text:
"Ambiguous Sex"--or Ambivalent Medicine?
by Alice Domurat Dreger
Republished with kind permission from The Hastings Center Report May/Jun 1998, Volume 28, Issue 3 Pages 24-35.
Subject terms: "Medical ethics," Surgery, Sexes, Reproductive system, Child development, Babies
Ethical issues in the treatment of intersexuality are examined. It is not at all clear if all or even most of the intersex surgeries done today involve what would legally and ethically constitute informed consent.
Copyright © The Hastings Center May/Jun 1998
What makes us "female" or "male," "girls" or "boys," "women" or "men"—our chromosomes, our genitalia, how we (and others) are brought up to think about ourselves, or all of the above? One of the first responses to the birth of a child of ambiguous sex by clinicians, and parents, is to seek to "disambiguate" the situation: to assign the newborn's identity as either female or male, surgically modify the child's genitalia to conform believably to that sex identity, and provide other medical treatment (such as hormones) to reinforce the gender decided upon. The assumptions that underly efforts to "normalize" intersexual individuals and the ethics of "treatment" for intersexuality merit closer examination than they generally receive.
A number of events have lately aroused substantial public interest in intersexuality (congenital "ambiguous sex") and "reconstructive" genital surgery. Perhaps the most sensational of these is the recent publication of unexpected longterm outcomes in the classic and well-known "John/Joan" case.1 "John" was born a typical XY male with a twin brother, but a doctor accidentally ablated John's penis during a circumcision at age eight months. Upon consultation with a team of physicians and sexologists at the Johns Hopkins Hospital (circa 1963) it was decided that given the unfortunate loss of a normal penis John should be medically reconstructed and raised as a girl-"Joan." Surgeons therefore removed John/Joan's testes and subsequently subjected Joan to further surgical and hormonal treatments in an attempt to make her body look more like a girl's. The team of medical professionals involved also employed substantial psychological counseling to help Joan and the family feel comfortable with Joan's female gender. They believed that Joan and the family would need help adjusting to her new gender, but that full (or near-full) adjustment could be achieved.
For decades, the alleged success of this particular sex reassignment had been widely reported by Hopkins sexologist John Money and others as proof that physicians could essentially create any gender out of any child, so long as the cosmetic alteration was performed early. Money and others repeatedly asserted that "Johns" could be made into "Joans" and "Joans" into "Johns" so long as the genitals looked "right" and everyone agreed to agree on the child's assigned gender. The postulates of this approach are summarized succinctly by Milton Diamond and Keith Sigmundson: "(1) individuals are psychosexually neutral at birth and (2) healthy psychosexual development is dependent on the appearance of the genitals" (p. 298). While not a case of congenital intersexuality, the John/Joan case was nevertheless used by many clinicians who treat intersexuality as proof that in intersex cases the same postulates should hold. The keys seemed to be surgical creation of a believable sexual anatomy and assurances all around that the child was "really" the assigned gender.
But reports of the success of John/Joan were premature-indeed, they were wrong. Diamond and Sigmundson recently interviewed the person in question, now an adult, and report that Joan had in fact chosen to resume life as John at age fourteen. John, now an adult, is married to a woman and, via adoption, is the father of her children. John and his mother report that in the Joan-years, John was never fully comfortable with a female gender identity. Indeed, Joan actively attempted to resist some of the treatment designed to ensure her female identity; for instance, when prescribed estrogens at age twelve, Joan secretly discarded the feminizing hormones. Depressed and unhappy at fourteen, Joan finally asked her father for the truth, and upon hearing it, "All of a sudden everything clicked. For the first time things made sense, and I understood who and what I was" (p. 300). At his request, John received a mastectomy at age fourteen, and for the next two years underwent several plastic surgery operations aimed at making his genitals look more masculine.2
Diamond and Sigmundson are chiefly interested in using this new data to conclude that "the evidence seems overwhelming that normal humans are not psychosocially neutral at birth but are, in keeping with their mammalian heritage, predisposed and biased to interact with environmental, familial, and social forces in either a male or female mode."3 In other words, sexual nature is not infinitely pliable; biology matters.
In their report, Diamond and Sigmundson also take the opportunity of publication to comment on the problem of the lack of long-term follow-up of cases like these. But what is also troubling is the lack of ethical analysis around cases like this-particularly around cases of the medical treatment of intersexuality, a phenomenon many orders of magnitude more common than traumatic loss of the penis. While there have been some brief discussions of the ethics of deceiving intersex patients (that discussion is reviewed below), the medical treatment of people born intersexed has remained largely ignored by ethicists. Indeed, I can find little discussion in the literature of any of the ethical issues involved in "normalizing" children with allegedly "cosmetically offensive" anatomies. The underlying assumption grounding this silence appears to be that "normalizing" procedures are necessarily thoroughly beneficent and that they present no quandaries. This article seeks to challenge that assumption and to encourage interested parties to reconsider, from an ethical standpoint, the dominant treatment protocols for children and adults with unusual genital anatomy.
Frequency of Intersexuality
Aside from the apparent presumption that "normalizing" surgeries are necessarily good, I suspect that ethicists have ignored the question of intersex treatment because like most people they assume the phenomenon of intersexuality to be exceedingly rare. It is not. But how common is it? The answer depends, of course, on how one defines it. Broadly speaking, intersexuality constitutes a range of anatomical conditions in which an individual's anatomy mixes key masculine anatomy with key feminine anatomy. One quickly runs into a problem, however, when trying to define "key" or "essential" feminine and masculine anatomy. In fact, any close study of sexual anatomy results in a loss of faith that there is a simple, "natural" sex distinction that will not break down in the face of certain anatomical, behavioral, or philosophical challenges.4
Sometimes the phrase "ambiguous genitalia" is substituted for "intersexuality," but this does not solve the problem of frequency, because we still are left struggling with the question of what should count as "ambiguous." (How small must a baby's penis be before it counts as "ambiguous"?) For our purposes, it is simplest to put the question of frequency pragmatically: How often do physicians find themselves unsure which gender to assign at birth? One 1993 gynecology text estimates that "in approximately 1 in 500 births, the sex is doubtful because of the external genitalia."5 I am persuaded by more recent, well-documented literature that estimates the number to be roughly 1 in 1,500 live births.6
The frequency estimate goes up dramatically, however, if we include all children born with what some physicians consider cosmetically "unacceptable" genitalia. Many technically nonintersexed girls are born with "big" clitorises, and many technically nonintersexed boys are born with hypospadic penises in which the urethral opening is found somewhere other than the very tip of the penis.
Historical Background
I came to this topic as an historian and philosopher of science. My initial interest was actually in learning how British and French medical and scientific men of the late nineteenth century dealt with human hermaphroditism. The late nineteenth century was a time when the alleged naturalness of European social sex borders was under serious challenge by feminists and homosexuals and by anthropological reports of sex roles in other cultures. I wanted to know what biomedical professionals did, at such a politically charged time, with those who inadvertently challenged anatomical sex borders.
The answer is that biomedical men tried their best to shore up the borders between masculinity and femininity.7 Specifically, the experts honed in on the ovarian and testicular tissues and decided that these were the key to any body's sexual identity. The "true sex" of most individuals thus by definition settled nicely into one of the two great and preferred camps, no matter how confusing the rest of their sexual anatomies. People with testicular tissue but with some otherwise "ambiguous" anatomy were now labeled "male pseudo-hermaphrodites"that is, "true" males. People with ovarian tissue but with some otherwise ambiguous anatomy were labeled "female pseudo-hermaphrodites""true" females.
