "nymphomania", which dates to the Victorian era but has been removed from the Psychological Association's DSM-IV. As related in Nymphomania: A History, (see page 139) there was a large up-swing in the public's recognition of "nymphomaniacs" during the 1960s and 1970s as public obscenity laws allowed the publication of erotica and pornography. But today, how many women do you know who are referred to as nymphos? I have heard of one. This meme of female sexuality has died out. Even during the height of its popularity, the idea of nymphomaniac nurses was more an excuse to put T&A on paper than an expression of the Sexy Nurse fantasy themes we have explored above. For example, here is a reader review of the book Nympho Nurses, published in 1969:
The female lead, Virginia, is a secretary for a Freudian psychotherapist, and nowhere near a nurse, nor a nympho but simply a sexually liberated 23-year-old woman in the 1960s. Some bright editor... sure was paying attention here. “She works for a doctor — she must be a nurse!”
No, the nymphomaniac meme is dead, and the nympho nurse stereotype, if it ever existed, is dead, too.

So if we remove nymphomaniac, we are left with Angel, Battleaxe, Handmaiden, and Matron. Of these, I believe the "Matron" may or may not have been a stereotype, but if it was, it was tied to historical conditions that have passed--namely, the days when nurses were trained on the job in certificate programs, when nurses lived in dormities as single women, when nurses had to wear closely defined uniforms, etc. I cannot recognize the Matron as a stereotype today.

It is my contention that the Sexy Nurse is an archetypal fantasy that relies on integrating the remaining three stereotypes--Angel, Battleaxe, and Handmaiden--which I see as true, ongoing stereotypes of nurses held by the public and presented in the media. As such, the proper way to conceive of the relationships is shown in the following diagram:Note that there is no stereotype for the lesbian nurse fantasy. As I mentioned above, for men, fantasizing about WSW is widespread and not confined to any other genre or theme of erotica. Men do not require any stereotype about nurses to fantasize about WSW nurses (although I note that often the dominatrix and lesbian fantasy themes are mixed in Sexy Nurse fantasies). If we were investigating the Sexy Cab Driver, then there would be lesbian cab driver fantasies; if the Sexy Chef, then lesbian culinary erotica; etc.

I have already given examples above of the types of fantasy connected with each theme. Let me simply re-inforce the reasonableness of the Angel-accommodation and Battleaxe-dominatrix couplings by pulling two images of Sexy Nurses off the web that demonstrate both:In this image, the Sexy Nurse's dialogue balloon "does this help?" captures the quintessence of both the altruistic Angel stereotype and the sexual accommodation seduction fantasy.In this image, the Sexy Nurse brandishes a syringe and needle--symbol of the sadistic Battleaxe stereotype--implying the upcoming painful IM shot that the nurse will administer regardless of the patient's protestations. Coming from a nurse dressed like this one, we can expect the shot will be followed by a spanking, also regardless of the patient's protestations.

As for the Handmaiden-doctor seduction coupling, see the footnote below.


the Sexy Nurse personality: are nurses really whores?

Working in the hospital with nurses was the first time I heard the joke phrase "a hard man is good to find". This play on words drew uproarious laughter from the nurses present at the nurses' station when it was uttered. An observer might draw unwanted conclusions from this little scene, though, as it would seem to confirm all the Sexy Nurse nymphomaniac fantasies that men have of nurses' reactions to male genitalia. Is it possible that nurses really are whores?

No, but you might be forgiven for thinking otherwise. In addition to noticing whether patients are fit or fat and what their personal hygiene is like, nurses pick up on unmentionables and sometimes share them***. I have heard nurses both criticizing and singing the praises of male patients' genitalia. I have heard them spreading the news when a well-muscled fellow is admitted. I have seen middle-aged nurses vying over patient assignments when a handsome 20-something is in one of the unit beds.
Frankly, doctors are not like this. They go to school for 4 years to learn how to see human physiology as a giant BioChem equation. Then they go to school for another 4 years to learn how to objectify and compartmentalize the body and dissociate their emotions from their analytic tasks. Then they're beat down in residency with overwork and lack of rest. I've never heard a doctor make a non-medical comment about a patient unless it was about their personality.

Nurses often enter the hospital world of naked bodies as 20 year olds with only 2-3 years of school. Nursing instructors are still dispensing advice to students on what to do if a patient gets an erection, and nursing schools are still graduating nurses whose primary exposure to and physical contact with men has been with patients. Nurses usually have little interest in physiology beyond what they need to know to do their jobs, and they really do see the patients as whole persons more than the medical profession. It would be a surprise if nurses were able to put aside whole categories of emotional reactions as easily as doctors.

