Blood Donation, Ideology, and Science

The FDA has shortened the deferral for men who have sex with men (MSM) for giving blood.

The new rules decrease the time down to a year, meaning that gay, bi, and closeted men must be celibate for a year in order to give blood. Understandably, this rubs a lot of liberals the wrong way. It is worth noting that there are two “flavors” of objection here. There are those who wish to lift the ban entirely; this article will more directly address them. Then there are those who would change the ban; this piece dips into that debate but it is much more complicated and I do not have a final recommendation there.

Liberals who are usually proud that the progressive wing is more interested in rational policy have deployed a series of arguments that ignore or distort the statistical reality of the public health issue. To be sure, there are good political reasons to support a different set of policies, but public health is not one of them.

To understand the relative risks here, we have to do some arithmetic. As a baseline, men who have sex with men account for about 8% of the population, with gay men being only a fraction of that. At the same time, about 60% of new cases come from that group. 8% of the population generates 60% of new HIV cases every year. Even a crude estimate here suggests that MSM are 17 times more at risk than all the behaviors that constitute not being a man having sex with men. Mileage obviously varies; it is not, for example, 17 times more risky to share needles than to have same-sex relationships nor is all MSM behavior created equal.

A duplicitous argument that gets made—though, I tend to think it gets made in good faith—is that the risks come primarily from behavior. This is true, to a point. The risk from anal sex, for example, is the same for heterosexual and homosexual intercourse provided one of the partners is HIV positive. This is duplicitous because assuming that the playing field is level distorts the practical risk. HIV prevalence is plainly much higher among men who have sex with men, and so the behavior is more risky.

The risks we are talking about, however, are small. The “eclipse period”, the time between becoming infectious and being able to test positive is about 2 weeks. With 30,000 new MSM cases every year, that means that each new case is undetectable for about 4% of that year. About 1,200 cases of new HIV cases from MSM are undetectable at a given moment. Donor rates are tricky, but if men who have sex with men give at about the national rate, 5% a year, that means that we’re looking at 2.5 people slipping past. Because donations are often split between plasma and red blood cells, that is 5 new cases. That is all at once not much and an unacceptable public health risk.

The second safeguard in place is a test with a 45 day eclipse period. Used by itself, lifting the ban would be a catastrophe, but the point is that it is used to catch those the first test might have failed on. This means that a 45-day deferral makes more sense. A 6-month deferral basically guarantees that this second test will not fail, and so the two tests taken together should make the blood-supply completely safe as safe as the deferral is respected. Those suggesting that a year ban is long have a point, but for the second test to be meaningful, the ban must be measured in months. The FDA will not move below a year because there is no study backing 6 months or less. I have the luxury as a blogger to spitball a bit.

It is worth reflecting here on one of the very few cases of transmission in the United States since 2003. A man lied to avoid a deferral, and infected a transfusion recipient with HIV. He may well have infected another, except the patient died and researchers were unable to follow up. This alone should temper the well-intentioned calls to lift the MSM ban in its entirety. If you are lying about your deferral, stop.

Now, the current ban is more than a little ham-fisted. While I obviously believe relative risk in MSM populations justifies a deferral that specifies MSM, limiting the deferral to anal-sex and other high-risk acts makes sense based on the risks of, for example, oral sex. Things are murkier on the issue of monogamous partnerships, but it is worth noting that heterosexuals are assumed to trust their partner. A heterosexual woman is asked if her partners have had MSM contact; it is hard to believe that those answering “no” are always right. Still, the numbers game being what it is, the FDA may not care. (Gay men are not inherently more likely to cheat, but they are inherently more likely to cheat with a man.) This gets us far enough into the weeds—and far enough from the lift-the-ban comments I had in mind—that I am going to stop shy of taking a firm stance about this specific change. I’d be interested what commentators think of the balance of both the hard risks and the very real respectability politics at work behind such a change.