By equating sex identity simply with gonadal tissue, almost every body could be shown really to be a "true male" or a "true female" in spite of mounting numbers of doubtful cases. Additionally, given that biopsies of gonads were not done until the 1910s and that Victorian medical men insisted upon histological proof of ovarian and testicular tissue for claims of "true hermaphroditism," the only "true hermaphrodites" tended to be dead and autopsied hermaphrodites.
Nevertheless, new technologies-specifically laparotomies and biopsies-in the 1910s made this approach untenable. It now became possible (and, by the standing rules, necessary) to label some living people as "true" hermaphrodites via biopsies, and disturbed physicians noted that no one knew what to do with such people. There was no place, socially or legally, for true hermaphrodites.Moreover, physicians found case after case of extremely feminine-looking and feminine-acting women who were shown upon careful analysis to have testes and no ovaries. The latter were cases of what today is called androgen-insensitivity syndrome (AIS), also known as testicular feminization syndrome. We now know that individuals with AIS (roughly 1/60,0008) have an XY ("male") chromosomal complement and testes, but their androgen receptors cannot "read" the masculinizing hormones their testes produce. Consequently, in utero and throughout their lives, their anatomy develops along apparently "feminine" pathways. AIS is often not discovered until puberty, when these girls do not menstruate and a gynecological examination reveals AIS. Women with AIS look and feel very much like "typical" women, and in a practical, social, legal, and everyday sense they are women, even though congenitally they have testes and XY chromosomes.
In the 1910s, physicians working with intersexuality realized that assigning these women to the male sex (because of their testes) or admitting living true hermaphrodites" (because of their ovotestes) would only wreak social havoc. Consequently, in practice the medical profession moved away from a strict notion of gonadal "true sex" toward a pragmatic concept of "gender" and physicians began to focus their attentions on gender "reconstruction."Elaborate surgical and hormonal treatments have now been developed to make the sexual anatomy more believable, that is, more "typical" of the gender assigned by the physician.
Dominant Treatment Protocols
Thus the late twentieth century medical approach to intersexuality is based essentially on an anatomically strict psychosocial theory of gender identity. Contemporary theory, established and disseminated largely via the work of John Money9 and endorsed by the American Academy of Pediatrics10, holds that gender identity arises primarily from psychosocial rearing (nurture), and not directly from biology (nature); that all children must have their gender identity fixed very early in life for a consistent, "successful" gender identity to form; that from very early in life the child's anatomy must match the "standard" anatomy for her or his gender; and that for gender identity to form psychosocially boys primarily require "adequate" penises with no vagina, and girls primarily require a vagina with no easily noticeable phallus.11
Note that this theory presumes that these rules must be followed if intersexual children are to achieve successful psychosocial adjustment appropriate to their assigned gender-that is, if they are to act like girls, boys, men, and women are "supposed" to act. The theory also by implication presumes that there are definite acceptable and unacceptable roles for boys, girls, men, and women, and that this approach will achieve successful psychosocial adjustment, at least far more often than any other approach.
Many parents, especially those unfamiliar with sex development, are bothered by their children's intersexed genitals and receptive to offers of "normalizing" medical treatments. Many also actively seek guidance about gender assignment and parenting practices. In the United States today, therefore, typically upon the identification of an "ambiguous" or intersexed baby teams of specialists (geneticists, pediatric endocrinologists, pediatric urologists, and so on) are immediately assembled, and these teams of doctors decide to which sex/gender a given child will be assigned. A plethora of technologies are then used to create and maintain that sex in as believable a form as possible, including, typically, surgery on the genitals, and sometimes later also on other "anomalous" parts like breasts in an assigned male; hormone monitoring and treatments to get a "cocktail" that will help and not contradict the decided sex (and that will avoid metabolic dangers); and fostering the conviction among the child's family and community that the child is indeed the sex decided"psychosocial" rearing of the child according to the norms of the chosen sex. Doctors typically take charge of the first two kinds of activities and hope that the child's family and community will successfully manage the all-critical third.
Clinicians treating intersexuality worry that any confusion about the sexual identity of the child on the part of relatives will be conveyed to the child and result in enormous psychological problems, including potential "dysphoric" states in adolescence and adulthood. In an effort to forestall or end any confusion about the child's sexual identity, clinicians try to see to it that an intersexual's sex/gender identity is permanently decided by specialist doctors within forty-eight hours of birth. With the same goals in mind, many clinicians insist that parents of intersexed newborns be told that their ambiguous child does really have a male or female sex, but that the sex of their child has just not yet "finished" developing, and that the doctors will quickly figure out the "correct" sex and then help "finish" the sexual development. As the sociologist Suzanne Kessler noted in her ground-breaking sociological analysis of the current treatment of intersexuality, "the message [conveyed to these parents] … is that the trouble lies in the doctor's ability to determine the gender, not in the baby's gender per se."12 In intersex cases, Ellen Hyun-Ju Lee concludes, "physicians present a picture of the `natural sex,' either male or female, despite their role in actually constructing sex."13
Because of widespread acceptance of the anatomically strict psychosocial theory of treatment, the practical rules now adopted by most specialists in intersexuality are these: genetic males (children with Y chromosomes) must have "adequate" penises if they are to be assigned the male gender.When a genetic male is judged to have an "adequate" phallus size, surgeons may operate, sometimes repeatedly, to try to make the penis look more "normal." If their penises are determined to be "inadequate" for successful adjustment as males, they are assigned the female gender and reconstructed to look female. (Hence John to Joan.) In cases of intersexed children assigned the female sex/gender, surgeons may "carve a large phallus down into a clitoris" (primarily attempting to make the phallus invisible when standing), "create a vagina using a piece of colon" or other body parts, "mold labia out of what was a penis," remove any testes, and so on.14
Meanwhile, genetic females (that is, babies lacking a Y chromosome) born with ambiguous genitalia are declared girls-no matter how masculine their genitalia look. This is done chiefly in the interest of preserving these children's potential feminine reproductive capabilities and in bringing their anatomical appearance and physiological capabilities into line with that reproductive role. Consequently, these children are reconstructed to look female using the same general techniques as those used on genetically male children assigned a female role. Surgeons reduce "enlarged" clitorises so that they will not look "masculine." Vaginas are built or lengthened if necessary, in order to make them big enough to accept average-sized penises. Joined labia are separated, and various other surgical and hormonal treatments are directed at producing a believable and, it is hoped, fertile girl.
What are the limits of acceptability in terms of phalluses? Clitorises-meaning simply phalluses in children labeled femaleare frequently considered too big if they exceed one centimeter in length.15 Pediatric surgeons specializing in treating intersexuality consider "enlarged" clitorises to be "cosmetically offensive" in girls and therefore they subject these clitorises to surgical reduction meant to leave the organs looking more "feminine" and "delicate."16 Penises—meaning simply phalluses in children labeled male-are often considered too small if the stretched length is less than 2.5 centimeters (about an inch). Consequently, genetically male children born at term "with a stretched penile length less than 2.5 [centimeters] are usually given a female sex assignment."17
Roughly the same protocols are applied to cases of "true" hermaphroditism (in which babies are born with testicular and ovarian tissue). Whereas the anatomico-materialist metaphysics of sex in the late nineteenth century made true hermaphrodites an enormous problem for doctors and scientists of that time, clinicians today believe that "true hermaphrodites" (like "pseudo-hermaphrodites") can be fairly easily retrofitted with surgery and other treatment to either an acceptable male or acceptable femalesex/gender.