If you doubt what I'm saying, just re-read the above description of the Dentyne Ice commercial released by the Center for Nursing Advocacy. The author of this press release has described the younger male patient as a "hottie." This is not the character's name or role, it is the author's impression and description of the commercial, and it's been released by the Center as a critique of media portrayals of sexualized nurse-patient relations!

But the fact that nurses are also women doesn't mean nurses are a bed bath away from groping their patients any more than a police officer is a pat-down away from groping an arrest. The very conditions under which this professional work takes place strips it of erotic energy for the professional. Moreover, what I'm describing is inside information, not accessible to the public and, therefore, cannot be the conceptual basis on which the Sexy Nurse fantasy is built.

One place the public has contact with nurses is personal life. Perhaps the psychology of the Sexy Nurse fantasy is built on concepts developed from people befriending and dating nurses? Are they real tigers outside the hospital? Not in my experience. Although I have found nurses sometimes self-identify as "hard-working, hard-partying" (more widespread in emergency and critical care nurses), this is not really the case. The nurse as hard-drinking independent girl exists alongside the tortured alcoholic artist, the musician who takes shots between sets at his gig, the policeman who drops into the pub for a cold one after his shift, and the journalist/novelist who keeps a shot-glass and bottle of whiskey next to his typewriter. And of course we are familiar with the martini-drinking army surgeons of M*A*S*H. These are all stories that stressed-out professionals tell about themselves when their jobs start to take over their lives. It doesn't mean that they're really any more vice-prone, licentious, or fast-living than anyone else.

I think the real conceptual basis on which the psychology of the Sexy Nurse rests is the difference in physical contact that occurs inside and outside the hospital. The difference between how I interact physically with a stranger in the health care system and a stranger in the supermarket are qualitatively different. When you're inside the health care system, this is obvious and normal to you.

A man learns, I think, that if he goes to a bar and a woman is interested in him, she pays attention and may touch him. A woman who interacts with a man by touching or hanging onto his arm or shoulder in a bar is sending a signal. If she isn't making a pass at him, she is at least sending a signal that he holds some interest for her.

Anyone in health care understands that when a nurse touches a man on the arm, shoulder, or anywhere, it sends no such signal. Most people outside the health care system understand this as well. However, it is very possible that not everyone does. In fact, for a man who has been conditioned to associate touch with intimacy of some degree, it may be nigh on impossible not to get signals crossed.

In my opinion, the conceptual origins of the Sexy Nurse are to be found in the fact that nurses touch men and do not exhibit shame or revulsion. Outside the health care system, this characteristic would be interpreted as an invitation to some degree of intimacy, even if only increased conversation. It is true that nurses and health care are different. It is difficult to work in health care and be embarassed about aspects of human life. This is a fact that any nursing instructor may be heard to say to nursing students, and it is very true. An inside nursing joke that "a hard man is good to find" does not represent the fact that nurses are whores, but it does represent the fact that nurses have reduced shame in the face of the realities of human life. It is this reduced shame, and the experience of it by patients, that leads to fantasies about the possible outcomes of touch and physical closeness that arise between nurses and patients.

conclusion: why a bloke's against a bloke


So basically I've concluded that rather than a real nursing stereotype, the Sexy Nurse is a foolish fantasy that is based on misperceptions on the part of non-health-care-workers, especially men, about the relationship between physical contact, shame, and sexual and emotional intimacy between nurses and patients.

There are multiple objections that can be made to the presentation of the Sexy Nurse in media. There is an argument that it is bad for patients and health care workers. But mostly, I think, women find it unnerving to think that men sexualize them in the course of health care. Frankly, I do as well.

All women need to be aware that men can and will sexualize almost anything. This has entered pop culture lingo as "Rule 36," and it is true. This may bother women, but it doesn't bother me in principle. This is what men are and how Nature in its Providence provides for babies. However, as a man, I am disturbed that men would sexualize their own sickness.