There is another angle we could take as far as MSM specifications. We could say, as a matter of identity politics, that we do not accept singling out gay, bi, and closeted men and will instead use behaviors. By analogy, we do not use race as a category for deferrals despite the fact that a case could be constructed for it. In other words, factoring in politics may be legitimate, but it does not change the fact that lifting the MSM ban in a broad sense would be a catastrophe.

The lesson here, I think, is that liberals are low information voters just the same as conservative ones. We see discrimination against gay, bi, and closeted folks and assume it cannot be rational policy. The more sophisticated of us construct an argument around that and find advantageous evidence. The FDA has done themselves no favors by delaying a needed policy change and making homophobic comments during open discussions.

But it does not change the basic facts: there is a real risk to doing away with the MSM deferral.



Verde, te quiero verde.

Of all things Donald Trump could make me think of, it is the Spanish poem, Romance Sonambulo by Federico Garcia Lorca. The title means “Ballad of the Sleepwalker” and is famously difficult to interpret and thereby translate. The opening lines are rich with implication that only deepens as they are repeated. Verde, green, is the color of life, but also of jealousy and decay. Te quiero has shades of meaning from sexual desire to longing. These ideas, life and lust and longing and death and decay all weave through the poem.

None of that reminds of me of Donald Trump. Instead, it is my favorite poem by Lorca, who lived in Spain at the time of the Fascist takeover. There has been a lot of talk about whether or not Trump is a fascist or what we’re seeing now is a neo-fascist moment. The answer, I think, is not singular. There are alarming ingredients coming together in the United States around Donald Trump, but it is probably early to say we’re careening towards fascism.

This is exactly the kind of thing that the internet is bad at. The headline—DONALD TRUMP IS NOT REALLY A FASCIST BUT RATHER PART OF A WORRYING TREND TOWARDS NEO-FASCIST IDEOLOGY WHICH, IF LEFT UNCHECKED, POSES A THREAT TO AMERICAN DEMOCRACY THAT NONETHELESS MAY NEVER BE REALIZED—is not exactly made-for-clickbait material. Still, it is worth exploring why the truth is for once equivalence.

Checks and Balances

What is remarkable about the fascist leaders is that they are all surprising candidates for dictatorship. Hitler’s rise to power and consolidation took the world by surprise—and even many of this allies. Hitler swept into power in 1933 on a cocktail of antisemitism and economic populism. The similarities to Trump are neither superficial nor lockstep. The following year, however, he purged a number of his apparent allies who were not sufficiently under his direct control.

To put this in a more American way, fascism eliminates political checks and balances. All presidential candidates get a bit caviler about the powers they will have, promising to work for something they have little control over. Trump has been unusually brazen in his insistence that he can and will act unilaterally. So far he’s not touched on actually arguing that he will bypass Congress, but that is the clear implication of most of what he says.

Franco followed a different path by necessity. Spain collapsed into civil war rather than the (relatively) bloodless electoral takeover of Germany. But after the war, Franco turned on the very structure that catapulted him to power. He was a major player in the revolution, but a single dictator was not a certainty. Nonetheless, he eliminated all checks and balances until he was the supreme fascist leader. Moussilini followed much the same program as Hitler, though it is worth noting that there was much more intimidation at the polls. After winning the election, he consolidated power around himself.

It worth noting at this juncture that without Trump, Conservatives have been engaging in voter disenfranchisement on a massive scale. There has been a tendency to point to our robust democratic ideals when suggesting that there is no fermenting fascist future for the United States, but Trump and the rest of his party are shockingly okay with rigging the polls. Some have come right out and said it is about that.

This is obviously not equivalent to what the fascists did. But there is an alarming, albeit quiet trend towards viewing election outcomes as justifying election policies. As long as the right people—emphasis on the right—vote, it is a just election. This is one of our checks on political power, and Trump’s party is surprisingly hostile to democratic principles.