One of the troubling aspects of these protocols are the asymmetric ways they treat femininity and masculinity. For example, physicians appear to do far more to preserve the reproductive potential of children born with ovaries than that of children born with testes. While genetically male intersexuals often have infertile testes, some men with micropenis may be able to father children if allowed to retain their testes.18
Similarly, surgeons seem to demand far more for a penis to count as "successful" than for a vagina to count as such. Indeed, the logic behind the tendency to assign the female gender in cases of intersexuality rests not only on the belief that boys need "adequate" penises, but also upon the opinion among surgeons that "a functional vagina can be constructed in virtually everyone [while] a functional penis is a much more difficult goal."19 This is true because much is expected of penises, especially by pediatric urologists, and very little of vaginas. For a penis to count as acceptable"functional"-it must be or have the potential to be big enough to be readily recognizable as a "real" penis. In addition, the "functional" penis is generally expected to have the capability to become erect and flaccid at appropriate times, and to act as the conduit through which urine and semen are expelled, also at appropriate times. The urethral opening is expected to appear at the very tip of the penis. Typically, surgeons also hope to see penises that are "believably" shaped and colored.
Meanwhile, very little is needed for a surgically constructed vagina to count among surgeons as "functional." For a constructed vagina to be considered acceptable by surgeons specializing in intersexuality, it basically just has to be a hole big enough to fit a typical-sized penis. It is not required to be self-lubricating or even to be at all sensitive, and certainly does not need to change shape the way vaginas often do when women are sexually stimulated. So, for example, in a panel discussion of surgeons who treat intersexuality, when one was asked, "How do you define successful intercourse? How many of these girls actually have an orgasm, for example?" a member of the panel responded, "Adequate intercourse was defined as successful vaginal penetration."20 All that is required is a receptive hole.
Indeed, clinicians treating intersex children often talk about vaginas in these children as the absence of a thing, as a space, a "hole," a place to put something. That is precisely why opinion holds that "a functional vagina can be constructed in virtually everyone"because it is relatively easy to construct an insensitive hole surgically. (It is not always easy to keep them open and uninfected.) The decision to "make" a female is therefore considered relatively fool-proof, while "the assignment of male sex of rearing is inevitably difficult and should only be undertaken by an experienced team" who can determine if a penis will be adequate for "successful" malehood.21
The strict conception of "normal" sexual anatomy and "normal" sex behavior that underlies prevailing treatment protocols is arguably sexist in its asymmetrical treatment of reproductive potential and definitions of anatomical "adequacy." Additionally, as Lee and other critics of intersex treatment have noted, "[d]ecisions of gender assignment and subsequent surgical reconstruction are inseparable from the heterosexual matrix, which does not allow for other sexual practices or sexualities. Even within heterosexuality, a rich array of sexual practices is reduced to vaginal penetration."22 Not surprisingly, feminists and intersexuals have invariably objected to these presumptions that there is a "right" way to be a male and a "right" way to be a female, and that children who challenge these categories should be reconstructed to fit into (and thereby reinforce) them.
Indeed, beside the important (and too often disregarded) philosophical-political issue of gender roles, there is a more practical one: how does one decide where to put the boundaries on acceptable levels of anatomical variation? Not surprisingly, the definition of genital "normality" in practice appears to vary among physicians. For example, at least one physician has set the minimum length of an "acceptable" penis at 1.5 centimeters.23
Indeed, at least two physicians are convinced (and have evidence) that any penis is a big enough penis for male adjustment, if the other cards are played right. Almost a decade ago Justine Schober (nee Reilly), a pediatric urologist now based at the Hamot Medical Center in Erie, Pennsylvania, and Christopher Woodhouse, a physician based at the Institute of Urology and St. George's Hospital in London, "interviewed and examined 20 patients with the primary diagnosis of micropenis in infancy" who were labeled and raised as boys. Of the post-pubertal (adult) subjects, "All patients were heterosexual and they had erections and orgasms. Eleven patients had ejaculations, 9 were sexually active and reported vaginal penetration, 7 were married or cohabitating and 1 had fathered a child."24
Schober and Woodhouse concluded that "a small penis does not preclude normal male role" and should not dictate female gender reassignment. They found that when parents "were well counseled about diagnosis they reflected an attitude of concern but not anxiety about the problem, and they did not convey anxiety to their children. They were honest and explained problems to the child and encouraged normality in behavior. We believe that this is the attitude that allows these children to approach their peers with confidence" (p. 571).
Ultimately, Schober and Woodhouse agreed with the tenet of the psychosocial theory that assumes that "the strongest influence for all patients [is] the parental attitude." But rather than making these children into girls and trying to convince the parents and children about their "real" feminine identity, Schober and Woodhouse found that "the well informed and open parents … produced more confident and better adjusted boys." We should note that these boys were not considered "typical" in their sex lives: "The group was characterized by an experimental attitude to [sexual] positions and methods…. The group appears to form close and long-lasting relationships. They often attribute partner sexual satisfaction and the stability of theirrelationships [with women partners] to their need to make extra effort including nonpenetrating techniques" (p. 571).
"Ambiguous" genitalia do not constitute a disease. They simply constitute a failure to fit a particular (and, at present, a particularly demanding) definition of normality. It is true that whenever a baby is born with "ambiguous"genitalia, doctors need to consider the situation a potential medical emergency because intersexuality may signal a potentially serious metabolic problem, namely congenital adrenal hyperplasia (CAH), which primarily involves an electrolyte imbalance and can result in "masculinization" of genetically female fetuses. Treatment of CAH may save a child's life and fertility At the birth of an intersex child, therefore, adrenogenital syndrome must be quickly diagnosed and treated, or ruled out. Nonetheless, as medical texts advise, "of all the conditions responsible for ambiguous genitalia, congenital adrenal hyperplasia is the only one that is life-threatening in the newborn period," and even in cases of CAH the "ambiguous" genitalia themselves are not deadly.25
As with CAH's clear medical issue, doctors now also know that the testes of AIS patients have a relatively high rate of becoming cancerous, and therefore AIS needs to be diagnosed as early as possible so that the testes can be carefully watched or removed. However, the genitalia of an androgen-insensitive person are not diseased. Again, while unusual genitalia may signal a present or potential threat to health, in themselves they just look different. As we have seen, because of the perception of a "social emergency" around an intersex birth, clinicians take license to treat nonstandard genitalia as a medical problem requiring prompt correction. But as Suzanne Kessler sums up the situation, intersexuality does not threaten the patient's life; it threatens the patient's culture.
