Rene Descartes ‘s Dualism of matter and mind

Toward the end of the Renaissance period, a radical epistemological and metaphysical shift overcame the Western psyche. The advances of Nicolaus Copernicus, Galileo Galilei and Francis Bacon posed a serious problem for Christian dogma and its dominion over the natural world. Following Bacon’s arguments, the natural world was now to be understood solely in terms of efficient causes (ie, external effects). Any inherent meaning or purpose to the natural world (ie, its ‘formal’ or ‘final’ causes) was deemed surplus to requirements. Insofar as it could be predicted and controlled in terms of efficient causes, not only was any notion of nature beyond this conception redundant, but God too could be effectively dispensed with.

In the 17th century, René Descartes’s dualism of matter and mind was an ingenious solution to the problem this created. ‘The ideas’ that had hitherto been understood as inhering in nature as ‘God’s thoughts’ were rescued from the advancing army of empirical science and withdrawn into the safety of a separate domain, ‘the mind’. On the one hand, this maintained a dimension proper to God, and on the other, served to ‘make the intellectual world safe for Copernicus and Galileo’, as the American philosopher Richard Rorty put it in Philosophy and the Mirror of Nature (1979). In one fell swoop, God’s substance-divinity was protected, while empirical science was given reign over nature-as-mechanism – something ungodly and therefore free game.

Nature was thereby drained of her inner life, rendered a deaf and blind apparatus of indifferent and value-free law, and humankind was faced with a world of inanimate, meaningless matter, upon which it projected its psyche – its aliveness, meaning and purpose – only in fantasy. It was this disenchanted vision of the world, at the dawn of the industrial revolution that followed, that the Romantics found so revolting, and feverishly revolted against.

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The French philosopher Michel Foucault in The Order of Things (1966) termed it a shift in ‘episteme’ (roughly, a system of knowledge). The Western psyche, Foucault argued, had once been typified by ‘resemblance and similitude’. In this episteme, knowledge of the world was derived from participation and analogy (the ‘prose of the world’, as he called it), and the psyche was essentially extroverted and world-involved. But after the bifurcation of mind and nature, an episteme structured around ‘identity and difference’ came to possess the Western psyche. The episteme that now prevailed was, in Rorty’s terms, solely concerned with ‘truth as correspondence’ and ‘knowledge as accuracy of representations’. Psyche, as such, became essentially introverted and untangled from the world.

Foucault argued, however, that this move was not a supersession per se, but rather constituted an ‘othering’ of the prior experiential mode. As a result, its experiential and epistemological dimensions were not only denied validity as an experience, but became the ‘occasion of error’. Irrational experience (ie, experience inaccurately corresponding to the ‘objective’ world) then became a meaningless mistake – and disorder the perpetuation of that mistake. This is where Foucault located the beginning of the modern conception of ‘madness’.

Although Descartes’s dualism did not win the philosophical day, we in the West are still very much the children of the disenchanted bifurcation it ushered in. Our experience remains characterised by the separation of ‘mind’ and ‘nature’ instantiated by Descartes. Its present incarnation  – what we might call the empiricist-materialist position  –  not only predominates in academia, but in our everyday assumptions about ourselves and the world. This is particularly clear in the case of mental disorder.

Common notions of mental disorder remain only elaborations of ‘error’, conceived of in the language of ‘internal dysfunction’ relative to a mechanistic world devoid of any meaning and influence. These dysfunctions are either to be cured by psychopharmacology, or remedied by therapy meant to lead the patient to rediscover ‘objective truth’ of the world. To conceive of it in this way is not only simplistic, but highly biased.

While it is true that there is value in ‘normalising’ irrational experiences like this, it comes at a great cost. These interventions work (to the extent that they do) by emptying our irrational experiences of their intrinsic value or meaning. In doing so, not only are these experiences cut off from any world-meaning they might harbour, but so too from any agency and responsibility we or those around us have – they are only errors to be corrected.

In the previous episteme, before the bifurcation of mind and nature, irrational experiences were not just ‘error’ – they were speaking a language as meaningful as rational experiences, perhaps even more so. Imbued with the meaning and rhyme of nature herself, they were themselves pregnant with the amelioration of the suffering they brought. Within the world experienced this way, we had a ground, guide and container for our ‘irrationality’, but these crucial psychic presences vanished along with the withdrawal of nature’s inner life and the move to ‘identity and difference’.

In the face of an indifferent and unresponsive world that neglects to render our experience meaningful outside of our own minds  –  for nature-as-mechanism is powerless to do this  –  our minds have been left fixated on empty representations of a world that was once its source and being. All we have, if we are lucky to have them, are therapists and parents who try to take on what is, in reality, and given the magnitude of the loss, an impossible task.

But I’m not going to argue that we just need to ‘go back’ somehow. On the contrary, the bifurcation of mind and nature was at the root of immeasurable secular progress –  medical and technological advance, the rise of individual rights and social justice, to name just a few. It also protected us all from being bound up in the inherent uncertainty and flux of nature. It gave us a certain omnipotence – just as it gave science empirical control over nature – and most of us readily accept, and willingly spend, the inheritance bequeathed by it, and rightly so.

It cannot be emphasised enough, however, that this history is much less a ‘linear progress’ and much more a dialectic. Just as unified psyche-nature stunted material progress, material progress has now degenerated psyche. Perhaps, then, we might argue for a new swing in this pendulum. Given the dramatic increase in substance-use issues and recent reports of a teenage ‘mental health crisis’ and teen suicide rates rising in the US, the UK and elsewhere to name only the most conspicuous, perhaps the time is in fact overripe.

However, one might ask, by what means? There has been a resurgence of ‘pan-experiential’ and idealist-leaning theories in several disciplines, largely concerned with undoing the very knot of bifurcation and the excommunication of a living nature, and creating in its wake something afresh. This is because attempts at explaining subjective experience in empiricist-materialist terms have all but failed (principally due to what the Australian philosopher David Chalmers in 1995 termed the ‘the hard problem’ of consciousness). The notion that metaphysics is ‘dead’ would in fact be met with very significant qualification in certain quarters – indeed, the Canadian philosopher Evan Thompson et alargued along the same lines in a recent essay in Aeon.

It must be remembered that mental disorder as ‘error’ rises and falls with the empiricist-materialist metaphysics and the episteme it is a product of. Therefore, we might also think it justified to begin to reconceptualise the notion of mental disorder in the same terms as these theories. There has been a decisive shift in psychotherapeutic theory and practice away from the changing of parts or structures of the individual, and towards the idea that it is the very process of the therapeutic encounter itself that is ameliorative. Here, correct or incorrect judgments about ‘objective reality’ start to lose meaning, and psyche as open and organic starts to come back into focus, but the metaphysics remains. We ultimately need to be thinking about mental disorder on a metaphysical level, and not just within the confines of the status quo.

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How to make Elite colleges Less elitist

UP NEXT: TEACHER WALKOUT IGNORES NC’S CRISIS OF STUDENT ACHIEVEMENT

How to Make Elite Colleges Less Elitist

AP Photo/Charles Krupa, File

How to Make Elite Colleges Less Elitist

By Jane S. Shaw
October 06, 2017

The facts are pretty damning: The Ivy League and other selective schools are bastions of privileged students.

According to a study by the Jack Kent Cooke Foundation, colleges are “highly stratified by socioeconomic class, with 72 percent of students in the nation’s most competitive institutions coming from families in the wealthiest quartile.”

Similarly, a study for the Internal Revenue Service found “children whose parents are in the top 1% of the income distribution are 77 times more likely to attend an Ivy League college than those whose parents are in the bottom income quintile.”

In September, the influential online magazine Politicoblamed U.S. News and World Report’s college rankings for perpetuating such elitism. The widely watched listings favor schools whose incoming freshmen have high SAT scores, which tend to correlate with income. And U.S. News gives high marks to schools with low acceptance rates—top-rated Princeton accepted only 7 percent of its applicants in 2016.

Then there is the simple fact that costs are at stratospheric levels. Attending Williams College, U.S. News’ highest-ranked liberal arts school, costs $66,240 per year. Such figures are intimidating to any applicant, even when schools promise they will provide enough aid to make education affordable.

The top colleges undeniably attract and welcome the rich, but before we batter down the doors of the schools with federal regulations to provide greater access, we should recognize that the impetus for some of these attacks is left-wing social engineering.

For example, Richard Kahlenberg, coauthor of the Cooke study, does not simply seek high-achieving students with low incomes; he and his colleagues want the admissions process to reward disadvantaged students for their “distance traveled.”

The Cooke study not only recommends giving preference to students whose family income is low, but also to students whose parents have low-status occupations and low levels of education. It approves of techniques like the UCLA law school’s “class-based affirmative action program,” which considers “parental education, income, and net worth,” as well as “the applicant’s neighborhood (percentage of families headed by single-parent households, proportion of families on public assistance and percentage who had not graduated from high school).”

Such practices are designed, in part, to replace affirmative action, the long-standing admission policies that give special preferences on the basis of race.

Affirmative action is crumbling. Why? First, it discriminates on the basis of race, which under most circumstances is unconstitutional. Second, it favors less-qualified applicants, who squeeze out highly accomplished applicants with racial backgrounds considered to be “advantaged,” such as Asian Americans, even when an applicant does not come from a wealthy family. Third, minority students, who, like other students, might be exceptionally successful at ordinary schools, can falter at more rigorous ones. They are “mismatched.” For such reasons, courts restrict the use of race-based admissions, although the Supreme Court has endorsed their limited use to spur student diversity.