Superpower Angst

I’m taking some cues from Megan McArdle’s piece, Trump Is Scary, but not ‘Fascist’ Scary. In it she argues that America’s Democracy is more robust than those that gave rise to the fascists. I tend to agree, but I also find her worrying blase about the ingredients that she identifies to make fascism. Again, this is a calibration issue. None of these are perilously close to bringing about the end of Democracy, but each is in an early form that demands our swift attention.

She points to robust institutions, and that is her strongest point. However, those institutions are very much in decline—and this is not a widely disputed fact. What is disputed is if America is declining gracefully to a first-among-superpowers status or towards something worse. American power peaked in the 70s and was boosted in the 90s by the collapse of the Soviet Union. Our current power is on borrowed time as is. Here we are different from the fascists, who had shattered post-war societies to prey upon, but not nearly so different.

Again, on calibration: the US is not collapsing in any immediate way. We are just less able to assert our power than we were in, say, 1950. I suspect this is part of the generational divide between Democrats and Republicans. The US really has had to negotiate more, especially in Europe and East Asia. It is now possible for the world to work around US obstruction. We remain first among the world powers. The anxiety around that decline is fueling Trump supporters.

Government Thugs

Romance Sonambulo is about a man who returns to his lover’s house, bleeding from the chest. (Cue debate: is he nominally alive when he arrives, or a ghost?) He is greeted by his lover’s grieving father, who wonders why he did not come back sooner. In time we learn that the man was pursued by the Spanish Civil Guard, and presumably they shot him.

There is some politics in making the Civil Guard the villains in the poem. Lorca’s socialist wing tended to view them as thugs, and at times they were. But more to the point, they supported the Crown when he published Romance Sonambulo and the Socialists did not.

But it was prophetic nonetheless. The Civil Guard became one of the forces that supported the Franquistos in the Civil War and helped him maintain power after. This paramilitary ingredient is important in all fascist regimes. The Blackshirts were Italy’s answer. The SA helped the Nazis come to power, but it was the Gestapo that Hitler relied on.

One does not need to strain imagination to see the Blackshirts forming in the United States. The violence at Trump rallies and the militia movement both offer a seam of violence for a neo-fascist to tap into. The police forces are also more conservative than ever. (And we hardly need to speculate what racially motivated political violence by the police might look like.) It does require imagination at this juncture, thankfully.

The last thing to thank about is the question is the military. This gets us into pure speculation. Our admirably apolitical military might stand by the side. That they might stage a coup to restore the Republic is not exactly reassuring. How alien this feels should by your clue that we’re not facing down an immediate fascist takeover.

The Republicans and the Fascists

Another one of the things that we have protecting us is Federalism. That this does make an appearance in McArdle’s piece surprised me. It is not outside the realm of possibility that a fascist could do away with the national-level checks and balances. Congress would have to unify against the president, which would be a major factor in the success of a fascist takeover.

But the reason the American republic has endured has a lot more to do with the way powers are delegated to the states. Trump, or anyone else, would have to deal with States’ rights and powers. Again, a fascist wave could weaken those institutions as well. And Trump is hardly the only one going down the fascist road. Among the governors, there has been an alarming erosion of state-level democracy. Michigan reserves the right to replace elected governments with one appointed by the governor. Many states have seen a consolidation of power and regulation around the Statehouses’ interests.

Here Spain offers us some guidance as well. The Spanish Republic, which was much weaker than the American one, devolved into Civil War. It was essentially the Army and its conservative supporters against the Provinces and their liberal supporters. Civil War, not takeover, is the historical precedent in the United States. (The Republic won last time, reassuringly.)

Our republican checks would slow a fascist takeover—and tip the balance in favor of maintaining Democracy.

This Time it will be Different

One of the most remarkable facts about Lorca was that he was gay. The 20s in Europe and the United States were something of a resurgence for homosexuality. Contrary to what you may believe, the toleration and recognition of same-sex relations has ebbed and flowed through the centuries. There is significant evidence that prior to the 13th century the Catholic Church tolerated and even sanctified same-sex relationships. (They were unions of friends, but quite a few documents have apparent winking and nodding about what good friends they are. Very good friends. The Church supports this kind of friendship, which is just friendship, we all know it is just friendship.)