Psychological Health and the Problem of Deception
Clearly, in our often unforgiving culture intersexuality can also threaten the patient's psyche; that recognition is behind the whole treatment approach. Nevertheless, there are two major problems here. First, clinicians treating intersex individuals may be far more concerned with strict definitions of genital normality than intersexuals, their parents, and their acquaintances (including lovers). This is evidenced time and again, for example, in theJohn/Joan case:
John recalls thinking, from preschool through elementary school, that physicians were more concerned with the appearance of Joan's genitals than was Joan. Her genitals were inspected at each visit to The Johns Hopkins Hospital. She thought they were making a big issue out of nothing, and they gave her no reason to think otherwise. John recalls thinking: "Leave me be and then I'll be fine…. It's bizarre. My genitals are not bothering me; I don't know why it is bothering you guys so much."26
Second, and more basically, it is not self-evident that a psychosocial problem should be handled medically or surgically. We do not attempt to solve the problems many dark-skinned children will face in our nation by lightening their skins. Similarly, Cheryl Chase has posed this interesting question: when a baby is born with a severely disfigured but largely functional arm, ought we quickly remove the arm and replace it with a possibly functional prosthetic, so that the parents and child experience less psychological trauma27? While it is true that genitals are more psychically charged than arms, genitals are also more easily and more often kept private, whatever their state. Quoting the ideas of Suzanne Kessler, the pediatric urologist Schober argues in a forthcoming work that "Surgery makes parents and doctors more comfortable, but counseling makes people comfortable too, and [it] is not irreversible." She continues: "Simply understanding and performing good surgeries is not sufficient. We must also know when to appropriately perform or withhold surgery. Our ethical duty as surgeons is to do no harmand to serve the best interests of our patient. Sometimes, this means admitting that a 'perfect' solution may not be attainable."28
Ironically, rather than alleviating feelings of freakishness, in practice the way intersexuality is typically handled may actually produce or contribute to many intersexuals' feelings of freakishness. Many intersexuals look at these two facts: (1) they are subject, out of "compassion," to "normalizing" surgeries on an emergency basis without their personal consent, and (2) they are often not told the whole truth about their anatomical conditions and anatomical histories. Understandably, they conclude that their doctors see them as profound freaks and that they must really be freaks. H. Martin Malin, a professor in clinical sexology and a therapist at the Child and Family Institute in Sacramento, California, has found this to be a persistent theme running through intersexuals' medical experience:
As I listened to [intersexuals'] stories, certain leit motifs began to emerge from the bits of their histories. They or their parents had little, if any, counseling. They thought they were the only ones who felt as they did. Many had asked to meet other patients whose medical histories were similar to their own, but they were stonewalled. They recognized themselves in published case histories, but when they sought medical records, were told they could not be located…. The patients I was encountering were not those whose surgeries resulted from life-threatening or seriously debilitating medical conditions. Rather, they had such diagnoses as "micropenis" or "clitoral hypertrophy." These were patients who were told-when they were told anything-that they had vaginoplasties or clitorectomies because of the serious psychological consequences they would have suffered if surgery had not been done. But the surgeries had been performed-and they were reporting longstanding psychological distress. They were certain that they would rather have had the "abnormal" genitals they [had] had than the "mutilated" genitals they were given. They were hostile and often vengeful towards the professionals who had been responsible for their care and sometimes, by transference, towards me. They were furious that they had been lied to.29
Given the lack of long-term follow-up studies it is unclear whether a majority of intersexuals wind up feeling this way, but even if only a small number do we must ask whether the practice of deception and "stonewalling" is essentially unethical.
Why would a physician ever withhold medical and personal historical information from an intersexed patient? Because she or he believes that the truth is too horrible or too complicated for the patient to handle. In a 1988 commentary in the Hastings Center Report, Brendan Minogue and Robert Tarszewski argued, for example, that a physician could justifiably withhold information from a sixteen-year-old AIS patient and/or her parents if he believed that the patient and/or family was likely to be incapable of handling the fact that she has testes and an XY chromosomal complement.30 Indeed, this reasoning appears typical among clinicians treating intersexuality; many continue to believe that talking truthfully with intersexuals and their families will undo all the "positive" effects of the technological efforts aimed at covering up doubts. Thus despite intersexuals' and ethicists' published, repeated objections to deception, in 1995 a medical student was given a cash prize in medical ethics by the Canadian Medical Association for an article specifically advocating deceiving AIS patients (including adults) about the biological facts of their conditions. The prize-winner argued that "physicians who withhold information from AIS patients are not actually lying; they are only deceiving" because they selectively withhold facts about patients' bodies.31
But what this reasoning fails to appreciate is that hiding the facts of the condition will not necessarily prevent a patient and family from thinking about it. Indeed, the failure on the part of the doctor and family to talk honestly about the condition is likely only to add to feelings of shame and confusion. One woman with AIS in Britain writes, "Mine was a dark secret kept from all outside the medical profession (family included), but this [should] not [be] an option because it both increases the feelings of freakishness and reinforces the isolation."32 Similarly, Martha Coventry, a woman who had her "enlarged" clitoris removed by surgeons when she was six, insists that "to be lied to as a child about your own body, to have your life as a sexual being so ignored that you are not even given the decency of an answer to your questions, is to have your heart and soul relentlessly undermined."33
Lying to a patient about his or her biological condition can also lead to a patient unintentionally taking unnecessary risks. As a young woman, Sherri Groveman, who has AIS, was told by her doctor that she had "twisted ovaries" and that they had to be removed; in fact, her testes were removed. At the age of twenty, "alone and scared in the stacks of a [medical] library," she discovered the truth of her condition. Then "the pieces finally fit together. But what fell apart was my relationship with both my family and physicians. It was not learning about chromosomes or testes that caused enduring trauma, it was discovering that I had been told lies. I avoided all medical care for the next 18 years. I have severe osteoporosis as a result of a lack of medical attention. This is what lies produce."34
Similarly, as B. Diane Kemp-"a social worker with more than 35 years' experience and a woman who has borne androgen insensitivity syndrome for 63 years"notes, "secrecy as a method of handling troubling information is primitive, degrading, and often ineffective. Even when a secret is kept, its existence carries an aura of unease that most people can sense … Secrets crippled my life."35
Clearly, the notion that deception or selective truthtelling will protect the child, the family, or even the adult intersexual is extraordinarily paternalistic and naive, and, while perhaps well-intentioned, it goes against the dominant trend in medical ethics as those ethics guidelines are applied to other, similar situations. In what other realms are patients regularly not told the medical names for their conditions, even when they ask? As for the idea that physicians should not tell patients what they probably "can't handle," would a physician be justified in using this reasoning to avoid telling a patient she has cancer or AIDS?
In their commentary in the Hastings Center Report Sherman Elias and George Annas pointed out that a physician who starts playing with the facts of a patient's condition may well find himself forced to lie or admit prior deception. "Practically," Elias and Annas wrote, "it is unrealistic to believe that [the AIS patient] will not ultimately learn the details of her having testicular syndrome. From the onset it will be difficult to maintain the charade."36 They also note that without being told the name and details of her condition any consent the AIS patient gives will not truly be "informed." As an attorney Groveman too argues "that informed consent laws mandate that the patient know the truth before physicians remove her testes or reconstruct her vagina.37
Informed Consent and Risk Assumption
It is not at all clear if all or even most of the intersex surgeries done today involve what would legally and ethically constitute informed consent. It appears that few intersexuals or their parents are educated, before they give consent, about the anatomically strict psychosocial model employed. The model probably ought to be described to parents as essentially unproven insofar as the theory remains unconfirmed by broad-based, longterm follow-up studies, and is directly challenged by cases like the John/Joan case as well as by evermounting "anecdotal" reports from former patients who, disenfranchised and labeled "lost to follow-up" by clinicians, have turned to the popular press and to public protest in order to be heard. Of course, as long as intersex patients are not consistently told the truth of their conditions, there is some question about whether satisfaction can be assessed with integrity in long-term studies.