Sickness is not a man's strong suit, mating-wise. Although the occasional patient may be attractive to the occasional nurse, in general, a man who can't even sit up by himself because he's had his chest cracked open and sewn shut again doesn't hold much appeal. Working with nurses, I can confirm that a hospital unit is full of things that seem to need a stroke, smack, jiggle, or grind. But as a patient, I would be embarassed to notice this, as my condition would put me in a rather bad position. When men can't recognize this and instead fantasize--as in the Donna the Night Nurse fantasy above--being brought chocolate cake and handjobs, I find myself calling into question their masculinity.


footnotes

* fantasy footnote: It should be noted that there is a fourth theme that provides an exception to the rule that the Sexy Nurse fantasy relies on a fantasy of submissive, or at least passive, male sexual role. The fourth theme is doctor seduction. Doctor seduction may occur when a doctor seduces a nurse but is more akin to the true Sexy Nurse fantasy when a nurse seduces a doctor. However, in both these instances, the fantasy power dynamic is changed as a seduced doctor is desired by the nurse for reasons of status and not as an extension of her caregiving role. For example, this book Naked Nurse, whose cover blurb says "she admired his skill in surgery; and his lust in bed."
I'm fairly sure Naked Nurse was aimed at male audiences and not at women. However, the doctor seduction theme is relatively absent from erotica aimed at men. I assume this is because most men would have difficulty empathizing with the doctor role. In fact, as a doctor is a high-status role out of the reach of most men, I suspect doctor seduction is actually a turn-off for most men. It is notable that most of the doctor seduction erotica is actually romance work aimed at women. For example, Nurse Fairchild's Decision seems to be on the same surgery handmaiden theme as Naked Nurse, but obviously a different emphasis with the blurb "She had won her place in a big New York hospital, but would her passionate young heart betray her?":
Cover Girl Nurse, "Was she really a dedicated nurse, or still just a glamour girl?":
Nurse With A Dream, "After Nurse Kyria's adventure with a society playboy, could she go back to her smalltown hospital and the doctor who loved her?"
More doctor seduction theme Sexy Nurse erotica at Vintage Nurse Romance Novels blog. I need hardly point out that these trashy novellas are aimed at young women who might be considering careers in nursing, or women who fantasize about a nursing career. If nursing advocates want to dispell the notion that nurses are unserious goldiggers looking for doctor husbands, they need to look in their own backyards first and criticize women who actually fantasize about meeting high-status men...

** archetype footnote: I wonder whether, for example, pedophilia is a perverse archetype of sexual desire or whether it might be a dysfunctional variegation of another sexual archetype such as seduction or initiation.

*** taking a peak footnote: To be fair, the nurses in my current unit, the ICU, are much more serious and less gossipy than what I ran into on other units.

Dubbonet and gin

Previously, I posted on my love of gin. It's not really kosher low-carb/Paleo, but it's history and heaven in a bottle. The other day, I bought a bottle of Dubonnet. Not very enjoyable, but then I noted that the late Queen Mother's favorite drink was Dubonnet and gin. Aha!

I won't buy another bottle of Dubonnet, I think, but spending an afternoon drinking with gin and browsing the web wasn't a total loss.

Wolfgang Lutz, RIP

Peter of Hyperlipid points us to the fact that Dr. Wolfgang Lutz passed away. His book Life without Bread is available from Amazon. I'm not really familiar Dr. Lutz, but I'm always impressed with the pre-WWII Germans. One of the more diabolical aspects of National Socialism was discrediting the beautiful culture German intellectuals had developed. As Scott Locklin has argued, the modern age with its fetishes for technological gadgets have nothing on the scientific progress of an earlier age.

Tsunami fallout: elderly deaths & radiation panic

The fallout from the Japanese tsunami continues. My mother informed me today that health care workers had abandoned their patients in a nursing home, and 14 elderly Japanese had died. Her tone suggested that somehow I bore some responsibility for the deaths. Of course I don't. Do the Japanese even?
There's no doubt that the tsunami is causing problems for patients and elderly people. Lack of power and supplies in the middle of winter puts patients at risk of death from hypothermia, starvation, and other causes. Unfortunately, supplies are something health care workers cannot create out of thin air. In the context of possible radiation poisoning, what are hospital and nursing home workers accomplishing by staying in harm's way?

In emergency services, it is well understood that protection of the EMTs is a prerequisite for care. Failure to put on gloves will fail you in an EMT practical exam, as will failing to secure a scene and wait for police intervention when appropriate. The rationale is clear and understandable: for a HCW to put himself in harm's way potentially creates more patients while simultaneously removing the only possibility for assistance. Similar logic would guide doctors and nurses in an emergency. In winter, without power, does it make sense for HCW to risk hypothermia when they can't actually provide heat and food to the patients anyhow? No. And when there is a radiation leak, should HCW stay at the patient bedside when they can't provide care anyhow?