With racial preferences under attack, the shift to socioeconomic preferences has begun.

Sadly, there is no reason to believe that such programs will bring major positive changes. For one thing, the policies can be easily “gamed”—deliberately living in a bad neighborhood could add points toward admission.

We need to step back and consider the larger picture: The “top” schools get the best students because getting into a highly ranked college has become a mania of the middle class, as Andrew Ferguson described in his book “Crazy U.”

Furthermore, this middle- and upper-class competition illustrates a phenomenon recorded by Charles Murray in his 2012 book,“Coming Apart,” a study of the growing cultural divide between white people of different classes.  He found a growing split between people in well-educated, high-earning communities (which he labeled “Belmont”) and people in poorer communities (which he labeled “Fishtown”).

The well-off residents of Belmont instill in their children disciplined behavior that enables them to learn effectively and make progress toward career goals. The resulting habits make their children prime candidates for selective schools. Meanwhile, the residents of Fishtown are routinely experiencing socially harmful behaviors—such as dropping out of high school and having children without being married—and lacking discipline from either strict parents or demanding jobs. Good students in Fishtown are lucky to enter any college.

Yes, there are deserving students who try hard in Fishtown, and those students might benefit from socioeconomic preferences. But tailoring admissions standards to bring them into elite colleges is not the way to go.

Instead, colleges (with support from private donors) could increase access simply by expanding their recruitment visits. As Caroline Hoxby and Christopher Avery pointed out in the 2013 Brookings study that sparked many of the concerns about high-achieving, low-income students, one of the biggest problems is finding the students in the first place. They are scattered in out-of-the-way schools, where no college bothers to send a recruiter and no guidance counselor knows how to help them.

A little more recruitment effort, not social engineering, will bring in students who are being left out of selective colleges.

Jane S. Shaw (think@heartland.org) is the higher education editor of School Reform News and chair of the James G. Martin Center for Academic Renewal.

available in data_random_forests.txtfor analysis:

Separate the data into three classes:

Split the data into training and testing datasets:

Specify the grid of parameters that you want the classifier to test. Usually, we keep one parameter constant and vary the other parameter. We then do it vice versa to figure out the best combination. In this case, we want to find the best values for n_estimators and max_depth. Let’s specify the parameter grid:

Let’s define the metrics that the classifier should use to find the best combination of parameters:

For each metric, we need to run the grid search, where we train the classifier for a particular combination of parameters:

Print the score for each parameter combination:

Print the performance report:

The full code is given in the file run_grid_search.py. If you run the code, you will get this output on the Terminal for the precision metric:

My First Machine Learning Project: Designing a Hate Speech Detecting Algorithm

Machine Learning and Hate Speech Detection

Go to the profile of Yoo Beyoung Woo(류병우)

Greetings, ladies and gentlemen! I’m 류병우(Yoo Beyoung Woo), an aspiring amateur data scientist who likes conducting projects involving data analysis or machine learning. In this post, I’m going to share a project that I’ve been recently working on: building a hate speech detecting artificial intelligence. I’ve never made an artificial intelligence program before, and since hate-speech-detection is one of the most basic projects…

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Ensemble Learning In Artificial Intelligence

Ensemble Learning refers to the process of building multiple models and then combining them in a way that can produce better results than individual models.

Visualisation in Python


Getting started with Visualizations in Python

Go to the profile of Pranjal Gupta

Pranjal GuptaFollowingMay 1

Photo by M. B. M. on Unsplash

Visualizing anything gives us a better understanding, a holistic picture of things, be it the monthly turn over of your company, the increasing temperature, or even tensed situations where you could have outrun everyone else, believe me, the later one works.

The aim of art is to represent, not the outward appearance of things, but their inward significance. 
 — Aristotle

Visualization is an art, it does not just represent the data better, but it actually pictures the trends, the patterns and other signs that are hidden deep within the data, and can’t be figured out just staring at the data.

It’s one of the crucial arts’ that need to be mastered by anyone who wants to pursue Data Science, without which you’ll be incomplete, your assignments, your tasks will be incomplete especially when you turn up to someone to explain, Why did this Happen?

Let’s have a look at some of the most common plots;


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Linda Kinstler | Longreads | May 2019 | 10 minutes (2,527 words)

How does one recognize catastrophe, when it comes? What does it look like, how does it sound and smell? If it is an invisible catastrophe, how can you know when you are near it, and when you are far away? And what if it is an everlasting catastrophe, a disaster with a long half-life, so no matter how much time passes, it never quite goes away, and in some places, it only grows stronger? And when a decision from on high announces that it is time to try to move past it, to lay a wreath and get on with life, how does one mark the anniversary of a disaster still in motion, a crisis without end?

Last week marked yet another anniversary of the explosion of the Vladimir I. Lenin Nuclear Power Station’s Reactor No. 4. Thirty-three years ago, in the early hours of the morning on April 26, 1986, an ill-fated safety test unleashed an explosion equivalent to sixty tons of TNT, obliterating the reactor and sending the contents of its core — uranium fuel, graphite, zirconium, and a noxious mixture of radioactive gases — into the surrounding air, water, and earth.

The event has often been described as an unprecedented nuclear disaster, given that its effects imperiled vast swathes of the global population and threatened to make much of present-day Belarus and Ukraine uninhabitable. The word “Chernobyl” itself has become a metonym for a certain kind of calamity, one that unfolds dramatically, all at once, yet also unwinds silently and slowly, unleashing its litany of misfortunes upon the world at an epochal speed and scale. The paradox of Chernobyl, the same paradox that cripples all climatic calamities, is that it exists on several time scales at once. Some people, animals, and things process chronic exposure to radioactivity more swiftly than others; pine trees are more susceptible than birch trees, barn swallows more vulnerable than other birds, and winter wheat seeds are far more likely to reproduce contamination than soybeans, which alter their molecular composition to protect themselves from radiation. Chernobyl, as it’s most famous chronicler Svetlana Alexievich writes, “is above all a catastrophe of time.”

Its anniversaries, then, tend to reflect its paradoxical nature; they force the difficult question of how a city, a country, and the global community can commemorate an ongoing catastrophe, especially when its principle causes and effects remain partially obscured. The first anniversary of Chernobyl, in April 1986, marked the launch of a Soviet counterpropaganda campaign to contain negative foreign press reports about the scale of the damage and the risks that remained. The intended effect was not to suggest that the disaster never happened, but rather that it was over and the world could move on. On the second anniversary, Valery Legasov, one of the lead scientists tasked with investigating and mitigating the consequences of the disaster, recorded his final testimony about its causes and cover-up and hanged himself in his Moscow apartment. In 2011, the 25th anniversary, the Ukrainian government prepared to open the Chernobyl Exclusion Zone as a tourist attraction; in 2016, three decades after the explosion, an international team of architects slid a new, sparkling, steel sarcophagus called the New Safe Confinement over the remains of Reactor Number Four, and the Ukrainian president signed a decree designating the radiated and abandoned lands surrounding the nuclear site a UNESCO Biosphere Reserve. An outgrowth of the UN environmental agency’s “Man and Biosphere” Program, the decree was part of an attempt reconcile humanity with its ruined environment, to fit man back into nature, to see if each can survive the other. The terrain would be “re-wilded,” its fauna recovered and conserved. Environmentalists hoped that this process would give the land “a chance to naturally rewind,” to undo its unfortunate history, to erase the final traces of the events of 1986.

How does one mark the anniversary of a disaster still in motion, a crisis without end?

This year’s anniversary, marked by a trio of new documentary and historical projects, feels different, and perhaps somewhat darker, than many of those that have come before. These new accounts of Chernobyl disabuse their audiences of the notion that the earth can ever “naturally rewind.” They uncover its hidden history and its lingering effects, and though they take very different approaches to telling its story, each portrays Chernobyl as a harbinger of environmental catastrophes to come. Moreover, these three new accounts of Chernobyl each offer their own answer to a literary question that may very well determine how long our planet remains hospitable to human life: What narrative form can adequately capture the planetary stakes of an invisible, climatic disaster, one that threatens everything and everyone and will never burn itself out?

Journalist Adam Higginbotham’s Midnight in Chernobyl: The Untold Story of the World’s Greatest Nuclear Disaster is a deeply reported and entirely accessible tick-tock account of the meltdown and the days and weeks that followed. His book, which opens with a series of maps and a cast of characters, often reads like a dramatic screenplay (and should win some kind of award for its first line: “Senior Lieutenant Alexander Logachev loved radiation the way other men loved their wives”). His account captures the dreary, silent calm that preceded the explosion; in the reactor control room, the deputy chief is exhausted and unhappy, the scheduled safety test yet to begin. And then there is terror, chaos, and confusion — no one can believe that the reactor core has exploded, and so one by one, these men march to their deaths, simply to see it for themselves.

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Midnight in Chernobyl is a tale in two parts: the first, “The birth of a city,” describes the construction of Chernobyl and the aggressive scale and scope of the Soviet nuclear project, until the night when it all comes undone. Part two, the “death of an empire,” documents the rushed efforts to avert doomsday scenarios. The cleanup effort, in Higginbotham’s telling, is dubbed “The Battle of Chernobyl,” a containment effort that required nearly the whole strength of the Soviet armed forces, a campaign that turned the exclusion zone into a “radioactive battlefield encircled by a besieging army.” Five men are put on trial for a breach of safety regulations “resulting in a loss of life at an explosion-prone plant,” which Higginbotham points out, is “an inventive legal gambit — never before had Soviet jurists considered a nuclear power station an installation likely to explode.” A few years later, the ones who don’t die in prison are set free, their sentences annulled, “since the state responsible for imposing [them] no longer existed.”