At a finer level, many of the latest particular cosmetic surgeries being used on intersexed babies and children today remain basically unproven as well, and need to be described as such in consent agreements. For example, a team of surgeons from the Children's Medical Center and George Washington University Medical School has reported that in their preferred form of clitoral "recession" (done to make "big" clitorises look "right"), "the cosmetic effect is excellent" but "late studies with assessment of sexual gratification, orgasm, and general psychological adjustment are unavailable … and remain in question."38 In fact the procedure may result in problems like stenosis, increased risk of infections, loss of feeling, and psychological trauma. (These risks characterize all genital surgeries.)
This lack of long-term follow-up is the case not only for clitoral surgeries; David Thomas, a pediatric urologist who practices at St. James's University Hospital and Infirmary in Leeds, England, recently noted the same problem with regard to early vaginal reconstructions: "So many of these patients are lost to follow-up. If we do this surgery in infancy and childhood, we have an obligation to follow these children up, to assess what we're doing."39 There is a serious ethical problem here: risky surgeries are being performed as standard care and are not being adequately followed-up.40
The growing community of open adult intersexuals understandably question whether anyone should have either her ability to enjoy sex or her physical health risked without personal consent just because she has a clitoris, penis, or vagina that falls outside the standard deviation. Even if we did have statistics that showed that particular procedures "worked" a majority of the time we would have to face the fact that part of the time they would not work, and we need to ask whether that risk ought to be assumed on behalf of another person.
Beyond "Monster Ethics"
In a 1987 article on the ethics of killing one conjoined twin to save the other, George Annas suggested (but did not advocate) that one way to justify such a procedure would be to take "the monster approach." This approach would hold that conjoined twins are so grotesque, so pathetic, any medical procedure aimed at normalizing them would be morally justified.41 Unfortunately, the present treatment of intersexuality in the U.S. seems to be deeply informed by the monster approach; ethical guidelines that would be applied in nearly any other medical situation are, in cases of intersexuality, ignored. Patients are lied to; risky procedures are performed without follow-up; consent is not fully informed; autonomy and health are risked because of unproven (and even disproven) fears that atypical anatomy will lead to psychological disaster. Why? Perhaps because sexual anatomy is not treated like the rest of human anatomy, or perhaps because we simply assume that any procedure which "normalizes" an "abnormal" child is merciful. Whatever the reason, the medical treatment of intersexuality and other metabolically benign, cosmetically unusual anatomies needs deep and immediate attention.
We can readily use the tools of narrative ethics to gain insight into practices surrounding intersexuality. There are now available many autobiographies of adult intersexuals.42 Like that of John/Joan, whether or not they are characteristic of long-term outcomes these autobiographies raise serious questions about the dominant treatment protocols.
Narrative ethics also suggests that we use our imaginations to think through the story of the intersexual, to ask ourselves, if we were born intersexed, what treatment we would wish to have received. Curious about what adult nonintersexuals would have chosen for themselves, Suzanne Kessler polled a group of college students regarding their feelings on the matter. The women were asked, "Suppose you had been born with a larger than normal clitoris and it would remain larger than normal as you grew to adulthood. Assuming that the physicians recommended surgically reducing your clitoris, under what circumstances would you have wanted your parents to give them permission to do it?" In response,
.bq About a fourth of the women indicated they would not have wanted a clitoral reduction under any circumstance. About half would have wanted their clitoris reduced only if the larger than normal clitoris caused health problems. Size, for them, was not a factor. The remaining forth of the sample could imagine wanting their clitoris reduced if it were larger than normal, but only if having the surgery would not have resulted in a reduction in pleasurable sensitivity.43
Meanwhile, in this study, "the men were asked to imagine being born with a smaller than normal penis and told that physicians recommended phallic reduction and a female gender assignment." In response All but one man indicated they would not have wanted surgery under any circumstance. The remaining man indicated that if his penis were 1 cm. or less and he were going to be sterile, he would have wanted his parents to give the doctors permission to operate and make him a female. (p. 36)
Kessler is cautious to note that we need more information to assess this data fully, but it does begin to suggest that given the choice most people would reject genital cosmetic surgery for themselves.
As an historian, I also think we need to consider the historical and cultural bases for genital conformity practices, and realize that most people in the U.S. demonstrate little tolerance for practices in other cultures that might well be considered similar. I am, of course, talking about the recent passage of federal legislation prohibiting physicians from performing "circumcision" on the genitalia of girls under the age of eighteen, whether or not the girls consent or personally request the procedure. African female genital "cutting" typically involves, in part, excision of the clitoral tissue so that most or all clitoral sensation will be lost. While proponents of this traditional female genital "cutting" have insisted this practice is an important cultural tradition-analogous to male circumcision culturallyadvocates of the U.S. law insist it is barbaric and violates human rights. Specifically, in the federal legislation passed in October 1996 Congress declared that: "Except as provided in subsection (b), whoever knowingly circumcises, excises, or infibulates the whole or any part of the labia majora or labia minora or clitoris of another person who has not attained the age of 18 years shall be fined under this title or imprisoned not more than 5 years, or both."44
Subsection "b" specifies that: "A surgical operation is not a violation of this section if the operation is (1) necessary to the health of the person on whom it is performed, and is performed by a person licensed in the place of its performance as a medical practitioner; or (2) performed on a person in labor or who has just given birth and is performed for medical purposes connected with that labor or birth."
Surgeons treating intersexuality presumably would argue that the procedures they perform on the genitals of girls (which clearly include excision of parts of the clitoris) are indeed "necessary to the health of the person on whom it is performed." While it is easy to condemn the African practice of female genital mutilation as a barbaric custom that violates human rights, we should recognize that in the United States medicine's prevailing response to intersexuality is largely about genital conformity and the "proper" roles of the sexes. Just as we find it necessary to protect the rights and well-being of African girls, we must now consider the hard questions of the rights and well-being of children born intersexed in the United States.
As this paper was in process, the attention paid by the popular media and by physicians to the problems with the dominant clinical protocols increased dramatically, and many more physicians and ethicists have recently come forward to question those protocols. Diamond and Sigmundson have helpfully proposed tentative new "guidelines for dealing with persons with ambiguous genitalia."45
As new guidelines are further developed, it will be critical to take seriously two tasks. First, as I have argued above, intersexuals must not be subjected to different ethical standards from other people simply because they are intersexed. Second, the experiences and advice of adult intersexuals must be solicited and taken into consideration. It is incorrect to claim, as I have heard several clinicians do, that the complaints of adult intersexuals are irrelevant because they were subjected to "old, unperfected" surgeries. Clinicians have too often retreated to the mistaken belief that improved treatment technologies (for example, better surgical techniques) will eliminate ethical dilemmas surrounding intersex treatment. There is far more at issue than scar tissue and loss of sensation from unperfected surgeries.
The author wishes to thank Aron Sousa, Cheryl Chase, Michael Fisher, Elizabeth Gretz, Daniel Federman, the members of the Enhancement Technologies and Human Identity Working Group, and Howard Brody, Libby Bogdan-Lovis, and other associates of the Center for Ethics and Humanities in the Life Sciences at Michigan State University for their comments on this work.
This article is adapted from Hermaphrodites and the Medical Invention of Sex, by Alice Domurat Dreger, to be published this month by Harvard University Press. Copyright 1998 by Alice Domurat Dreger. All rights reserved.
Alice Domurat Dreger, "`Ambiguous Sex'-or Ambivalent Medicine? Ethical Issues in the Treatment of Intersexuality," Hastings Center Report 28, no. 3 (1998): 24-36.
