Backtalk

The profiles and photos in our special "Women of the World" issue drew admirers, while Paul Ehrlich, Anne Ehrlich, and Gretchen Daily ignited debate over population. A critic engaged Jeremy Rifkin over the so-called jobless recovery. And a drug company responded to our investigation of its migraine drug, Imitrex.

IN HER HANDS

It has always astonished me how the powers of global denial can render the challenges, and the oppression, and the courage of the majority of the population of the world, invisible. Mother Jones' special edition, "Women of the World" (Sept./Oct.), begins to show what media and culture and consciousness will look like as this imbalance in humanity becomes rectified. It's a revelation to see.

The scope of the inquiry was impressive and important, but what I'm going to cherish over the long term is the dignity of the images.

What is so incredible to me about this issue is actually how beautiful it is visually. I don't think that's trivial. To see the faces and the lives of women who are the bedrock of their communities in Brazil and in Haiti and in Mali makes immediate what is really the lifeblood of the society, which dominant classes in dominant hemispheres tend to take for granted and trivialize. It's something that I'm going to cherish visually because it's like shining a light on lives that the well-being of the world depends on. Our willingness to see and validate them will determine whether these communities thrive or suffer.

If culture were to reflect what is really important globally, this is what it would look like.

You need dynamite to blow apart the last vestiges of repressive stereotypes of women. These images are it.

Naomi Wolf, Author ofFire With Fire
Washington, D.C.

There's a tendency for Americans not to be very global in their thinking. One important aspect of the World Conference on Women in Beijing last September is that it did globalize people's thinking, and as a result, we have a broader view of what has to happen in our own country.

It's been suggested that the conference was dominated by a "Western feminist ideology." That's an insult to all the thousands of women who partic ipated--upwards of 30,000. They came from 184 countries, the largest numbers from the developing world. It's an insult to those women to suggest that they're being dominated by a small group of people from the West.

As the profiles in your issue make clear, women across the globe share concerns. They share concerns, for example, about violence, whether it's in the home, in the streets, or on the borders. Women everywhere share concerns about day-to-day survival because women are the majority of the poor, and therefore, the majority of the hungry and illiterate.

The ultraright-wingers who are presently dominating politics in the United States Congress are not really concerned with positive, people-minded change. They don't want everyone to have a fair share of our economy. They regard the Beijing conference--as they should--as a threat.

Bella Abzug, Co-chair, Women's Environmental Development Organization
New York, N.Y.

WHAT WILL IT TAKE?

Mother Jones has done a creditable job explaining the complexity of humane policy to halt worldwide population growth ("What It Will Take," Sept./Oct.). The policy dilemma is revealed by two of Mother Jones' informants. States Russian Zhanna Kapralova: "I would have had more children if life were better." Also hear, try to really hear, Zenebu Tulu in Ethiopia: "If I were wealthy, say if I had horses and a better house, I'd have more children." So how does one help the women economically without encouraging them, and many like them, to increase their family size?

The dilemma is repeated in data from every country I study. When people perceive a windfall of economic opportunity, they raise their family-size target and have more children. This means that programs undertaken in the name of assistance with development have often done harm.

The converse is also true. A sense of limits promotes reproductive and marital caution. Limits are everywhere apparent, and I think that this is the main reason fertility rates are declining, nearly worldwide, today.

Examples cited in Mother Jones that might seem at variance with my conclusions are not really anomalies. For example, Italy, Spain, and Russia share the distinction of having the lowest fertility rates in the world. Although rich by world standards, these countries compare themselves with the rest of Europe, and by this standard, they feel poor. Moreover, the poorest regions of each country (e.g., southern Italy) have had the fastest decline in fertility rates.

My advocacy for microloans to women is consistent with my views on the dynamics of fertility. Microloans do not immediately raise consumption (and any eventual increment is clearly linked to savings and reinvestment). Neither do microloans reduce a woman's workload. They are small and must be repaid. But they allow her to focus work more productively for her ultimate, long-term benefit. Microloans' effect on fertility operates through an economic calculation that most women can make. The time spent on child-rearing competes with time available for developing the business. Child-rearing acquires an opportunity cost when women enter the cash economy.

To Paul Ehrlich I would say, measure the deleterious effects of population growth through the changes in the lives and status of women. "Missing women" statistics will rise as population pressure grows, because women are devalued in overpopulated societies. I think demography drives the valuation of women, not the other way around.

Virginia Abernethy, Ph.D., Author of Population Politics, Vanderbilt School of Medicine
Nashville, Tenn.

Although Paul and Anne Ehrlich and Gretchen Daily concede that modification of consumption and production patterns in the U.S. and other industrial countries is part of the solution [to the population problem], they seem to regard the manipulation of female fertility worldwide as the easier option. Women and their partners indeed are looking for ways to manage their sexuality and fertility safely, but on their own terms, in pursuit of their own interests, in the context of local and not global problems.