Chroniclers of Chernobyl have often been tempted to portray it as a catalyst for the collapse of the Soviet Union. The disaster strained Mikhail Gorbachev’s program of “openness,” and presented his government with a virtually insurmountable health, environmental, and political crisis. Belief in the system made it impossible to believe that the system could fail. “Our faith in Soviet socialism will always be rewarded,” an elder statesman admonishes a group of Soviet bureaucrats gathered in a Pripyat bunker in HBO’s forthcoming drama miniseries, Chernobyl. “The state tells us the situation here is not dangerous. Listen well.” In a later episode, a trio of soldiers tasked with hunting and killing irradiated house pets takes their lunch break in front of an abandoned building marked with a banner that reads: “Our goal: Happiness for all!”


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The series, written by Craig Mazin, follows a similar script as Midnight in Chernobyl, taking viewers from the control room of Reactor Number Four to the meeting rooms of the Kremlin — in neither space can the men believe that the reactor core exploded, so Gorbachev dispatches his deputy Boris Shcherbina (played by Stellan Skarsgård) to go to Ukraine and peer into the abyss. The first three episodes depict the grim explosion, the hushed evacuation of the residents of Chernobyl and the neighboring town, Pripyat, and the anguished cries of the firefighters sent to extinguish the radioactive flames as they lie in their Moscow hospital beds and their skin melts into their sheets. (Everyone speaks with British accents; casting director Nina Gold searched London for “Chernobylly type[s].”) Jared Harris delivers an emotional performance as Legasov, who has the unhappy role of telling Gorbachev the bad news. “An RBMK reactor uses Uranium-235 as fuel,” he tells the general secretary. “Every atom of U-235 is like a bullet, traveling at nearly the speed of light, penetrating everything in its path, woods, metal, concrete…Every gram holds a billion, trillion bullets. That’s in one gram. Chernobyl holds over 3 million grams, and right now it is on fire. Most of these bullets won’t stop firing for 100 years.”

Perhaps that’s the way to convey the danger of climatic catastrophe, to render it in terms of more familiar threats. Both Higginbotham and Mazin choose to depict Chernobyl as a singular event, another dark episode of history. They document the dramatic eruption of uranium bullets, yet only begin to trace what happens when and where they land. That work is left to the historian Kate Brown, whose new book, Manual for Survival: A Chernobyl Guide To The Future, takes the form of an epistemological quest, an effort to document the true extent of the damage Chernobyl wrought: “I set out to substantiate every claim, cross-reference it, and use the archives as my guide,” Brown writes. Her goal, “to provide a better guide to survive nuclear disaster,” is informed by her conviction that “underestimating Chernobyl damage has left humans unprepared for the next disaster.” Looking into the past, Brown traces the acceleration of the environmental fragility and societal precarity that will define generations to come.

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Her slow, elegant approach to capturing the true nature of the disaster is starkly at odds with that of Mazin and Higginbotham. Like most of Brown’s work, Manual for Survival is concerned above all with the status of the archive, with the difficulty of preserving invisible damage and discerning the truth from shelves full of lies. The Soviet apparatus went to great lengths to cover up the extent of the disaster, yet some citizens took it upon themselves to document it all the same, and it is their work that Brown champions and upon which her findings rely.

In Brown’s telling, it becomes abundantly clear that Chernobyl cannot be described as a domestic incident, and neither can its cover up. While it is true that Soviet propaganda “was written into governance, into the warp and weave of daily life,” she underscores that Soviet scientists were far more familiar with the effects of radiation poisoning than their western counterparts, some of whom, in the decades following the disaster, would arrive like white knights in Kyiv and Moscow only to make matters worse. Foreign experts, like many Soviet politicians, considerably downplayed the toxicity and extent of the radiation exposure, in no small part because information about previous nuclear accidents was either classified, missing, or faulty. Brown elaborates upon the inner workings of foreign agencies in order to “spotlight the arsenal of tactics scientific administrators deployed to make the reports of a wide range of health problems in the Chernobyl territories go away,” she writes. “They drew from a well-known toolbox of tactics familiar from controversies surrounding lead, tobacco, and chemical toxins. The playbook was rich and varied: classify data, limit questions, stonewall investigations, block funding for research, sponsor rival studies, relate dangers to ‘natural’ risks, draw up study protocols designed to find nothing but catastrophic effects.” Admit only what cannot be denied. “The politics of science surrounding Chernobyl,” she explains, “shows how people who were paid to produce knowledge generated instead a lasting ignorance.”

Manual for Survival’ is concerned above all with the status of the archive, with the difficulty of preserving invisible damage and discerning the truth from shelves full of lies.

Then as now, part of that ignorance is historical: Chernobyl was neither the first disaster to strike the land beneath it, nor did it unleash a truly unprecedented amount of radiation into the atmosphere — that honor is shared jointly among Cold War nations, whose nuclear weapons tests collectively released radioactive emissions a thousand times worse than those from Chernobyl. “In this global context, Chernobyl wasn’t the largest nuclear emergency in human history,” Brown writes. Instead, she claims, the disaster “was just a waving red flag pointing to other disasters hidden by Cold War national security regimes.” It was not an accident nor a singular event, but rather “a point on a continuum” of exposures, “an acceleration on a time line of destruction or as an exclamation point in a chain of toxic exposures that restructured the landscape, bodies, and politics.”

Chernobyl, in this sense, is a crisis that has never stopped unfolding, or as Brown puts it, it is a calamity “with no perceptible end.” It is just as much an environmental disaster as a crisis of information; Cold War politics prevented the free exchange of scientific knowledge, making a bad situation infinitely worse. Brown explains how, in 1986, Russian scientists asked UN officials for “precise information” about how the “Life Span Study” of Japanese survivors of the nuclear bomb was carried out; they were instead presented with data about a chemical explosion in Italy. Likewise, when US television networks aired footage of what was purportedly the burning Chernobyl plant, “the shots were actually of a fire at a cement factor in Trieste, Italy.” Manual for Survival has been met with strident criticism from some sectors of the scientific community, particularly from the physicists and environmentalists whose methods she criticizes. They argue that she misunderstands how radiation impacts the body, that she mischaracterizes their research, and take issue, in particular, with her reliance upon the research of the Belarusian scientist Yury Bandazhevsky, who in 1989 founded the first institute to study the impact of the disaster in the country it hit the hardest. These responses to Brown’s work seem to almost make her point for her, underscoring how the scientific community continues to overlook and undermine unorthodox sources of knowledge. Scientists, like storytellers, are hardly immune to “fuzziness of memory,” she writes. The bodies, trees, and berries she comes across in Ukraine and Belarus betray the long-term impacts of radiation, even if their condition has not been peer-reviewed.

Underestimating the damage, and clinging to the false hope that a similar catastrophe could never unfold in an “open, democratic society,” Brown claims, “left humans unprepared for the next disaster.” Following the Fukushima nuclear disaster in 2011, “Japanese businesspeople and political leaders responded in ways eerily similar to Soviet leaders,” she writes. They obfuscated the scale of the damage and dismissed concerns over health and safety, Brown writes. “Without a better understanding of Chernobyl’s consequences, humans get stuck in an eternal video loop, the same scene playing over and over.” Manual for Survival is a guide to breaking free of this bleak, recursive story, an attempt at decelerating the frequency of exposures. Unlike Soviet manuals for life after Chernobyl, Brown’s book comes with a single recommendation: if we are to survive, not only must we educate ourselves about the full extent of the danger ahead, but also, and most importantly, we must understand that we are already living with our mistakes.

* * *

Linda Kinstler is a writer based in Berkeley, California. Her writing appears in The AtlanticThe Guardian Long ReadThe 

Truth About Dentistry

Truth About Dentistry

It’s much less scientific—and more prone to gratuitous procedures—than you may think.

Arsh Raziuddin

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In the early 2000s Terry Mitchell’s dentist retired. For a while, Mitchell, an electrician in his 50s, stopped seeking dental care altogether. But when one of his wisdom teeth began to ache, he started looking for someone new. An acquaintance recommended John Roger Lund, whose practice was a convenient 10-minute walk from Mitchell’s home, in San Jose, California. Lund’s practice was situated in a one-story building with clay roof tiles that housed several dental offices. The interior was a little dated, but not dingy. The waiting room was small and the decor minimal: some plants and photos, no fish. Lund was a good-looking middle-aged guy with arched eyebrows, round glasses, and graying hair that framed a youthful face. He was charming, chatty, and upbeat. At the time, Mitchell and Lund both owned Chevrolet Chevelles, and they bonded over their mutual love of classic cars.

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Lund extracted the wisdom tooth with no complications, and Mitchell began seeing him regularly. He never had any pain or new complaints, but Lund encouraged many additional treatments nonetheless. A typical person might get one or two root canals in a lifetime. In the space of seven years, Lund gave Mitchell nine root canals and just as many crowns. Mitchell’s insurance covered only a small portion of each procedure, so he paid a total of about $50,000 out of pocket. The number and cost of the treatments did not trouble him. He had no idea that it was unusual to undergo so many root canals—he thought they were just as common as fillings. The payments were spread out over a relatively long period of time. And he trusted Lund completely. He figured that if he needed the treatments, then he might as well get them before things grew worse.