The 20s saw gay neighborhoods form and a sort of cosmopolitan tolerance form in major cities. This did not extend to protections—it was still perilous to acknowledge it publicly. And the fascists opposed this.

The fascists takeovers happened at the end of one of the most cosmopolitan eras the West had known. The Fascists saw themselves as a needed response to those ideals, restoring the glory of the West. (The irony that they cited the Greeks and the Romans will not be lost on students of history.) Their close relationship with the Church is striking.

This is doubtless one of the closest parallels. The groups in the United States most comfortable with Trump are those most comfortable with the mixing of Church and State. They are those most comfortable with persecuting those with different faiths. The United States is in the middle of deciding just how much Protestant groups will get to set policy and is not passing the tests resoundingly.

A Majority Support Trump

I am optimistic that this will pass—that this is a high water mark for fascism in the United States, and a low one by any standard. But my optimism is not because of the robustness of our political institutions, per se. It is because Trump cannot get the numbers to win.

Vox takes the somewhat placid view that if Trump scraped together the numbers to become president, he would have a tough time overcoming Congress and the other hurtles. I am less sure. The piece is correct that, “it won’t be a bit like running his own company.” And therein would lie the showdown.

In this scenario, a majority of people voted for Trump. When he does not get his way, he’ll start grandstanding about how he should get his way. If he has the support to violate the Constitution, he very well might. This will trigger a Constitutional crisis, requiring Congress to impeach him. (Allow me to take a moment to repeat how much elections besides the president matter.)

Here a number of variables come into play. How willing are Trump supporters to put up with violating the Constitution? Ignoring what he will term “activist judges”? How about their willingness to enforce these changes for him? What will our military and law enforcement do? Remember, this is the majority of the country we’re talking about.

That the best argument is that he’s set to lose in the polls is not a reassuring one to me. A large minority of voters are feeling comfortable with his racism and grandstanding. (He has about the same level of support as Sanders, with way more potential to pick up more.) Again, this is far from arguing we’re on the edge of a fascist takeover, just that it is possible to downplay these risks too much.

A Path Besides Fascism?

Romance Sonambulo ends with the revelation that the dying man’s lover has hung herself in grief. She has been left hanging and has turned green with rot. Green, oh how I love you green. The Spanish Civil Guard is going door to door looking for the man as he laments all the things he could have had if things had turned out differently, agreeing with the accusations of his lover’s father.

We don’t know exactly which fascist group killed Lorca. He had gone into hiding, aware that his politics and sexuality made him a target. Where just 6 years before he had been openly pursuing relationships with men and supporting Socialism, he now faced death. He was taken and never seen again, and the details from those days do not add up to any certain final resting place. At the age of 40, one of the finest poets Spain had ever known found himself on the wrong side of a fascist takeover.

This is the part of Trump’s rhetoric that has drawn the biggest comparison to fascism. The fascists are not the only ones to have attempted mass incarceration and genocide. (The United States during the fascist period famously imprisoned Japanese-Americans, and less famously discussed the possibility of genocide. (Yes, if you went to IU, that Paul V. McNutt.) The worrying strains of fascism could come together as something entirely new.

Attacks on Muslims, and possible formal sanctions, are not out of line with American history. In that way, Trump could call for a return to a less inclusive Democracy. Not fascism, but I would forgive you for pointing out that that kind hair-splitting does no one any good. Pointing out that the American Democracy has always been conditioned on the access white protestants grant does not really assuage my fears, even if it re-aligns them.


McArdle and others are right to say we should slow down. The ingredients for a fascist takeover, by Trump or anyone else, are not quite there. But Trump and his supporters have long been eroding the safeguards that we rely on. We are missing the paramilitary force, but the political violence needed is fermenting. Trump has no clear path to eliminating the checks and balances on him, but he has been very willing to say that they should not apply to him. The States pose a major hurdle, but they too are oddly willing to let the principles of democracy go when it suits them. Other fascist institutions, like a cozy relationship with one religious group and the persecution of others, are dangerously popular.