Population control policies lead to gross abuses, especially when applied in the context of gender-based discrimination. Where it is conception of sons rather than of children that is at stake, as in China and most of South Asia, the availability of amniocentesis and ultrasound services, which coincidentally reveal the sex of the fetus, has led to high levels of abortion of female fetuses. Family planning technologies and services, female education and income, cannot be the whole solution in societies in which females are not valued and not empowered to make their own decisions.

Janice Jiggins, Author of Changing the Boundaries
The Netherlands

In the midst of the exciting, multifaceted, worldwide mobilization of women for the Beijing conference, your issue on the women of the world was a slap in the face. Just as the nongovernmental organization conference in Huairou was affirming the power of "Looking at the World Through Women's Eyes," Mother Jones was looking at women through the eyes of the powerful.

Your interviews with women are presented in the context of essays about "the underlying population concern." The push to improve women's lives, Mother Jones warns, won't succeed if it is "perceived as failing to address the underlying population concern." It's the age-old perspective of the powerful: making sure women are doing the appropriate thing with their fertility.

If you don't want to project the idea that improving women's lives is just a means to controlling population, you shouldn't surround your brief portraits of women with ponderous essays on population.

Jean Tepperman, Columnist, San Francisco Bay Guardian
San Francisco, Calif.

I want to thank you for the fair and evenhanded treatment you gave women and the population issue. Having studied both for over 20 years, I have tired of what appears to be the politically correct, knee-jerk response on the part of too many of my friends on the left. Namely, that the population threat is just another manufactured theory of the elite to keep us under its boot, fuel racism (immigrants), etc.

God knows the elite never runs short of contrived ways to keep us in job-economic bondage, but the threat of overpopulation is not one of them. Ehrlich is, and always has been, right on the mark when it comes to population. If the world had listened to him (if Cairo had happened in 1970 and been implemented by, say, 1975), we would already be living in a better world, headed in the right--instead of wrong--direction.

Barry Parsons
Daytona Beach, Fla.

THE END OF WORK?

Jeremy Rifkin's story ("Vanishing Jobs," Sept./Oct.) misleads on three major counts.

He identifies the main "malaise" of the American economy as a lack of jobs, yet in the past 20 years (1975-95), the number of employed grew by more than 35 million. Since 1989, the peak of the previous growth cycle, the number employed increased 6 million--hardly a "jobless recovery."

His villain is automation, but there is no evidence that new technology reduces the total number of jobs, only that it displaces workers, causing hardship to some and gain to others. The U.S. and Japan, with much greater diffusion of information technology than Europe, have had much higher overall job growth.

"Nearly 44 percent" of employed women, he claims, would prefer more time with their families to more money. But a recent survey by the Families and Work Institute (Wall Street Journal, May 11, 1995) shows that 58 percent of employed women, 18 to 44 years old, do not want to give up either of their simultaneous work and home roles, and almost half said they would keep working even if they had enough money to live comfortably. Women have made big gains in the so-called jobless economy, and most would hardly want a return to the family wage system (husband works, wife depends).

No doubt the workplace has changed. Global competition and information technology mean flexible production and that translates into more temporary, part-time, and self-employed workers. But the bigger change is the massive number of new, highly schooled workers--especially women, but also Indian and Russian software engineers--who want part of the action. The feminist revolution, new communications technology, and an open-door immigration policy give U.S. employers a lot more bargaining power than they had 20 years ago.

So the problem is not the end of work. Rather, Americans have been cast adrift from social institutions--family, union, welfare state--organized around an industrial notion of (white) male, full-time, family-wage, single-career jobs. Now that the notion is history, we need new reintegrative institutions, not just more jobs or a shorter workweek.

Reintegration has to start with an overhaul of our knowledge distribution policy, especially enhancing low- and middle-income families' capacity to access high-quality education. Whether Rifkin likes it or not, education and training are becoming as much a part of working life as work itself. But beyond that, we need good old incomes policies--higher minimum wages, expanded income tax credits to the working poor, national health care, and less immigration--to raise incomes for those with plenty of work but earning low wages.

Martin Carnoy, professor of education and economics, Stanford University
Stanford, Calif.

Jeremy Rifkin replies: It is true that some new jobs are being created, but they are, for the most part, low-level service employment and temporary or contingent work. High-wage manufacturing jobs and many skilled and professional white-collar jobs continue to decline, a victim of corporate re-engineering and information age technologies. What distinguishes the Industrial Age from the new Information Age is that the latter is based on ever-smaller elite workforces accompanied by increasingly sophisticated, intelligent machines.

Dr. Carnoy is correct that we need to upgrade workers' skills. But even if every American were reskilled, the knowledge sector will be unable to accommodate more than 20 percent of the workforce, leaving 80 percent vulnerable to underemployment and unemployment.

As to Dr. Carnoy's comments regarding women's work preferences: Virtually every survey of the past several years indicates that both women and men would prefer fewer hours of work and more time at home and in the community, if their wages and benefit packages would not suffer.