The story of the 128 elderly patients found and the 14 deaths seems to have originated with irresponsible Japan-based journalist Ben Doherty. His report, which was picked up by mutliple media outlets like the Sydney Morning Herald and Slate e-zine, says that Japanese military forces found abandoned patients, as though the hospital staff had slunk off in secret without telling anyone.

As actual Japanese journalists of the Mainichi Daily News report, the military was scheduled to meet the caregivers of the 128 patients but never showed up. They then left to seek shelter from the radiation. They planned to go back, but the government ordered everyone to stay inside. In the US, this would seem like an excuse, but as Doherty himself reports, Japanese have died in collapsing buildings because they were told to stay put, such is the propensity to follow orders in Japan.

In more positive news, over 100 elderly home residents were saved when a home in Yokohama sent buses to pick them up.

Arthur Caplan, a bioethicist, addresses the question of what to do about patients during an emergency by comparing the tsunami to Hurricane Katrina. Apparently, a number of patients who were found dead around New Orleans had massive amounts of morphine and Versed in their systems, raising the question of how to leave patients.

The Derb on the plume

The other major health story to come out of the tsunami so far is the radiation plume from the Fukushima nuclear plants that is traveling toward the west coast and California. Blogger Skepchick has a series on the power plant composed of interviews with her father, a nuclear engineer. I haven't actually read the story, but she has a cool retro photo of her with her father, so I'm taking the opportunity to post it:Whatever the nuclear engineer has to say, infamous political commentator John Derbyshire gives us a healthy dose of reality on this week's RadioDerb. Here's a selection from the transcript:
I guess it's not surprising that reaction to Japan's nuclear plant crisis has been hysterical. Tokyo will have to be evacuated! A great plume of radioactive dust is crossing the Pacific! Flee! Flee! Take to the hills! America's stock of iodine pills has sold out. Makers of hazmat suits are doing brisk business. Is this the end of the world? No, but a lot of people think they can see it from here.

For crying out loud. The worst case scenario anyone has so far been able to come up with from Fukushima is that there will be a melt-down at one or more of the reactors, destroying the containment vessel. That, remember, is the total worst case, which can likely be averted.

What happens then? Well, a plume of radioactive steam and smoke goes up around 1500 feet into the air for the few hours, at worst days, it takes to control the fire. Is that bad? It's way bad, but only for the immediate neighborhood — max twenty miles in whichever direction the wind's blowing. You wouldn't want to be eating any lettuce grown under that 20 mile plume. Tokyo? Ah, that's 150 miles away. Los Angeles? Five and a half thousand.

Even that may be overstating things. At Chernobyl, a far worse situation, the fire burned not for hours but for months. The debris went not 1500 feet into the air, but thirty thousand feet. Even so, there is no evidence that anyone more than twenty miles away came to any harm, other than by eating contaminated food, which was a dumb thing to do.

Here's a pop quiz: What was the death toll from Chernobyl — a far worse disaster than anything we can expect at Fukushima, remember? Well, 31 died when the thing blew. A hundred and thirty-four people got injurious doses of radiation, and some of those people have died in the quarter-century since, though many from causes not related to radiation. Wikipedia lists 60 known deaths from the explosion and radiation overdoses. However, UNSCEAR — that's the United Nations Scientific Committee of the Effects of Atomic Radiation — gives the number as 57. Estimates of the number who may eventually die from cancers triggered by lower radiation doses are all over the place. UNSCEAR claimed four thousand cases of thyroid cancer up to 2002, but this number is widely disputed, and thyroid cancer is anyway preventable with iodine supplements. Even if you get thyroid cancer it's highly treatable, with 5-year survival rates 85 percent for females and 74 percent for males. And again, the peril there was from contaminated food and water, which people ought to have been prevented from ingesting.

So if you're having nightmares about Los Anglenos glowing in the dark, forget it. The last estimate I've seen for deaths from the earthquake and tsunami was nudging 15,000, and that will probably go higher. Chernobyl, a far worse disaster than Fukushima, most likely killed less than five percent of that number, perhaps less than two percent. Japan has suffered a terrible catastrophe, but Fukushima is merely a footnote. So please, calm down and stop screaming. Last year 269 people were killed in traffic accidents on the streets of New York City. It's unlikely in the extreme that Fukushima will kill that many Japanese. It's an order of magnitude more unlikely that it will cause even a single American to lose a day off work. Calm down for goodness' sake.