1 Milton Diamond and H. Keith Sigmundson, Sex Reassignment at Birth: Long-Term Review and Clinical Implications, Archives of Pediatrics and Adolescent Medicine 15 (1997): 298-304.
2 For a more in-depth biography, see John Colapinto, The True Story of John/Joan, Rolling Stone, 11 December 1997, pp. 55ff.
3 Diamond and Sigmundson, "Sex Reassignment," p. 303.
4 I discuss this at length in Dreger, Hermaphrodites and the Medical Invention of Sex (Cambridge, Mass.: Harvard University Press, 1998); see especially prologue and chap. 1.
5 See Ethel Sloane, Biology of Women, 3d ed. (Albany: Delmar Publishers, 1993), p. 168. According to Denis Grady, a study of over 6,500 women athletes competing in seven different international sports competitions showed an incidence of intersexuality of one in 500 women, but unfortunately Grady does not provide a reference to the published data from that study (Denise Grady, "Sex Test," Discover, June 1992, pp. 78-82). That sampled population should not simply be taken as representative of the whole population, but this number is certainly higher than most people would expect.
6 Anne Fausto-Sterling, Sexing the Body: How Biologists Construct Sexuality (New York: Basic Books, forthcoming 1999), chap. 2; Fausto-Sterling, "How Dimorphic Are We?" American Journal of Human Genetics (forthcoming); and personal communication. The highest modern-day estimate for frequency of sexually ambiguous births comes from John Money, who has posited that as many as 4 percent of live births today are of "intersexed" individuals (cited in Anne Fausto-Sterling, "The Five Sexes," The Sciences 33 [1993]: 20-25). Money's categories tend to be exceptionally broad and poorly defined, and not representative of what most medical professionals today would consider to be "intersexuality."
7 Dreger, Hermaphrodites, chaps. 1-5; for a summary of the scene in Britain in the late-nineteenth century, see Dreger, "Doubtful Sex: The Fate of the Hermaphrodite in Victorian Medicine," Victorian Studies 38 (1995): 335-69.
8 Stuart R. Kupfer, Charmain A. Quigley, and Frank S. French, "Male Pseudohermaphroditism," Seminars in Perinatology 16 (1992): 319-31, at 325.
9 For summaries and critiques of Money's work on intersexuality, see especially: Cheryl Chase, "Affronting Reason," in Looking Queer: Image and Identity in Lesbian, Bisexual Gay and Transgendered Communities, ed. D. Atkins (Binghamton, N.Y.: Haworth, 1998); "Hermaphrodities with Attitude: Mapping the Emergence of Intersex Political Activism," GLQ 4, no. 2 (1998): 189-211; Anne Fausto-Sterling, "How to Build a Man," in Science and Homosexualities, ed. Vernon A. Rosario (New York: Routledge, 1997), pp. 219-25; and Ellen Hyun-Ju Lee, "Producing Sex: An Interdisciplinary Perspective on Sex Assignment Decisions for Intersexuals" (Senior Thesis, Brown University, 1994).
10 American Academy of Pediatrics (Section on Urology), Timing of Elective Surgery on the Genitalia of Male Children with Particular Reference to the Risks, Benefits, and Psychological Effects of Surgery and Anesthesia, Pediatrics 97, no. 4 (1996): 590-94.
11 For example, see Patricia K. Donahoe, "The Diagnosis and Treatment of Infants with Intersex Abnormalities," Pediatric Clinics of North America 34 (1987): 1333-48.
12 Suzanne J. Kessler, "The Medical Construction of Gender: Case Management of Intersexed Infants," Signs 16 (1990): 3-26; compare the advice given by Cynthia H. Meyers-Seifer and Nancy J. Charest, "Diagnosis and Management of Patients with Ambiguous Genitalia," Seminars in Perinatology 16 (1992): 33239.
13 Lee, "Producing Sex," p. 45.
14 Melissa Hendricks, "Is It a Boy or a Girl?" John Hopkins Magazine (November, 1993): 10-16, p. 10.
15 Barbara C. McGillivray, "The Newborn with Ambiguous Genitalia," Seminars in Perinatology 16 (1991): 365-68, p. 366. 16. Kurt Newman, judson Randolph, and Kathryn Anderson, "The Surgical Management of Infants and Children with Ambiguous Genitalia," Annals of Surgery 215 (1992): 644-53, pp. 651 and 647.
17 Meyers-Seifer and Charest, "Diagnosis and Management," p. 337. See also Kupfer, Quigley, and French, "Male Pseudohermaphroditism," p. 328; Rajkumar Shah, Morton M. Woolley, and Gertrude Costin, "Testicular Feminization: The Androgen Insensitivity Syndrome," Journal of Pediatric Surgery 27 (1992): 757-60, p. 757.
18 Justine Schober, personal communication; for data on this, see Justine M. Reilly and C.R.J. Woodhouse, "Small Penis and the Male Sexual Role," Journal of Urology 142 (1989): 569-71.
19 Robin J.O. Catlin, Appleton eF Lange Review for the USMILE Step 2 (East Norwalk, Connecticut: Appleton & Lange, 1993), p. 49.
20 See the comments of John P Gearhart in M. M. Bailez, John P Gearhart, Claude Migeon, and John Rock, "Vaginal Reconstruction After Initial Construction of the External Genitalia in Girls with Salt-Wasting Adrenal Hyperplasia," Journal of Urology 148 (1992): 680-84, p. 684.
21 Kupfer, Quigley, and French, "Male Pseudohermaphroditism," p. 328.
22 Lee, "Producing Sex," p. 27.
23 See Donahoe, "The Diagnosis and Treatment of Infants with Intersex Abnormalities."
24 Reilly and Woodhouse, "Small Penis," p. 569.
25 Patricia K. Donahoe, David M. Powell, and Mary M. Lee, "Clinical Management of Intersex Abnormalities," Current Problems in Surgery 28 (1991): 515-79, p. 540.
26 Diamond and Sigmundson, "Sex Reassignment," pp. 300301.
27 Cheryl Chase, personal communication.
28 Quoted in Justine M. Schober, "Long-Term Outcomes, ed. Pierre of (Philadelphia: William B. Saunders, for Intersex," Pediatric Surgery and Urology: Long Term Outcomes, ed. Pierre D. E. Mouriquand (Philadelphia: William B. Saunders, forthcoming).
29 H. M. Malin, personal communication of 1 January 1997 to Justine M. Schober, quoted in Schober, "Long-Term Outcome."
30 Brendan P Minogue and Robert Taraszewski, "The Whole Truth and Nothing But the Truth?" (Case Study), Hastings Center Report 18, no. 5 (1988): 34-35.
31 Anita Natarajan, Medical Ethics and Truth Telling in the Case of Androgen Insensitivity Syndrome, Canadian Medical Association Journal 154 (1996): 568-70. (For responses to Natarajan's recomendations by AIS women and a partner of an AIS woman, see Canadian Medical Association Journal 154 [1996]: 1829-33.)
32 Anonymous, Be Open and Honest with Sufferers, British Medical Journal 308 (1994): 1041-42.
33 Martha Coventry, Finding the Words, Chrysalis: The Journal of Transgressive Gender Identities 2 (1997): 27-30.
34 Sherri A. Groveman, Letter to the Editor, Canadian Medical Association Journal 154 (1996): 1829, 1832.
35 B. Diane Kemp, Letter to the Editor, Canadian Medical Association Journal 154 (1996): 1829.
36 Sherman Elias and George J. Annas, "The Whole Truth and Nothing But the Truth?" (Case Study), Hastings Center Report 18, no. 5 (1988): 35-36, p. 35.