What is so desperately needed is a national debate, in every country, on how best to distribute the vast productivity gains of the Information Age economy, so that the benefits of laborsaving technology can be shared by more than the corporate elite and stockholders.

GLAXO'S HEAD CASE

Migraine is a chronic condition that can be devastating to the 23 million Americans estimated to have it. The pain and associated symptoms can be so severe that sufferers often spend days at a time in darkened rooms, avoiding as much light, sound, and smell as possible. Since 1991 (1993 in the United States), Imitrex has been available to help relieve this disabling condition for appropriate patients. More than 2 million people have used Imitrex.

Nicholas Regush correctly reports ("Migraine Killer," Sept./Oct.) that Imitrex is not appropriate for every patient. As we make clear in our product labeling, and as we made clear to Regush, certain people, with certain types of heart disease, should not take it. Others, with risk factors for heart disease, should be evaluated by a physician to determine if Imitrex is appropriate therapy.

Glaxo Wellcome has conducted clinical trials of more than 19,000 people, which have demonstrated the medicine's clinical safety and efficacy profile in the treatment of migraines. We continue to monitor the medicine, and report to the FDA any information we receive of an adverse event, including death. It is extremely important to understand that the company reports adverse events whether or not any causal link between the adverse event and the medicine has been established. Regush's article seemed to imply that if an adverse event is reported to the FDA, it means the medicine caused the adverse event. That is not the case. Imitrex has not been definitively established as the cause of any death.

Dr. Donna Gutterman, Medical Affairs, Glaxo Wellcome
London, England

As a physician involved in the care of headache patients for almost two decades, I have seen the terrible toll migraine takes on its sufferers and their families. A study by Dr. Glen Solomon and his colleagues at the Cleveland Clinics on the "Quality of Life and Well-Being of Headache Patients" found the quality of life of chronic sufferers was worse in comparison to diseases such as arthritis, diabetes, depression, and back problems. Yet in spite of the widespread prevalence of migraine and its impact on sufferers, their families, and society, it remains underdiagnosed and undertreated.

No agent studied in migraine has ever been scrutinized worldwide as much as Imitrex. In my own study of the first 100 patients in our clinic who were given Imitrex, the drug was effective 84 percent of the time, with an average time to relief of 41 minutes. Patients were carefully screened, as all should be, to ensure the diagnosis of migraine and the absence of heart disease, stroke, and uncontrolled hypertension.

Most patients tolerate the medication well. I have not heard the words "miracle" or "magic" used as often as I have with Imitrex. It has truly been a godsend to the great majority of patients and enhanced their quality of life immensely.

I advocate the approval of Imitrex at the 3 mg subcutaneous dose [as opposed to Glaxo's recommended dosage of 6 mg]. It is effective in 55 percent of patients and would help to ensure a wider magin of safety. A general rule of thumb in regard to any pharmacological teament is "start low and go slow." Hopefully, Imitrex will pave the way for the discovery of other agents, which will prove effective and bring the 100 percent safety requirements we are all longing for.

Fred D. Sheftell, M.D., President, American Council for Headache Education
Woodbury, N.J.

Nicholas Regush responds: I am encouraged to discover that Dr. Donna Gutterman of Glaxo Wellcome acknowledges that Imitrex is not appropriate for every patient. Gutterman, however, fails to address the crux of my story, which is that doctors cannot possibly determine with any reasonable degree of accuracy who should or should not be prescribed Imitrex. Even the FDA concedes this point.

Imitrex can affect heart vessels and has the potential to induce a heart attack. People who already have some disease developing in their heart vessels should clearly stay away from the drug. Doctors, however, do not have the necessary diagnostic means at thier disposal to rule out complelely the possibility of heart disease in all their migraine patients. Under these conditions, the drug becomes a crapshoot. Yet this simple and pivotal fact is absent from the company's labeling of Imitrex. To continue to ignore this issue, as Glaxo Wellcome does in its labeling--with the FDA's approval--is, at the very least, grossly irresponsible.

Gutterman seems to write off the thousands of voluntary reports on the side effects associated with use of Imitrex, including death and hundreds of life-threatening problems, as not having been firmly established. If she is so confident that Imitrex is not the culprit in many of these cases, then I would ask that she submit the full details of these reports to Mother Jones for analysis by independent experts. I might also remind Gutterman that FDA memos reported in my story reveal that it was thought within the agency that the use of Imitrex would lead to harm in a significant number of users. For reasons still unclear, the FDA felt these patients could be sacrificed to some greater hypothetical good.

As for Dr. Sheftell's attempts to favorably compare Imitrex to other medications, I would much rather see methodologically sound science do that job (and it hasn't thus far) than accept his anecdotal speculations. He may be in the dark concerning the possibility of properly ruling out patients who should not be given the drug. I imagine most doctors are.

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