The smoking auscultation game

Over at In Mala Fide, there is an unhelpful article on the "benefits" of smoking. This put in mind of a game I used to play with myself when working on the Progressive Care Unit.

When meeting a new patient for the first time, I would auscultate the lungs, then guess whether the person was a smoker or non-smoker. I would then ask them if they smoked to find out whether I could guess from lung sounds about smoking status.

This game doesn't work in ICU due to ventilators, etc. However, in the year I worked on PCU, I had an almost 100% track record in being able to guess correctly when someone was a smoker. I had only one false negative (guessed a smoker was a non-smoker) and one false positive (guessed a non-smoker was a smoker) the whole year.

Smokers have what I can only describe as a "dulling" of all sounds in all lobes of the lungs. I mark this as "diminished sounds" on the physical assessment form, but it is different from the diminished sounds due to shallow breathing, positioning, or body mass.

The thing I found most interesting about this game is that I could guess who were smokers even when the patients had stopped smoking years beforehand. Except in one case, every time I guessed a patient was a smoker but they told me they weren't, I would ask, "oh, but did you used to smoke?" Invariabely, they would drop their shoulders and tell me yes, but they quit 5, 10, 30 years ago. Literally, I was on one occasion able to correctly identify a smoker 30 years after they quit!

smoking from a nurse's perspective

One thing that bothers me about both anti-smoking campaigns and "pro-smoker" activitists is the focus on lung cancer. One thing that is readily apparent to nurses is that smoking has much broader effects on the body than simply being a risk factor for lung cancer. In fact, I would suggest that, in terms of overall quality of life for large numbers of people, lung cancer is one of the lesser problems of smoking.

The first thing that becomes apparent to health care workers about smokers is skin quality. Although I think everyone who knows smokers recognizes that smokers get craggley, grey skin as they age, most people think of this as only an aesthetic problem. But when your livelihood involves working with people's skin as nurses do, you start to understand that craggley grey skin means sick skin. Remember, the skin is not just the outside of the body, it is a living organ with biological functions, and when it gets tough or discolored, this means it is not healthy.

Another thing noticeable to health care workers is the poor quality of smokers' veins. You have to remember that the inside of arteries and veins are a layer of cells, just as skin is a layer of cells. If the outside looks craggley and grey, the inside is equally diseased. Most people can't see the inside of their veins, but nurses can see them indirectly by virtue of putting in IV lines. As any nurse will tell you, a long-time smoker will have small and brittle veins.

The third thing is overall energy levels and activity. Sometimes active older patients will come into the hospital with cardiac arrhythmias, etc. But I have never met an active older smoker. It could be coincidence in the sense that active smokers are less likely to be admitted, but my experience tells me that smokers become much less active as they age than do non-smokers.

Although my experience of working in a PCU/cardiac care did nothing to change my mind about the correctness of Atkins/low carb/paleo eating, I did have to concede that the health nazis are pretty much correct about smoking. I say that as an intermittent cigar and pipe smoker, too.

Fashion, uniforms, and sexy nurses

Fashion label Louis Vuitton had a show not too long in the past that showcased a new line of leather handbags. The image of the white-clad nurse was used to set off the cases. Since there hasn't been a revival of anything fashionwise related to the nursing uniform, I can only imagine that the point was to draw attention to the bags' similarity to old-fashioned medical bags and, in drawing attention itself, to dispell any criticism of the bags as boringly derivative of the old medical bags. No doubt fashion insiders would have different explanations.As I mentioned on a previous post of The Sexy Nurse Report series, the white-clad nursing uniform that is ubiquitous in Sexy Nurse imagery remains so because it has social and aesthetic cache. While it's true that presenting nurse imagery of this uniform promotes misguided thinking about the nursing profession, it has remained for reasons other than a desire on the part of the public to think of nurses as "handmaidens" to doctors, etc. It is a powerful visual image in its own right.

Why it should be a powerful image, I am not entirely certain. How did any fashion arise in any time? Fashion is in conversation with its own history at all times but must also give a nod to the aesthetics of the human body as well as functionality and other considerations. As can be seen from the following fashion photo, the white nursing uniform in broad outline is a modern white dress that is still favored today.
history of the (white) nursing uniform

I don't want to write a lot about the history of the nursing uniform. This is information that is pretty much available to anyone with access to an academic library or the Internet. If you are looking for a good starting point for research, try the dyk2 site and its mirror. These both have lots of photos.