37 Groveman, "Letter to the Editor," p. 1829.
38 Newman, Randolph, and Anderson, "Surgical Management," p. 651.
39 "Is Early Vaginal Reconstruction Wrong for Some Intersex Girls?" Urology Times (February 1997): 10-12.
40 Intersexuals are understandably tired of hearing that "long-term follow-up data is needed" while the surgeries continued to occur. On this, see especially the guest commentary by David Sandberg, "A Call for Clinical Research," Hermaphrodites with Attitude (Fall/Winter 1995-1996): 8-9, and the many responses of intersexuals in the same issue.
41 George J. Annas, "Siamese Twins: Killing One to Save the Other" (At Law), Hastings Center Report 17, no. 2 (1987): 2729.
42 See, for example, M. Morgan Holmes, "Medical Politics and Cultural Imperatives: Intersex Identities beyond Pathology and Erasure" (M.A. Thesis, York University, 1994); Chase, "Hermaphrodites with Attitude"; Geoffrey Cowley, "Gender Limbo," Newsweek, 19 May 1997, pp. 64-66; Natalie Angier, "New Debate Over Surgery on Genitals," New York Times, 13 May 1997; "Special Issue: Intersexuality," Chrysalis: The Journal of Transgressive Gender Identities 2 (1997). Intersexual autobiographies are also from peer support groups, including the Intersex Society of North America. For information about support groups see the special issue of Chrysalis, vol. 2, 1997.
43 Suzanne J. Kessler, Meanings of Genital Variability Chrysalis: The Journal of Transgressive Gender Identities 2 (1997): 33-37.
44 Omnibus Consolidated Appropriations Bill, H.R. 3610, PL. 104-208.
45 Milton Diamond and Keith Sigmundson, Management of Intersexuality: Guidelines for Dealing with Persons with Ambiguous Genitalia, Archives of Pediatric and Adolescent Medicine 151 (1997): 1046-50.
Reproduced with permission of the copyright owner. Further reproduction or distribution is prohibited without permission.


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BETHLEHEM, Pa. -- DeSean Jackson and Jeremy Maclin got into a brief argument late into the morning practice and spent the remainder of the practice and the walk off the field in an animated conversation.
"It's training camp. There's no bad vibe between us two," Maclin said. "We talked something out and that's all it was. I don't hate him, he doesn't hate me. We're still good. We're still friends. There was a little mix up and it's all good now."
Maclin wouldn't explain what brought about the spat, although it took place after a 7-on-7 drill. The two Eagles wide receivers walked off the field together and as they got closer to a gaggle of reporters, Maclin could be heard saying, "We're still cool."
They then proceeded to the autograph line where each signed for a number of fans.
"It was nothing major," Maclin said. "Like I said, it was over and done with. Like I said, 'We're still cool.'"
Jackson hasn't been talking to the media since he arrived at training camp.
As great as it is for the Eagles to have so many talented offensive skill players, there are always potential drawbacks. One of the concerns could be pass distribution.
As Maclin was asked about the quarrel, Jackson emerged from the locker room. Maclin was kiddingly asked by a reporter if the argument was about who was the bigger star.
"None of that," Maclin said.
The Eagles' two star receivers then walked separately to their cars -- Jackson's black Porsche and Maclin's white Range Rover -- and sped off.

subset: commoncrawl


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Football Team Honor Waterboy
Noah VanVooren has been a big supporter of The Little Chute High School football team in Wisconsin and is the teams manager/water boy. Noah, who is a senior with Down syndrome, has always been there to show his team pride and encourage players all throughout high school. For the last game and senior night, he served as team captain and led the team out to the field AND got to suit up for the first time ever on Friday night. On the last play of the game, he scored a touchdown!!!


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The launcher surfaces the apps, contacts and information you'd want based on your context: your location, the time of day, your individual preference, and more. All your apps and information will remain on your phone, they'll just be neatly organized and easier to access!
MAIN LAUNCHER FEATURESSmart Folders™ Your apps are automatically organized in folders that you choose, keeping your homescreen neat. Folders also contain convenient cards with articles, videos, and more.
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Presidential candidate Jon Huntsman just rolled out his agenda for creating US jobs. Mitt Romney is expected to do the same in coming days. And President Obama's deliberations over a new jobs plan – what to include and when to roll it out – have been in the news all week.
That's a lot of focus on jobs policy.
Oh, and the Chamber of Commerce and AFL-CIO are among the groups on the policymaking sidelines that are doing the same thing.
Why now?
It's not like unemployment is a new problem that's just been discovered. The US jobless rate has been above 8 percent for 2-1/2 years.
But, although the health of the economy and state of the job market rank consistently as Americans' top concerns in polls, Washington's attention to the question of how to improve job creation has ebbed and flowed.
Several factors explain the recent resurgence, and most of them are not too difficult to guess:
• The election campaign for 2012 is ramping up. Candidates including the current occupant of the White House are feeling the strong incentive to focus on what matters to voters. The latter group includes lots of people without jobs, people who worry they could lose their job, and people who know their own finances would be helped by a stronger, job-growing economy.
• Labor Day is coming this weekend. It's an event that doesn't always factor into the nation's policy calculus. But with the weak economy, the holiday and the end of summer vacations provide a calendar prompt for job ideas to surface right around now.
• The economy is crying for help. Yes, unemployment has been a persistent problem for several years, but the sense of economic emergency arguably is higher now than at any time since the spring of 2009, when the Federal Reserve and Treasury were still wielding financial-crisis fire extinquishers. Economists in recent weeks shifted toward a heightened concern about the possibility of a new recession, and a flight to safety in financial markets has buoyed gold and US Treasury bonds. And this week a widely watched index of consumer confidence hit a two-year low.
• Jobs have cycled higher relative to other priorities. The flow of Washington imperatives since the financial crisis has sometimes seen jobs get eclipsed. In 2009 Mr. Obama pivoted for months toward health-care reform. This year Republicans have kept the spotlight on their goal of curbing federal spending and deficits. Having signed a Budget Control Act last month, based on a bipartisan deficit-reduction deal, Obama is eager to put the focus back on jobs.
If Obama can win Republican support for some policies that help the economy, that could help lift sagging approval ratings and bolster his reelection chances. If Republicans oppose his proposals, Obama can at least make that a campaign talking point, casting Republicans as obstructionists or obsessed soley with spending cuts.
For Republican rivals who hope to unseat Obama, unveiling policies aimed at employment gives them a chance to contrast themselves with what they argue has been a presidency of economic failures. Where Obama has emphasized efforts at temporary stimulus (a $787 billion Recovery Act, payroll-tax breaks, and more), Mr. Huntsman's plan, for example, focuses on a proposed permanent streamlining of the tax code and reducing regulatory burdens.
In fairness to Obama, he and other Democrats might embrace permanent tax reforms as well.
The procedural problem is that most Republicans (including Huntsman) want to do it on a "revenue-neutral" basis, while Democrats want to reap some extra tax revenue in what Obama calls a "balanced" effort to reduce future deficits. Also, the two sides differ on how much of the tax burden should be born by the richest Americans.
As long as neither party controls both Congress and the White House, new legislation on the issue is difficult.