Meanwhile, another of Lund’s patients was going through a similar experience. Joyce Cordi, a businesswoman in her 50s, had learned of Lund through 1-800-DENTIST. She remembers the service giving him an excellent rating. When she visited Lund for the first time, in 1999, she had never had so much as a cavity. To the best of her knowledge her teeth were perfectly healthy, although she’d had a small dental bridge installed to fix a rare congenital anomaly (she was born with one tooth trapped inside another and had had them extracted). Within a year, Lund was questioning the resilience of her bridge and telling her she needed root canals and crowns.

Cordi was somewhat perplexed. Why the sudden need for so many procedures after decades of good dental health? When she expressed uncertainty, she says, Lund always had an answer ready. The cavity on this tooth was in the wrong position to treat with a typical filling, he told her on one occasion. Her gums were receding, which had resulted in tooth decay, he explained during another visit. Clearly she had been grinding her teeth. And, after all, she was getting older. As a doctor’s daughter, Cordi had been raised with an especially respectful view of medical professionals. Lund was insistent, so she agreed to the procedures. Over the course of a decade, Lund gave Cordi 10 root canals and 10 crowns. He also chiseled out her bridge, replacing it with two new ones that left a conspicuous gap in her front teeth. Altogether, the work cost her about $70,000.A masked figure looms over your recumbent body, wielding power tools and sharp metal instruments, doing things to your mouth you cannot see.

In early 2012, Lund retired. Brendon Zeidler, a young dentist looking to expand his business, bought Lund’s practice and assumed responsibility for his patients. Within a few months, Zeidler began to suspect that something was amiss. Financial records indicated that Lund had been spectacularly successful, but Zeidler was making only 10 to 25 percent of Lund’s reported earnings each month. As Zeidler met more of Lund’s former patients, he noticed a disquieting trend: Many of them had undergone extensive dental work—a much larger proportion than he would have expected. When Zeidler told them, after routine exams or cleanings, that they didn’t need any additional procedures at that time, they tended to react with surprise and concern: Was he sure? Nothing at all? Had he checked thoroughly?

In the summer, Zeidler decided to take a closer look at Lund’s career. He gathered years’ worth of dental records and bills for Lund’s patients and began to scrutinize them, one by one. The process took him months to complete. What he uncovered was appalling.

We have a fraught relationship with dentists as authority figures. In casual conversation we often dismiss them as “not real doctors,” regarding them more as mechanics for the mouth. But that disdain is tempered by fear. For more than a century, dentistry has been half-jokingly compared to torture. Surveys suggest that up to 61 percent of people are apprehensive about seeing the dentist, perhaps 15 percent are so anxious that they avoid the dentist almost entirely, and a smaller percentage have a genuine phobia requiring psychiatric intervention.

When you’re in the dentist’s chair, the power imbalance between practitioner and patient becomes palpable. A masked figure looms over your recumbent body, wielding power tools and sharp metal instruments, doing things to your mouth you cannot see, asking you questions you cannot properly answer, and judging you all the while. The experience simultaneously invokes physical danger, emotional vulnerability, and mental limpness. A cavity or receding gum line can suddenly feel like a personal failure. When a dentist declares that there is a problem, that something must be done before it’s too late, who has the courage or expertise to disagree? When he points at spectral smudges on an X-ray, how are we to know what’s true? In other medical contexts, such as a visit to a general practitioner or a cardiologist, we are fairly accustomed to seeking a second opinion before agreeing to surgery or an expensive regimen of pills with harsh side effects. But in the dentist’s office—perhaps because we both dread dental procedures and belittle their medical significance—the impulse is to comply without much consideration, to get the whole thing over with as quickly as possible.

The uneasy relationship between dentist and patient is further complicated by an unfortunate reality: Common dental procedures are not always as safe, effective, or durable as we are meant to believe. As a profession, dentistry has not yet applied the same level of self-scrutiny as medicine, or embraced as sweeping an emphasis on scientific evidence. “We are isolated from the larger health-care system. So when evidence-based policies are being made, dentistry is often left out of the equation,” says Jane Gillette, a dentist in Bozeman, Montana, who works closely with the American Dental Association’s Center for Evidence-Based Dentistry, which was established in 2007. “We’re kind of behind the times, but increasingly we are trying to move the needle forward.”

Consider the maxim that everyone should visit the dentist twice a year for cleanings. We hear it so often, and from such a young age, that we’ve internalized it as truth. But this supposed commandment of oral health has no scientific grounding. Scholars have traced its origins to a few potential sources, including a toothpaste advertisement from the 1930s and an illustrated pamphlet from 1849 that follows the travails of a man with a severe toothache. Today, an increasing number of dentists acknowledge that adults with good oral hygiene need to see a dentist only once every 12 to 16 months.

Many standard dental treatments—to say nothing of all the recent innovations and cosmetic extravagances—are likewise not well substantiated by research. Many have never been tested in meticulous clinical trials. And the data that are available are not always reassuring.

The Cochrane organization, a highly respected arbiter of evidence-based medicine, has conducted systematic reviews of oral-health studies since 1999. In these reviews, researchers analyze the scientific literature on a particular dental intervention, focusing on the most rigorous and well-designed studies. In some cases, the findings clearly justify a given procedure. For example, dental sealants—liquid plastics painted onto the pits and grooves of teeth like nail polish—reduce tooth decay in children and have no known risks. (Despite this, they are not widely used, possibly because they are too simple and inexpensive to earn dentists much money.) But most of the Cochrane reviews reach one of two disheartening conclusions: Either the available evidence fails to confirm the purported benefits of a given dental intervention, or there is simply not enough research to say anything substantive one way or another.

Fluoridation of drinking water seems to help reduce tooth decay in children, but there is insufficient evidence that it does the same for adults. Some data suggest that regular flossing, in addition to brushing, mitigates gum disease, but there is only “weak, very unreliable” evidence that it combats plaque. As for common but invasive dental procedures, an increasing number of dentists question the tradition of prophylactic wisdom-teeth removal; often, the safer choice is to monitor unproblematic teeth for any worrying developments. Little medical evidence justifies the substitution of tooth-colored resins for typical metal amalgams to fill cavities. And what limited data we have don’t clearly indicate whether it’s better to repair a root-canaled tooth with a crown or a filling. When Cochrane researchers tried to determine whether faulty metal fillings should be repaired or replaced, they could not find a single study that met their standards.

“The body of evidence for dentistry is disappointing,” says Derek Richards, the director of the Centre for Evidence-Based Dentistry at the University of Dundee, in Scotland. “Dentists tend to want to treat or intervene. They are more akin to surgeons than they are to physicians. We suffer a little from that. Everybody keeps fiddling with stuff, trying out the newest thing, but they don’t test them properly in a good-quality trial.”

The general dearth of rigorous research on dental interventions gives dentists even more leverage over their patients. Should a patient somehow muster the gumption to question an initial diagnosis and consult the scientific literature, she would probably not find much to help her. When we submit to a dentist’s examination, we are putting a great deal of trust in that dentist’s experience and intuition—and, of course, integrity.

when zeidler purchased lund’s practice, in February 2012, he inherited a massive collection of patients’ dental histories and bills, a mix of electronic documents, handwritten charts, and X‑rays. By August, Zeidler had decided that if anything could explain the alarmingly abundant dental work in the mouths of Lund’s patients, he would find it in those records. He spent every weekend for the next nine months examining the charts of hundreds of patients treated in the preceding five years. In a giant Excel spreadsheet, he logged every single procedure Lund had performed, so he could carry out some basic statistical analyses.

The numbers spoke for themselves. Year after year, Lund had performed certain procedures at extraordinarily high rates. Whereas a typical dentist might perform root canals on previously crowned teeth in only 3 to 7 percent of cases, Lund was performing them in 90 percent of cases. As Zeidler later alleged in court documents, Lund had performed invasive, costly, and seemingly unnecessary procedures on dozens and dozens of patients, some of whom he had been seeing for decades. Terry Mitchell and Joyce Cordi were far from alone. In fact, they had not even endured the worst of it.Whereas medicine has reckoned with some of its own tendencies toward excessive and misguided treatment, dentistry has lagged behind.

Dental crowns were one of Lund’s most frequent treatments. A crown is a metal or ceramic cap that completely encases an injured or decayed tooth, which is first shaved to a peg so its new shell will fit. Crowns typically last 10 to 15 years. Lund not only gave his patients superfluous crowns; he also tended to replace them every five years—the minimum interval of time before insurance companies will cover the procedure again.

More than 50 of Lund’s patients also had ludicrously high numbers of root canals: 15, 20, 24. (A typical adult mouth has 32 teeth.) According to one lawsuit that has since been settled, a woman in her late 50s came to Lund with only 10 natural teeth; from 2003 to 2010, he gave her nine root canals and 12 crowns. The American Association of Endodontists claims that a root canal is a “quick, comfortable procedure” that is “very similar to a routine filling.” In truth, a root canal is a much more radical operation than a filling. It takes longer, can cause significant discomfort, and may require multiple trips to a dentist or specialist. It’s also much more costly.