Historical comparison is necessarily a messy endeavor. Trump was never going to be exactly a fascist because fascism makes the most sense in the 1930s. And the differences matter. But the bottom line is that these echoes and similarities are eating at foundational institutions and putting rights and democracy in peril. Maybe not immediately, maybe not for the 2016 election, but these are the early signs that America is losing its way.

Franco was in power until 1972, and during that time Lorca’s work was suppressed. It had a huge influence on Magical Realism in the New World, but important works were illegal in Spain. Spain has built durable democratic institutions since then, and is more insulated from a fascist takeover, though they too see worrying signs of repeating history.

Calibration is hard, but on the issue of Trump being a fascist I think we should be worried without being hysterical.

Why I Now Think Trump Could Get the Nomination

Before I talk about The Donald, I’d like you to think back to 2011 and 2012. In particular, think of Michelle Bachmann, Newt Gingrich, and Herman Cain. Remember them?

Each of them was either a front-runner or a major challenger to the eventual nominee, Mitt Romney. Each of them followed a very specific pattern. They would shoot up in the polls. They would be covered closely for a week or two. In that time we’d learn all sort of details that would scuttle their run.

Bachmann is actually too much of a fundamentalist (and her husband was a major liability). Her zany ideas did not withstand scrutiny. Herman Cain’s tax plan sounded crazy, and that is because it was. (999!) And Gingrich, who left office in disgrace, never did explain why he should be let back into office. If only he’d left before adding “Newtmentum” to our lexicon. A look back at the 2012 nomination data is a great trip into the past.

The reason I’ve been converted to thinking Trump could win this is that he is doing better than Romney. He has more of the larger field than Romney did and only briefly ceded the lead to Carson. With Carson on the way out, and he still holding his position, he is the one with everything to lose.

There is a danger to writing this after his comments about banning Muslim immigrants. This could be the thing that finally answers the question, “Has Trump gone too far?” But the answer to that has never been “yes” before. I call this phenomenon durability. I have no idea how to guess who is durable—I was in the camp that said Trump would fizzle. But Trump is definitely it. He is the candidate who has weathered enough storms that the safe bet is on him weathering the rest.

The media narrative is around Cruz or Rubio catching up with him. I won’t say no on this blog, but I will say I’m skeptical. Cruz is the easier candidate to doubt. He has all the media savvy of a dead salmon. Voters may have forgotten about what a disaster his shutdown was, but they will soon be reminded. Maybe he can spin it, but you’ll lose money on that bet.

Rubio to this point has been under-performing against pundit expectations, this amateur pundit included. The Jeb Bush protege should, by rights, be doing well. Except, by rights, Jeb Bush should be doing well. There is a theory that says he blew it, but he did not do anything that Romney did not do except have a certain brother named George. Maybe that was it, but I think voters just are not buying the insider candidates.

There is a case to be made here, and it is not about any one candidate overtaking him. Trump has been hanging out around 30%. Sure, he’s had good weeks and bad weeks, but 30%. As the field has consolidated—minor candidates are on their way out—he has not benefited. I cannot underscore how important this is to guessing what happens next.

Trump may have capped out his support. This is not about Cruz being able to beat him. This is just saying only about a third of the GOP are willing to vote for him and the rest are picking between who is left. As those candidates consolidate, one of them might pass Trump.

There are many ifs in that analysis. Trump may benefit from other lead candidates dropping out, and that might put his campaign very much ahead. Cruz and Rubio are mostly snapping up Fiorina and Carson’s support, and maybe Trump will do better if one of them leaves. Or maybe we will see that the party is deciding between loose-cannon senator and true-establishment senator and once they decide that will trump Trump, as it were.

Time will tell. But smart money is, I think, on Trump riding this all the way to the convention. There is a strong case to be made he will get the nomination once he is there.

And that is terrifying.