For my purpose, we only need to recognize that in the history of nursing, the white nursing uniform is not a standard. Herewith, a few historical images to make my point. First some period medieval and rennaisance imagery of nurses.

In the WWI era, uniforms tended to be long, cover a lot, and trend toward greys and subdued colors.
Common in this era was the very unsexy and unfashionable apron.
And with this apron, I think we have the origin of the modern image of the white nurse uniform. It is not, as you might imagine, that the white apron turned into a white uniform. Quite the opposite. It is the unfashionableness and lack of visual power in this apron that led to the downfall of this style of uniform. The connection is that WWI saw the nurse used in a national mobilization campaign to support the war effort. Take a look at advertisements from this period.

As you can see, advertising images from this period had very little to do with the reality of nursing uniforms like the ones shown in the photos above. The idealized, all-white uniform is simply a powerful visual image created, or at least enlarged and perfected, by advertisements and propaganda of this era.

However, as life imitates art, the images created by artists and advertisements for WWI became the reality of nursing uniforms by WWII.
Perhaps it was the widespread use of black-and-white photography and an increased consumption of magazines and media during the post-war era. Whatever the case, from this famous kiss to today, the white dress, stockings, and white cap have been considered the quintessential nursing uniform. The white uniform became "what a nurse wears" in the public imagination. This despite the fact that, as the following photo from the 1960s shows, real nurses continued to dress in a variety of ways.
white uniforms in the sexual revolution

As I mentioned in a previous post, the sexual revolution that started in the 1960s resulted in part in a breakdown of the censorship of sex in literature and, eventually, in pop culture, resulting in the free Internet pr0n available to all today. I documented some of the changes brought about by these new standards in my post Sinners in White.

But the changes in censorship did not apply to only books and the printed page. There was a rash of low quality films from this period that highlighted previously forbidden violence and sex. The term "grindhouse films" describes some of this phenomenon, as do the terms "sexploitation" and "blaxploitation," referencing films made on a low budget and meant to attract viewers purely by exploiting prurient interests or the desire of African-American viewers to see their own race and racial themes presented on screen.As any man will tell you, the male sexual psyche is an abundance of creative energy. Women in all sorts of roles became sexual characters as well as nurses. (This is in complete conformity with Rule 34, which is a truism of modern media and the male mind.)

As we have seen, the white nursing uniform we identify as a Sexy Nurse Uniform was thought of by the public at this time simply as "how nurses dress." So, it should come as no surprise if sexploitation and the public's perception of nursing resulted in the presentation on film of nurses in sexual situations wearing the stereotyped white uniform. And this is just what we got. For example, the 1970s film The Sensuous Nurse.
Midnight Blue was a sexploitation TV show that started in the 1970s and ran til 2002.

There was even a series of films with Charlie's Angels style Sexy Nurses that ran in the 1970s, starting with Night Call Nurses.



To be fair, films did recognize in a limited degree that nures wore other uniforms. As you can see from this foreign pr0n film, Sexy Nurses can dress in blue as well:Of course, sexploitation is only one step away from pornography. And we did start to get that as well. Note that in these ealier pornography films, as in Nurses Report above, the plots stay closer to a hospital-based script. This indicates to me that the Sexy Nurse, at this early point in time, was still essentially a fantasy that existed only in men's heads and in the seamy outlets like the occasional adult theatre where these fantasies could be played out. The Sexy Nurse as a nationally recognizable trope or image had not yet entered the general culture.


Later in the development of pr0n, the Sexy Nurse became less a fantasy tied to the real world and more a stock character. The plots, likewise, began to stray more from a recognizable hospital script:
In the present day, the Sexy Nurse is a full stock character, but at the same time, real nurses uniforms have less connection to the Sexy Nurse image. As a result, current pr0n films have taken to modifying the uniform with large medical crosses and red trim indicating the Red Cross color scheme so many identify with health care. These new Sexy Nurse portrayals can be downloaded all over the Internet.
And as others have pointed out or document regularly, pornography is now a part of our general culture. So, as you would expect, the current image of the Sexy Nurse in white (with red trim) uniform has become ubiquitous. As with the WWI artists creating the image of the nurse uniform that became a reality in following decades, life again imitates art, and imagery like that above can be seen in public. Celebrities are into it.
And if you want to dress up for Halloween, the Sexy Nurse is one of your best options, even at the last minute. In fact, if you do a Google search for nurse Halloween costumes, just see what you get.
conclusion