Read: Americans are going to Juarez for cheap dental care

Root canals are typically used to treat infections of the pulp—the soft living core of a tooth. A dentist drills a hole through a tooth in order to access the root canals: long, narrow channels containing nerves, blood vessels, and connective tissue. The dentist then repeatedly twists skinny metal files in and out of the canals to scrape away all the living tissue, irrigates the canals with disinfectant, and packs them with a rubberlike material. The whole process usually takes one to two hours. Afterward, sometimes at a second visit, the dentist will strengthen the tooth with a filling or crown. In the rare case that infection returns, the patient must go through the whole ordeal again or consider more advanced surgery.

Zeidler noticed that nearly every time Lund gave someone a root canal, he also charged for an incision and drainage, known as an I&D. During an I&D, a dentist lances an abscess in the mouth and drains the exudate, all while the patient is awake. In some cases the dentist slips a small rubber tube into the wound, which continues to drain fluids and remains in place for a few days. I&Ds are not routine adjuncts to root canals. They should be used only to treat severe infections, which occur in a minority of cases. Yet they were extremely common in Lund’s practice. In 2009, for example, Lund billed his patients for 109 I&Ds. Zeidler asked many of those patients about the treatments, but none of them recalled what would almost certainly have been a memorable experience.

In addition to performing scores of seemingly unnecessary procedures that could result in chronic pain, medical complications, and further operations, Lund had apparently billed patients for treatments he had never administered. Zeidler was alarmed and distressed. “We go into this profession to care for patients,” he told me. “That is why we become doctors. To find, I felt, someone was doing the exact opposite of that—it was very hard, very hard to accept that someone was willing to do that.”

Zeidler knew what he had to do next. As a dental professional, he had certain ethical obligations. He needed to confront Lund directly and give him the chance to account for all the anomalies. Even more daunting, in the absence of a credible explanation, he would have to divulge his discoveries to the patients Lund had bequeathed to him. He would have to tell them that the man to whom they had entrusted their care—some of them for two decades—had apparently deceived them for his own profit.

Arsh Raziuddin

the idea of the dentist as potential charlatan has a long and rich history. In medieval Europe, barbers didn’t just trim hair and shave beards; they were also surgeons, performing a range of minor operations including bloodletting, the administration of enemas, and tooth extraction. Barber surgeons, and the more specialized “tooth drawers,” would wrench, smash, and knock teeth out of people’s mouths with an intimidating metal instrument called a dental key: Imagine a chimera of a hook, a hammer, and forceps. Sometimes the results were disastrous. In the 1700s, Thomas Berdmore, King George III’s “Operator for the Teeth,” described one woman who lost “a piece of jawbone as big as a walnut and three neighbouring molars” at the hands of a local barber.

Barber surgeons came to America as early as 1636. By the 18th century, dentistry was firmly established in the colonies as a trade akin to blacksmithing (Paul Revere was an early American craftsman of artisanal dentures). Itinerant dentists moved from town to town by carriage with carts of dreaded tools in tow, temporarily setting up shop in a tavern or town square. They yanked teeth or bored into them with hand drills, filling cavities with mercury, tin, gold, or molten lead. For anesthetic, they used arsenic, nutgalls, mustard seed, leeches. Mixed in with the honest tradesmen—who genuinely believed in the therapeutic power of bloodsucking worms—were swindlers who urged their customers to have numerous teeth removed in a single sitting or charged them extra to stuff their pitted molars with homemade gunk of dubious benefit.

In the mid-19th century, a pair of American dentists began to elevate their trade to the level of a profession. From 1839 to 1840, Horace Hayden and Chapin Harris established dentistry’s first college, scientific journal, and national association. Some historical accounts claim that Hayden and Harris approached the University of Maryland’s School of Medicine about adding dental instruction to the curriculum, only to be rebuffed by the resident physicians, who declared that dentistry was of little consequence. But no definitive proof of this encounter has ever surfaced.

Whatever happened, from that point on, “the professions of dentistry and medicine would develop along separate paths,” writes Mary Otto, a health journalist, in her recent book, Teeth. Becoming a practicing physician requires four years of medical school followed by a three-to-seven-year residency program, depending on the specialty. Dentists earn a degree in four years and, in most states, can immediately take the national board exams, get a license, and begin treating patients. (Some choose to continue training in a specialty, such as orthodontics or oral and maxillofacial surgery.) When physicians complete their residency, they typically work for a hospital, university, or large health-care organization with substantial oversight, strict ethical codes, and standardized treatment regimens. By contrast, about 80 percent of the nation’s 200,000 active dentists have individual practices, and although they are bound by a code of ethics, they typically don’t have the same level of oversight.

Read: Why dentistry is separate from medicine

Throughout history, many physicians have lamented the segregation of dentistry and medicine. Acting as though oral health is somehow divorced from one’s overall well-being is absurd; the two are inextricably linked. Oral bacteria and the toxins they produce can migrate through the bloodstream and airways, potentially damaging the heart and lungs. Poor oral health is associated with narrowing arteries, cardiovascular disease, stroke, and respiratory disease, possibly due to a complex interplay of oral microbes and the immune system. And some research suggests that gum disease can be an early sign of diabetes, indicating a relationship between sugar, oral bacteria, and chronic inflammation.

Dentistry’s academic and professional isolation has been especially detrimental to its own scientific inquiry. Most major medical associations around the world have long endorsed evidence-based medicine. The idea is to shift focus away from intuition, anecdote, and received wisdom, and toward the conclusions of rigorous clinical research. Although the phrase evidence-based medicine was coined in 1991, the concept began taking shape in the 1960s, if not earlier (some scholars trace its origins all the way back to the 17th century). In contrast, the dental community did not begin having similar conversations until the mid-1990s. There are dozens of journals and organizations devoted to evidence-based medicine, but only a handful devoted to evidence-based dentistry.

In the past decade, a small cohort of dentists has worked diligently to promote evidence-based dentistry, hosting workshops, publishing clinical-practice guidelines based on systematic reviews of research, and creating websites that curate useful resources. But its adoption “has been a relatively slow process,” as a 2016 commentary in the Contemporary Clinical Dentistry journal put it. Part of the problem is funding: Because dentistry is often sidelined from medicine at large, it simply does not receive as much money from the government and industry to tackle these issues. “At a recent conference, very few practitioners were even aware of the existence of evidence-based clinical guidelines,” says Elliot Abt, a professor of oral medicine at the University of Illinois. “You can publish a guideline in a journal, but passive dissemination of information is clearly not adequate for real change.”

Among other problems, dentistry’s struggle to embrace scientific inquiry has left dentists with considerable latitude to advise unnecessary procedures—whether intentionally or not. The standard euphemism for this proclivity is overtreatment. Favored procedures, many of which are elaborate and steeply priced, include root canals, the application of crowns and veneers, teeth whitening and filing, deep cleaning, gum grafts, fillings for “microcavities”—incipient lesions that do not require immediate treatment—and superfluous restorations and replacements, such as swapping old metal fillings for modern resin ones. Whereas medicine has made progress in reckoning with at least some of its own tendencies toward excessive and misguided treatment, dentistry is lagging behind. It remains “largely focused upon surgical procedures to treat the symptoms of disease,” Mary Otto writes. “America’s dental care system continues to reward those surgical procedures far more than it does prevention.”

“Excessive diagnosis and treatment are endemic,” says Jeffrey H. Camm, a dentist of more than 35 years who wryly described his peers’ penchant for “creative diagnosis” in a 2013 commentary published by the American Dental Association. “I don’t want to be damning. I think the majority of dentists are pretty good.” But many have “this attitude of ‘Oh, here’s a spot, I’ve got to do something.’ I’ve been contacted by all kinds of practitioners who are upset because patients come in and they already have three crowns, or 12 fillings, or another dentist told them that their 2-year-old child has several cavities and needs to be sedated for the procedure.”

Trish Walraven, who worked as a dental hygienist for 25 years and now manages a dental-software company with her husband in Texas, recalls many troubling cases: “We would see patients seeking a second opinion, and they had treatment plans telling them they need eight fillings in virgin teeth. We would look at X-rays and say, ‘You’ve got to be kidding me.’ It was blatantly overtreatment—drilling into teeth that did not need it whatsoever.”Joyce Cordi’s new dentist says her X-rays resemble those of someone who had reconstructive facial surgery following a car crash.

Studies that explicitly focus on overtreatment in dentistry are rare, but a recent field experiment provides some clues about its pervasiveness. A team of researchers at ETH Zurich, a Swiss university, asked a volunteer patient with three tiny, shallow cavities to visit 180 randomly selected dentists in Zurich. The Swiss Dental Guidelines state that such minor cavities do not require fillings; rather, the dentist should monitor the decay and encourage the patient to brush regularly, which can reverse the damage. Despite this, 50 of the 180 dentists suggested unnecessary treatment. Their recommendations were incongruous: Collectively, the overzealous dentists singled out 13 different teeth for drilling; each advised one to six fillings. Similarly, in an investigation for Reader’s Digest, the writer William Ecenbarger visited 50 dentists in 28 states in the U.S. and received prescriptions ranging from a single crown to a full-mouth reconstruction, with the price tag starting at about $500 and going up to nearly $30,000.

A multitude of factors has conspired to create both the opportunity and the motive for widespread overtreatment in dentistry. In addition to dentistry’s seclusion from the greater medical community, its traditional emphasis on procedure rather than prevention, and its lack of rigorous self-evaluation, there are economic explanations. The financial burden of entering the profession is high and rising. In the U.S., the average debt of a dental-school graduate is more than $200,000. And then there’s the expense of finding an office, buying new equipment, and hiring staff to set up a private practice. A dentist’s income is entirely dependent on the number and type of procedures he or she performs; a routine cleaning and examination earns only a baseline fee of about $200.

In parallel with the rising cost of dental school, the amount of tooth decay in many countries’ populations has declined dramatically over the past four decades, mostly thanks to the introduction of mass-produced fluoridated toothpaste in the 1950s and ’60s. In the 1980s, with fewer genuine problems to treat, some practitioners turned to the newly flourishing industry of cosmetic dentistry, promoting elective procedures such as bleaching, teeth filing and straightening, gum lifts, and veneers. It’s easy to see how dentists, hoping to buoy their income, would be tempted to recommend frequent exams and proactive treatments—a small filling here, a new crown there—even when waiting and watching would be better. It’s equally easy to imagine how that behavior might escalate.

“If I were to sum it up, I really think the majority of dentists are great. But for some reason we seem to drift toward this attitude of ‘I’ve got tools so I’ve got to fix something’ much too often,” says Jeffrey Camm. “Maybe it’s greed, or paying off debt, or maybe it’s someone’s training. It’s easy to lose sight of the fact that even something that seems minor, like a filling, involves removal of a human body part. It just adds to the whole idea that you go to a physician feeling bad and you walk out feeling better, but you go to a dentist feeling good and you walk out feeling bad.”

B

in the summer of 2013, Zeidler asked several other dentists to review Lund’s records. They all agreed with his conclusions. The likelihood that Lund’s patients genuinely needed that many treatments was extremely low. And there was no medical evidence to justify many of Lund’s decisions or to explain the phantom procedures. Zeidler confronted Lund about his discoveries in several face-to-face meetings. When I asked Zeidler how those meetings went, he offered a single sentence—“I decided shortly thereafter to take legal action”—and declined to comment further. (Repeated attempts were made to contact Lund and his lawyer for this story, but neither responded.)

One by one, Zeidler began to write, call, or sit down with patients who had previously been in Lund’s care, explaining what he had uncovered. They were shocked and angry. Lund had been charismatic and professional. They had assumed that his diagnoses and treatments were meant to keep them healthy. Isn’t that what doctors do? “It makes you feel like you have been violated,” Terry Mitchell says—“somebody performing stuff on your body that doesn’t need to be done.” Joyce Cordi recalls a “moment of absolute fury” when she first learned of Lund’s deceit. On top of all the needless operations, “there were all kinds of drains and things that I paid for and the insurance company paid for that never happened,” she says. “But you can’t read the dentalese.”

“A lot of them felt, How can I be so stupid? Or Why didn’t I go elsewhere?” Zeidler says. “But this is not about intellect. It’s about betrayal of trust.”

In October 2013, Zeidler sued Lund for misrepresenting his practice and breaching their contract. In the lawsuit, Zeidler and his lawyers argued that Lund’s reported practice income of $729,000 to $988,000 a year was “a result of fraudulent billing activity, billing for treatment that was unnecessary and billing for treatment which was never performed.” The suit was settled for a confidential amount. From 2014 to 2017, 10 of Lund’s former patients, including Mitchell and Cordi, sued him for a mix of fraud, deceit, battery, financial elder abuse, and dental malpractice. They collectively reached a nearly $3 million settlement, paid out by Lund’s insurance company. (Lund did not admit to any wrongdoing.)

Lund was arrested in May 2016 and released on $250,000 bail. The Santa Clara County district attorney’s office is prosecuting a criminal case against him based on 26 counts of insurance fraud. At the time of his arraignment, he said he was innocent of all charges. The Dental Board of California is seeking to revoke or suspend Lund’s license, which is currently inactive.

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Many of Lund’s former patients worry about their future health. A root canal is not a permanent fix. It requires maintenance and, in the long run, may need to be replaced with a dental implant. One of Mitchell’s root canals has already failed: The tooth fractured, and an infection developed. He said that in order to treat the infection, the tooth was extracted and he underwent a multistage procedure involving a bone graft and months of healing before an implant and a crown were fixed in place. “I don’t know how much these root canals are going to cost me down the line,” Mitchell says. “Six thousand dollars a pop for an implant—it adds up pretty quick.”

Joyce Cordi’s new dentist says her X‑rays resemble those of someone who had reconstructive facial surgery following a car crash. Because Lund installed her new dental bridges improperly, one of her teeth is continually damaged by everyday chewing. “It hurts like hell,” she says. She has to wear a mouth guard every night.

What some of Lund’s former patients regret most are the psychological repercussions of his alleged duplicity: the erosion of the covenant between practitioner and patient, the germ of doubt that infects the mind. “You lose your trust,” Mitchell says. “You become cynical. I have become more that way, and I don’t like it.”

“He damaged the trust I need to have in the people who take care of me,” Cordi says. “He damaged my trust in mankind. That’s an unforgivable c

The Prince of Midwest

hain of all my used football mouth guards dating back to seventh grade. But then came Prince.

In my memory I recall the scene in Purple Rain of Prince and Appolonia making love in the barn. I knew that barn.

And my perception of masculinity, of beauty, of my own Midwest, expanded. Expanded a tad more than was sustainable, as it turned out, but expanded. Prince was not my single motivator, but he lit the incense. Within a year of watching Purple Rain I bought my first army surplus trench coat, rode a Greyhound bus out of Wisconsin to work as a cowboy in Wyoming, made my first trip to Europe, and began experimenting with hair mousse.

* * *

It’s tricky, tantamount to tacky, composing postmortem paens to people of renown. The pitfalls are plenty: reverse-engineered significance, boutique bereavement, the appropriation of grief as virtue-signaling, leveraging fame to which I have no claim.

In fact, I am simply sad that Prince Rogers Nelson is gone.

Hand over heart: I wrote the opening paragraph to this piece the week before he died.

* * *

For someone growing up in New Auburn, Wisconsin, Minneapolis was the distant mystery city. The few times I ventured across the Minnesota state line, I was a kid riding shotgun in a pickup truck with my dad and a load of lambs, and even then we went only as far as the St. Paul stockyards.

Minneapolis was a skyline cluster, a glow. Once my grandfather took me to the top of the IDS Center, but he wouldn’t spring for tickets to the observation deck. Instead we got a long elevator ride capped by a glimpse of sky. My perception of the metropolis remained that of a sidewalk-level hick craning his neck. I just remember glass and tall.

Then it was back to the farm. Two hours by sheep truck. Northwestern corner of Chippewa County, Wisconsin. Milk the cows, sling the manure, go to church every Sunday. A lean church, with lean beliefs. No movies, no radio, no dancing. Books, though? I had stacks. I was not unhappy.

* * *

In my memory I recall the scene in Purple Rain of Prince and Appolonia making love in the barn. I knew that barn. I knew the light striping through those rough-cut boards. Those rawbone beams. And while my churchly ways and other clumsinesses precluded me ever engaging in anything remotely approaching Prince’s gynecological gymnastics, I did indeed know what it was to kiss a girl with chaff in her hair.

All these rural vibes and here’s this glittering fellow in stilettos, ridiculous in the context, and yet — down there in the funk — hitting notes that resonated in the heart of a chaste doofus shod in Farm & Fleet clodhoppers. Old Man Johnson’s Farm? Where Prince took Appolonia on that Hondamatic? Its dead ringer sat right off our back forty. For real. Same barn, same surname. Ed Johnson. You could check the plat.


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But coldhearted fact-checking revealed my Purple Rain memory to be a conflation over time. The haymow scene wasn’t in the film but rather in the trailer. Even then it was just a half-second shot of Appolonia standing in straw. The lovemaking took place elsewhere.

Some of what I recollect was in the “When Doves Cry” video. And Old Man Johnson’s farm was name-checked in “Raspberry Beret,” which came out the year after Purple Rain.

But these little call-outs, these lyric and visual specifics — they threaded my coarse flannel with a strand of purple, connecting the stumblebum to the star.

* * *

Sometime around 1992, I co-wrote a frozen pizza commercial for a company in Eau Claire, Wisconsin. We drove to Minneapolis to edit the video at a production company called Crash+Sues.

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By then I’d come to know Minneapolis through a smattering of visits: The Metrodome for a Twins Game, a Neil Diamond concert at the Target Center, a Molly & the Heymakers show at First Avenue, an airport drop-off, a family reunion in the suburbs. In other words, as a tourist. But I knew the way, and the city felt less distant, less mysterious. A Badger State cheesehead to the core, I nonetheless came to think of it as “our” big city. Came a time when Manhattan-based publicists would schedule me on book tour flights out of Milwaukee. “It’s a five hour drive to Milwaukee from my farm,” I’d say, “But 90 minutes due west of here? Minneapolis! They have an airport there with airplanes that go all over the world!

“But…but you live in Wisconsin!” They said this more than once.

“Yes,” I always replied, “and we have an open border agreement with Minnesota.”

The Crash+Sues edit suite was set up like a mini-amphitheater. A few rows of desks and seating, and the monitors down front. There was no light but the screen-glow. The engineer said Prince had been there to work on a video. Slipped in and sat in the backmost row. Called for cuts and rewinds and playback quietly, but decisively. Then he left. I was taken by this image, of the electrifying performer in economy mode. Doing his work, then departing. Right here.