So here's a summary of my story about the white nurses uniform and the imagery of the Sexy Nurse.
  1. Before WWI, nurses wore aprons and other unsexy wear.
  2. During WWI, artists and advertisers got the war campaign bandwagon and started promoting images of the nurse all in white, a powerful visual image that worked well on posters and in advertisements.
  3. During WWII, the white nurses uniform previously promoted on posters became more of a widespread reality.
  4. With famous images like the V-J Day photograph of the sailor and nurse kissing, the white nurses uniform entered the public mind as the reality of "what a nurse looked like."
  5. The sexual revolution ended most censorship in the US and Europe. The result was the portrayal of nurses as sexual characters.
  6. Based on #4 and #5 above, it was only natural that sexualized images of nurses would portray them in the white uniform.
  7. As time has progressed, the Sexy Nurse in the white nursing uniform has become a stock character of pornography, while the real world of health care has moved away from the white nursing uniform, resulting in a severing of Sexy Nurse imagery from hospital- and health-care-based scripts.
  8. Pornography is now an accepted part of our culture and available generally. As a result, the image of the Sexy Nurse portrayed in pr0n has become the standard in the public mind, most visible in lame Halloween costumes.

So, to bring it back around to Louis Vuitton now, I think it is most likely that, although Vuitton's mankiller bags were modeled in nursing uniforms more similar to the real uniforms of the 1940s-1970s than to the fantasy uniforms of current pr0n, it is pornography that is responsible for the continuation of the public association of nursing with the white uniform.

Japan, 'kongo', and the earthquake

Author Robert Twigger has an article in The Independant about why Japan will recover:
In all areas of life the Japanese extol, in a light-hearted but determined way, konjo, or "guts". To possess it is seen as the norm rather than the exception. When I was earning my living in Tokyo as a teacher, I once phoned in to say that I had a temperature of 40C. I was told to go in anyway. (The Japanese sound like nurses! - ed.)
. . .
The tragedy now unfolding in Japan must dwarf any trite evaluation of that country's ability to recover, yet, as anyone who has experience of Japan and its history will opine: the Japanese are different.

The missing, then present, then missing pulse

From the "mistakes were made" file:

Post-op patient comes with multiple bypass procedures on one leg. The surgical leg had no pulses before surgery, even by doppler. The non-surgical leg had pulses that could be detected by doppler. Coming to me after surgery, the pedal and post-tibial pulses on the surgical leg are easily dopplered, though. The surgeon came with the patient and dopplered a popliteal pulse, pointed it out, and said that was the one he was concerned with.

Later in the evening, the patient's non-surgical leg pedal pulse disappears. The foot is warm, and the post-tibial is present. Probably not a good time to call. Then the non-surgical pedal pulse returns and the surgical pedal pulse disappears... erh?!

After some mucking around, it appears that turning the patient side-to-side causes the pedal pulse on one side to disappear and on the other side to re-appear. What gives? I don't know. Nobody else knows.

Judging either foot, the situation does not warrant a call to MD. However, the patient also has a swelling that appears to be a supremely enlarged mons pubis. It feels hard underneath. I'm thinking, hematoma?

Looking at the whole context, does the positional nature of the pedal pulses tell us anything about a possible hematoma in the pelvis?

Apparently, the answer is no. If you want to feel like an idiot, explain this theory to the surgeon at about, say... 4:00 AM.

Open letter to ANA on genetic testing

In reporting on the recent March 8-9 meeting of the MCG Panel of the FDA's advisory committee, I find it problematic that I have no recording or minutes of the meeting. Of the five W's of reporting, I am missing the vital Who and hoW components. So, I was taken by surprise yesterday as I was working on my call to nursing organizations to submit comments to federal docket FDA-2011-N-006 in support of patients' rights to view their own genetic information. It turns out the American Nurses' Association has already weighed in on this matter by sending Ann Maradiegue of George Mason University to testify before the panel on March 8th. The ANA has endorsed her testimony, which is available in PDF format from NursingWorld.org.