* * *

I rerun these fragments and uncertain memories not to claim Prince, but rather as thanks for the tangible good he did me. The paragraph I wrote the week before he died was for a chapter on aesthetics in a book about the 16th-century French philosopher Montaigne. That is not the sort of tangent a hay bale stacking farm boy follows without felicitous nudges.

I think of my young self trying to be Prince, a foolish pursuit on the face of it, but essential at the heart of it, leading as it did to other gracious worlds. I think of him at work in and around Minneapolis, percolating his purple explosion, and how a few grains drifted across the St. Croix River and settled on my boots.

And if my leaden feet were not lightened, if I did not morph into an irresistible sex machine, I did think, “Well, perhaps I don’t have to stay this way.” And then, with a lot more clomping than dancing, I found my way into a life beyond the farm, and for the following thirty years went daily to the keyboard, trying to make a little art.

* * *

We all end up dead meat. I can rhapsodize about the magic of a man even though I know full well he was mortal. But when I looked up from the manuscript I was working on that morning and saw the news, I wasn’t prepared for the sense of vacuum. He was right over there, I thought, casting my mind across the river. As early as this morning. Working.

Working. That was the thing. I never once saw Prince perform live. And even though I’d been to First Avenue — the seminal setting for Purple Rain — it took sitting in that little video studio for it to hit me: Minneapolis was where Prince worked. And ever since that day, I thought of him in that context. Just across the St. Croix. Working.

For plowing snow, hauling firewood, and because no matter how much French philosophy I read, nothing sorts my soul like rolling country roads in that truck.

Thanks to my background — raised by truckers, loggers, and small-patch farmers — I still struggle to get past the dumb trope of sneering at art as work. As if any given roadie hustles any less than any given logger. As if Prince’s dance-worn hips would be more honorably won had he ruined them kneeling to milk cows or trowel concrete.

I have an old pickup truck. For plowing snow, hauling firewood, and because no matter how much French philosophy I read, nothing sorts my soul like rolling country roads in that truck. So ten minutes out, when the initial vacuum of the news that he was gone had shifted to soft vertigo, I fetched the truck and drove to my neighbor’s place.

This particular neighbor had won some Grammys, and built a recording studio a couple cornfields over. It’s not Paisley Park, but it’s enough. You can rattle around some if you’re alone in there. The only person present was the house engineer, who did a stint with Prince. Some Vegas shows. We sat for maybe five minutes, talking about the artist and his work. The door was open, the spring breeze — still surprising that time of year — riffling lyric sheets on a desk. Prince was demanding, the engineer said. A force of nature. Totally wild and far out, difficult, but 100 percent knew what he wanted. “And if he had more arms and legs and hours in a day,” said the engineer, “he would have done it all his own damn self.”

* * *

Right around the 3:55 mark of “The Beautiful Ones,” Prince goes to screeching and subsequently tosses off a Hoo! that I could never hope to utter, but am utterly able to feel. Here, he seems to be saying, let me articulate that for you. Then he shoots that shy-sly grin, message being: Try to keep up, and you will eat my royal dust.

In a box in my barn there are snapshots of me reporting for skate-guard duty at the roller rink in 1986 wearing pink hair dye and a satin magenta head scarf. Goofy as hell and so short of the mark, but further proof that Prince precipitated profound change.

A friend said Prince created his own creative world around him, something many of us in the Midwest have had to do in one way or another.

A friend said Prince created his own creative world around him, something many of us in the Midwest have had to do in one way or another. When I heard Prince, when I saw Prince, I felt moved to be more than I was. The flat-footed white boy lip-syncing “When Doves Cry” in the mirror knowing full well he couldn’t so much as polka in shitkickers, let alone do the splits in high heels, was being propelled down a path toward what the philosopher Montaigne said was the greatest thing in the world: To know how to belong to oneself.

* * *

The other day I had to explain the Prince symbol to a thirty-something graphic designer. Time roars on and we soothe ourselves with generalizations and memories. Minneapolis is still a million things I’ll never know. But when my book tour is over and the plane descends, I am still a country boy looking for the Metrodome. I can still see Grandpa marveling at the Foshay Tower. I am still riding that sheep hauler home, but in the mirror the skyline glows beneath a thin purple scrim.

***

Excerpted from Under Purple Skies: The Minneapolis Anthology, edited by Frank Bures. Copyright © 2019 by Michael Perry. Reprinted by permission of Michael Perry.

Michael Perry is a humorist, radio host, songwriter, and The New York Times bestselling author of several nonfiction books, including Visiting Tom and Population: 485, as well as a novel, The Jesus Cow. He lives in northern Wisconsin with his family.

Longreads Editor: Aaron Gilbreath

In side lucrative business of Donating human Eggs

INSIDE THE QUIETLY LUCRATIVE BUSINESS OF DONATING HUMAN EGGS

ALYSSA FOOTE; GETTY IMAGES

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IT WAS A FACEBOOK AD THAT PROPELLED ASHLEIGH GRIFFIN TO ACT. SHE HAD HEARD ABOUT EGG DONATION FROM HER MOTHER, A NURSE, BUT NEVER THOUGHT OF IT AS ANYTHING MORE THAN AN ESOTERIC MEDICAL PROCEDURE.

THE AD IN HER Facebook feed in 2011 told a different story. It intrigued Griffin, promising her thousands of dollars for something her body produced on its own, with the bonus of helping another family. It even specified that the opportunity was tailor-made for young cash-strapped women in college, as she was. She clicked through, and only grew more curious. She tried to sign up, but quickly hit a wall. Griffin was 18, and the agency required donors be at least 21.

Just before her 21st birthday, she typed “egg donation” into Google, and off she went. Over the next four years, Griffin donated her eggs six times at three different clinics. Four of those times, her ovaries became painfully swollen and she experienced weight gain, abdominal pain, severe nausea, and had trouble urinating; once she was hospitalized. For her efforts, she was paid $61,000.

A 2016 Facebook ad for A Perfect Match, which connects aspiring parents with egg donors.A PERFECT MATCH

Egg donation is designed to help families who are having trouble conceiving. The process involves taking eggs from one woman, fertilizing the viable ones, and then transferring them either to the aspiring mother, or a surrogate, in the hope of achieving pregnancy. In practice, it’s often more complicated.

The first US child conceived from a donated egg was born in 1984. Since then, the procedure has grown into a thriving industry. Demand from aspiring parents, and a dearth of regulations, have spawned matchmaking agencies that offer to help parents find the perfect young woman whose eggs will result in the equally perfect child.

Donating eggs can be lucrative, with agencies paying as much as $50,000 per cycle in some cases. But donors say it also can be confusing and frightening, leaving the women on whom the industry rests feeling isolated and unaware of the risks. Some donors find the experience—which involves injecting yourself with hormone-filled syringes for 10 days or more until a doctor pierces your vaginal wall with thick needles to suck out the extra eggs you’ve produced—differs greatly from the marketing.

Facebook Groups

In response, some have joined private Facebook groups to share the nitty-gritty details, from how best to deal with the pain of your ovaries swelling to the size of grapefruits, to how to negotiate with doctors for safer hormonal doses (even if that produces fewer eggs), to how to report the payments on tax returns.

“There’s a huge lack of data there to really [allow women] to make informed decisions,” says Dr. Diane Tober, an assistant professor at the University of California, San Francisco, who studies egg donors. “And that’s really problematic, obviously, when you have people making decisions that could affect their future health, well-being, and their ability to have children.”

Ads or marketing materials targeting potential donors rarely mention the risks or common complaints. Liz Scheier donated eggs three times between 2005 and 2007, and says she was told there were no known risks associated with egg donation. Today, Scheier is a media liaison for We Are Egg Donors, a women’s health organization that works with more than 1,500 donors to promote transparency and advocate for their concerns. She says that donors nowadays hear the same line she did, delivered almost verbatim. But it’s missing one key detail. “There are no known risks because no one has looked,” she says.

“There’s a huge lack of data there to really [allow women] to make informed decisions.”

DR. DIANE TOBER, UNIVERSITY OF CALIFORNIA, SAN FRANCISCO,

Tober aims to change that. She has spent the past five years interviewing hundreds of egg donors and studying the short- and long-term impacts of the procedure. Her findings suggest that donating eggs is riskier than some agencies say, and that many egg donors don’t understand how the industry operates.

Some women suffer a reaction to the fertility injections known as ovarian hyperstimulation syndrome, which in extreme cases can be fatal. Tober says clinics often downplay the risks of the syndrome by citing statistics that apply only to the most severe cases, and glossing over other potential side effects of egg donation. She says her research has found that mild to moderate cases of ovarian hyperstimulation—including symptoms like abdominal pain, nausea, vomiting, diarrhea, and sudden weight gain—are “quite common” among egg donors, requiring hospitalization in some cases. Other donors suffer complications including ovarian torsion or surgical mishaps.

Looking back on her first donation, Griffin marvels at how little she knew about what she signed up for. “I had no idea what was going on,” she says.

That’s understandable. The process is complicated, involving screening, multiple tests, drug regimens, and finally, harvesting eggs.

Screenings and Tests

The screening alone can be arduous. Here are some of the requirements for donors working with A Perfect Match, a La Mesa, California, matchmaking agency: Potential donors must be between the ages of 19 and 29; have no criminal record; not be overweight; not taking antidepressant drugs; complete a medical and genetic questionnaire about themselves and their extended family; and submit academic transcripts and SAT/ACT scores. Potential donors must also submit to genetic testing; a psychological screening, the results of which they can’t see; a medical screening; an ultrasound, vaginal culture, and STD screening; and drug, nicotine, and alcohol screening.

After they are chosen by an aspiring parent, donors take medication to synchronize their menstrual cycles with the recipient’s. Then come the injections.

Normally, women produce one egg each cycle. To increase the chance of success, donors are given drugs to promote the production of additional eggs. Typically, donors are given dozens of lengthy syringes and tiny glass vials, and instructed to inject themselves with up to four drugs multiple times a day to coerce their ovaries into producing dozens of eggs, according to interviews with donors. Women are urged to stick the syringe in a fatty place on the body, like the stomach or thigh, to minimize bruising and pain from the needles, some of which are longer than an inch.

During this process, donors are instructed to abstain from sex, alcohol, drugs, tobacco, staying up late (or waking up too early), jumping, walking up stairs too aggressively, or any other activities that might jostle their swollen ovaries. Every one to three days they must visit a doctor—chosen by the intended parents or agency—for blood work and ultrasounds.

Griffin’s first donation was through the Pacific Fertility Center in San Francisco. She recalls meeting with a doctor to discuss potential risks, many of which she now thinks were downplayed. The clinic allowed her to choose when she wanted to donate and how many cycles she’d like to complete. She was in college at the time and needed cash, so she opted for two cycles, for which she was paid $8,000 each—in June and August 2014.

The first cycle was uncomfortable, she says. “I remember crying every single time they said I had to wait longer to donate the first time because I was so bloated and in so much pain that putting my heels on the ground hurt too much,” she recalls.

Once injections have been completed, the extraction surgery is scheduled at a clinic. The donor is sedated and a catheter is inserted. A needle is used to puncture her vaginal walls to get to the follicles, which are then drained. Because of the sedation, the donor is advised to rest at the doctor’s office for at least one hour following the procedure and be escorted home. Lab personnel inspect the extracted eggs and combine the viable ones with sperm in the hopes they’ll be fertilized.

“I had no idea what was going on.”

EGG DONOR ASHLEIGH GRIFFIN ON HER FIRST DONATION

Griffin says the doctor she met with at the start of her cycle reviewed potential side effects of the medication, like bloating, and told her ovarian hyperstimulation is “extremely rare.” But she says she experienced severe hyperstimulation, which left her extremely bloated, and suffering from nausea, vomiting, and abdominal pain. She spent one night in a hospital, while fluid was drained from her abdomen; she experienced similar, though less severe symptoms during three of her other donations.

Griffin says she couldn’t stand—much less work at her summer job at a childcare facility—for three weeks after the procedure; she says it took two months for her to return to normal. By that point, her second donation date was looming. Given her previous complications, Pacific Fertility staff said she could drop out, but she chose to continue.

“I didn’t feel super pressured into it, but I felt like I had made a commitment, and I was counting on the money,” said Griffin. “And I felt confident after conversations I had with them that they were going to do the medical part differently this time around.”

They did. For her second donation, she says clinic staff, at her behest, gave her less of the follicle stimulating medication, and it went well.

In a statement, a spokesperson for Pacific Facility said, “Our physicians and clinicians work with patients on custom care plans to ensure each individual receives the highest and most personal level of care.” The spokesperson declined to comment on Griffin’s version of events, citing patient privacy rules.

A Perfect Match CEO Darlene Pinkerton says these Facebook ads were “successful.”A PERFECT MATCH

Griffin says the experience left her feeling isolated. “That first time when I got really sick, the worst part of that was feeling like doctors didn’t understand what I was going through, the ER staff didn’t know, my friends didn’t get it.” She had a difficult time finding information online about egg donation from a donor’s perspective. Then she found the private, invite-only Facebook group created by We Are Egg Donors.

The group quickly became an invaluable resource for Griffin. It was the first time she had seen anyone, online or elsewhere, talk realistically about compensation and about the day-to-day realities of the process. “It’s a huge deal for me to have other people, even virtually, who have any idea [what it’s like],” she said.

In the group, donors post about their experiences, ask questions, and give advice to first-timers. The group screens potential members and enforces strict confidentiality rules; some donors have been banned for sharing information or screenshots of the group’s activities. The collective knowledge available through the group inspired Griffin to donate a third time.

Some of the group’s conversations veer into the unusual, and trying, aspects of the process. There are more than a dozen posts about how best to travel on a plane with your syringes full of hormones—which must stay refrigerated—without causing a panic at TSA (short answer: carefully, in an iced carry-on lunch box) and what to do if you’re in the air during one of your daily injection times (the plane bathroom is your best bet).

Darlene Pinkerton, the CEO of A Perfect Match, is well aware of the Facebook group, though she’s not a member. “I can almost always tell when someone is in [the group] because of the things they request,” she says. One common request among group members, she says, is for Lupron—a synthetic hormone that studies have shown decreases the likelihood of hyper-stimulation.

A Magnet for Overseas Couples

Egg donation has thrived in the US in part because there are few laws regarding the transfer of unfertilized eggs for reproductive purposes, according to industry experts. They say a handful of states have policies that touch on some aspect of egg donation, generally from the perspective of the recipient.

With few regulations, the US has become a magnet for well-off wannabe parents in other countries where egg donation is regulated, or illegal. Egg donation is barred in Germany, Italy, Norway, and China; paying women who donate eggs is prohibited in most of Europe, as well as in Canada and other nations.

“One of the main reasons people are coming to the United States [for egg donation] is because the laws and regulations make it so difficult in other countries,” says Dr. Lauren Jade Martin, an associate professor at Penn State studying the social impact of assisted reproductive technologies. A Perfect Match works with many intended parents from outside the US, says Pinkerton.

Though the process is labeled a “donation,” money is usually involved. And, as in many fields, donors are rewarded for past performance: The more cycles a donor has under her belt, the more she can make. A first-time donor typically will make about $8,000, with the payment rising to $10,000 for a second, according to interviews with donors and agency staff. Women with certain traits in demand from prospective parents—a high IQ, Ivy League education, modelesque features, sought-after ethnic backgrounds, or unique skills—are routinely offered $20,000 to $50,000.

At A Perfect Match, the typical first-time donor makes $15,000, says Pinkerton; some get $25,000. Jewish, East Asian, and Indian donors get paid even more, she says. “There’s a higher demand for a smaller number of people” in those groups, says Pinkerton. “So they can ask for higher compensation.”

American egg donation agencies rarely, if ever, refer to these transferred funds as payments, describing them as “compensation” for a donor’s time. The difference is important, as it’s illegal to sell human tissue in the US.

It wasn’t always like this. The American Society for Reproductive Medicine (ASRM), the leading medical organization for fertility centers, used to have suggested guidelines for donor pay. For more than a decade, the ASRM recommended that compensation not exceed $5,000 without justification, and that anything over $10,000 went “beyond what is appropriate.” The guidelines weren’t technically mandates, but they were widely followed.

“When you’re in the medical industry and you get ‘suggested guidelines’ from someone who does audits … they are not suggestions, they are rules,” says Valerie McMorris, who donated eggs in the 90s and now owns her own egg donation agency, Donor Services of NY.

Pinkerton of A Perfect Match says that when the ASRM guidelines were first set in 2000, she attempted to follow them, but quickly discovered that she couldn’t attract the highly educated, attractive, successful donors her clients sought without offering tens of thousands of dollars. “When ASRM restricted everyone to $10,000 I just felt it was so unfair to parents to send them back into the dark ages of having to choose a donor that really didn’t match their family or their values,” she recalled. “So I gave up after a month and just kept doing my own thing.”

In 2011, an egg donor sued ASRM over the organization’s compensation guidelines, which the donor claimed were a form of illegal price-fixing; other donors later joined the case. In a 2016 settlement, ASRM agreed to eliminate its payment suggestions, pay $1.5 million in legal fees, and give the plaintiffs $5,000 each. Agencies were freer to offer donors more money.

Following the settlement, McMorris says agencies from outside New York started targeting donors in the state, offering higher payments. “We were losing donors—the desirable donors, the ones that you want to share with your couples, the ones who are really motivated to move forward,” she says.

A screenshot of Donor Services of NY’s website.DONOR SERVICES OF NY

Since then, donor pay has soared, particularly for attractive, well-educated donors. But the more criteria in play, the harder it is to find a woman who not only matches the specifications, but is fertile, and wants to donate. McMorris says intended parents have become more demanding.

“Sometimes they’re ridiculously specific,” she says. “I’ll get a call from someone who’ll say: ‘I want a woman who is 5-11, blonde hair, blue-eyed, beautiful like a model, but really bright with an Ivy League education.’” McMorris recalled one person asking to only see donors with those credentials, plus each of their grandparents had to have lived past the age of 86.

Two of Griffin’s donations were arranged by A Perfect Match, for which she was paid $15,000 in 2015, and $20,000 in 2016. She says the higher compensation made it worth going through the agency’s more extensive screening process. Those procedures were done at a clinic near San Diego. For her most recent donation last summer, Griffin went back to Pacific Fertility, and was paid $10,000.

“Everybody every single step of the way is either getting a child or making money,” said Griffin. “The donors are making money, but the doctors and clinics are making money [too]. It’s an industry, so I don’t know why it’s only taboo for the egg donors to [treat] it as an industry.”