In reading Dr. Maradiegue's testimony, I was struck by how much she seems to stay "on message." It leads one to speculate that, as Dan Vorhaus and Daniel MacArthur have suggested, the outcome of the MCGP meeting was pretty much a forgone conclusion. For a fact-finding meeting, Dr. Maradiegue presents little transparency of the assumptions and reasoning underlying her testimony, while the research she presents tells us only that the industry is currently unregulated, which everyone knows. She presents no evidence in support of her implied preference for a "routed through a clinician" standard of regulation. The meeting, indeed, appears to have been an exercise in consensus-building rather than fact-finding.

Speaking as a nurse, I cannot endorse or agree with Dr. Maradiegue's testimony. She and the ANA claim to speak for all nurses on this matter. She told the MCGP that, in her testimony, she would inform them "what the nursing profession’s perspective is on the regulation of genetic tests, including Direct to Consumer genetic testing." However, she did not. If she had, her talk would have included statistics on professional opinion research conducted by the ANA. Instead, she has simply reiterated the opinions of select members of the ANA leadership. As the ANA does not license nurses or count them all as members, this is not the "nursing profession's perspective".

Therefore, I feel obliged to send Dr. Maradiegue and the ANA the following open letter critiqueing their statements and asking them to revise their position.


Ann Maradiegue, PhD
School of Nursing
George Mason University
Fairfax, Virginia
amaradie@gmu.edu


Dear Dr. Maradiegue:

As a nurse, I would like you to know how strongly I disagree with your March 8 testimony for the FDA on direct-to-consumer genetic testing and encourage you and the ANA to submit new comments on federal docket FDA-2011-N-0066.

In the coming era of cheap gene sequencing, access to and control of personal genomic data will--and should be--seen as a human right. Your testimony implied that health care professionals should be a protected category of Americans with an exclusive right to order and receive the results of genetic tests. As you must be aware, when whole genome sequencing becomes affordable in the near future, this standard of regulation must result in a denial of access to fundamental information about Americans' personal histories and relationships to our species and its development.

Moreover, your implicit suggestion that health care providers' interpretive abilities keep patients safe is disingenuous in multiple ways. First, as Bloss, Schork, and Topol (2011) demonstrated, the available evidence shows no harm to consumers in DTC genetic testing. Second, as you well know, neither APNs nor MDs receive education that specially qualifies them to interpret genetic data. Third, your comments presuppose genetic testing in the context of acutely or chronically ill patients when the FDA is considering regulation of all genetic testing. Fourth, your comments present a false dichotomy between an unregulated industry and clinician control of access to genetic data when a range of regulatory rules are possible that would not restrict Americans' access to their own personal genomes.

That genetic testing interpretation is complex and uncertain is due to the fact that genomewide profiling of the type offered in DTC testing is not diagnostic but reflective of risk, risk that is also found in lifestyle choices about exercise, substance use, and nutrition. In these other areas, knowledge of risk (and even advice about risk reduction) is openly available to patients without clinician intervention. Nurses should support a regulatory scheme that would promote testing accuracy but make information about genetic risks as available to Americans as information about lifestyle risks.

Your testimony puts you and the ANA, in the words of former President Clinton, "on the wrong side of history." Rather than leading change and advancing health, your testimony promotes social and technological stagnation that will send innovative industries overseas. Rather than promoting patient rights, your testimony acts as a handmaiden to the American Medical Association's docket comments and their misguided guild mentality toward the future of medicine. This guild mentality is reflected in your call for federal funds to educate nurses about genetics when you could have easily called for federal funds to improve science education and increase public knowledge of genetics.

I call on you to revise your position on DTC genetic testing. Your testimony's implicit support for the AMA's recommendation of a "routed through a clinician" regulatory standard can be undone by an explicit statement that this standard should be rejected. The FDA has re-opened its comment period for federal docket FDA-2011-N-0066. I encourage you and the ANA to submit comments in support of DTC regulation that would ensure the accuracy of consumer genetic tests while maintaining free and open access to their own genomes for all Americans.

Thank you for your attention.

[Updated March 15, 2011: Dr. Maradiegue responded to my e-mail by asking for my full name and "background information." While this is reasonable in polite society, it is also what someone would do if they intended to silence you by exerting professional pressure. No accusations here, but we must say "c'est la vie" and leave it at that...]

ResearchBlogging.org
Bloss, C., Schork, N., & Topol, E. (2011). Effect of Direct-to-Consumer Genomewide Profiling to Assess Disease Risk New England Journal of Medicine, 364 (6), 524-534 DOI: 10.1056/NEJMoa1011893