And that leads to the big question: With all the current focus on job policies, will anything actually happen that makes a difference to the economy?
The possibility shouldn't be ruled out, but several hurdles would need to be overcome. The first is partisanship. Obama says he'll propose measures that can win bipartisan support, but it's unclear if Republicans will embrace his proposals. One week after Obama addresses both houses of Congress, House Speaker John Boehner is planning his own jobs speech.
Second, even if policies are enacted, they may be modest in scope, given that the two parties have agreed to a fiscal path that focuses on reducing deficits.
But some moves that could bolster long-term economic growth – such as tax reform – need not cost a lot of money, and could begin bearing fruit fairly quickly.


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Editor's Warning: This week's Searching for Meaning contains wisdom not intended for children. If you are at all offended by controversial material, please refrain from reading and continue on about your day.
Not that I shouldn't be surprised, but it seems everyone wants to talk about the future of search. Quite a few opinions have emerged in my discussions recently, and the biggest question that seems to be on everyone's mind is How can we as an industry facilitate search becoming more mainstream and respected?
Of course, I could simply end this week's diatribe with a short and sweet "you gotta give it, to get it" pep talk, but I thought I would take an 800-or-so-word detour with a few thoughts on the "how to" in search marketing's quest for a seat at the big kid's table discussion.
Search Is a Private Joke
And no one is invited. Guarding the delicate secrets of Search Engine Optimization (SEO) science is a favorite pastime for many optimization gurus. The problem is secrets seem to be disappearing quickly as the search sites work to dispel many of the great myths of SEO with practical knowledge and common sense.
Now, what was that old saying about common sense?
Ah yes, common sense just isn't as common as it should be, and whichever side of the fence you sit on (white hat, black hat, grey hat), protecting or debunking search myths are perhaps not as important as welcoming new and curious members into the search community.
The specialized knowledge of search should be shared in order to raise the global profile of the discipline and tradecraft. All too often, those new to the search engine optimization business are treated like outsiders. Instead of a warm welcome, neophytes get a warm cup of "get lost," Oliver Twist style.
If you want to add credibility to the practice, stop treating people like bastard orphans and greet them happily into your world.
Organically Paid Sacrifice
While the industry should be invested in advancing the practice itself, many devote time to warring factions within the search disciplines. Natural optimization folks don't get along with paid people, and there seems to be no unifying force among them.
Where is William Wallace when you need him?
The bigger issue here is the comparison of online advertising and offline advertising. Or is it the comparison of online advertising and search? Microsoft is paying how many times earnings for aQuantive? Google shelled out how much for DoubleClick?
Guess what? All of the pieces of the marketing puzzle are converging from the data, and you can either jump on the train and ride it into town, or you stand there and watch the choo-choo pass you by.
It will take a brave heart to mend the wounds created by self-serving naysayers seeking attention instead of constructive solutions. The problem is sex, death, and lies still sell papers, and until we buck up and work together, the inevitable change just won't be as positive as we'd like.
Waiting for Google to Exhale
Somewhere along the line — it might have been the triple-digit stock price and billions in cash stockpile — quite a few people stopped what they were doing on the Web and started waiting for Google to create the next big innovation.
That's not to say there are no innovators left. If Jason Calacanis can Mahalo his way into a perceived better way to index the Web, and Tremor Media can sell American Express Card memberships in a mid-roll environment, there are still plenty of options out there for the little guy to innovate big.
And here's a little message for those providing venture capital out there: Just because one has exhibited scholastic aptitude sufficient to spell v-e-r-t-i-c-a-l s-e-a-r-c-h e-n-g-i-n-e, there may yet be better options out there for a first round of funding. Just a small suggestion.
Milking the Bull
Imagine the surprise of one farmer who tried to fill his bucket with sweet cream only to be kicked in the head by an angry bull. Moral: Even though you're an expert, it always pays to check your equipment carefully and proceed only when you are reasonably sure of a productive outcome.
Each and every day I spend in the search marketing world is a new and exciting challenge. For the last 30 days or so, much of my time has been spent either being interviewed or interviewing people to chat it up about the future direction of search and ultimately, SES.
Many old-school search and online advertising practitioners feel their world is being taken over (perhaps justifiably so) by the next generation of big marketers. Newsflash — attempting to restrict access or burying your head in the sand won't help — it isn't going to work for the phone book people, and won't work for you.
Related reading
How to pitch to top online publishers: 10 Exclusive survey insights
We surveyed 500+ online writers and editors from the New York Times, CNN, Cosmopolitan, and Mashable. 10 key insights to pitch to top online publishers.
Five search reports for ecommerce you can pull now to prep for Q4
For ecommerce companies, it's not too early to start preparing for the holiday season. Here are five search reports to pull now as you strategize for EOY.
Google + Amazon: Data on market share, trends, searches from Jumpshot
"We know Amazon and Google are big, but in reality many of us still underestimate them." Jumpshot's Head of Insights shares data on ecommerce market share.
Two simple behavioral levers to improve your link building efforts
There are only two broad strategies to improve your link building effectiveness, both of which come from a framework using BJ Fogg's behavior model.


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A major rewrite of U.S. financial regulations is largely on track, the two chairmen in charge of the legislation said after a meeting with Treasury Secretary Timothy Geithner on Capitol Hill Tuesday.
"I don't see any issue here that delays this from getting agreed to," House Financial Services Chairman Barney Frank told a small gaggle of reporters after the 30 minute meeting with Geithner and his Senate counterpart, Banking Committee Chairman Chris Dodd (D-Conn.) in Dodd's Senate hideaway office.
"We're making very substantial progress here" on issues including derivatives, higher capital standards for financial institutions, some consolidation of regulators and on not allowing 100 percent securitization, Frank said. "I believe we will have the rules in place, signed into law, before the old bad habits [return]."
Dodd offered a little less optimism than Frank, who has said Congress can complete financial reform this year, in terms of timing. "We want to clearly get something done if we can before the end of the year in our committee, and possibly beyond that," Dodd said. "But obviously health care will determine to some extent how much we can get done."
"There's a lot of commonalty and common interest in this, as I sense it as this point," Dodd said, but lawmakers still need to hammer out specifically how everything will work in legislative language. "We need to do this carefully and right. You're reorganizing a structure that hasn't been fundamentally changed since the 1930s you have to do this carefully."
"I think we're pretty well along. There are some ideas we hope can be embraced by people here who care about getting this done, stripping it of ideology."


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What is VERM and why is it here?
VERM is on the lips of every voting activist in town. That's Voter Education Registration and Mobilization, a coalition of more than a dozen organizations and individuals committed to getting citizens to the polls, no matter what it takes.
Anne Brown, executive director of the Public Housing Residents Association, credits housing activist Joy Johnson with bringing the idea of VERM to the city from a National Low-Income Housing Coalition conference where voter education was a hot topic.
Brown– who's in charge of the registration and mobilization committee– stresses VERM is not just about registration, and that education and getting to the polls are just as important.
The group has a voter guide to this year's election listing the positions of candidates George W. Bush and John F. Kerry– because naturally its nonprofit members can't endorse candidates.
The group has produced a public service announcement under the guidance of Charlottesville spokesman Maurice Jones that demonstrates how to use voting machines.
And with everybody and her brother trying to register voters in town, VERM coordinates those efforts to make sure Fridays After 5 isn't overrun with 15 tables all elbowing for would-be voters' signatures on registration forms.
As soon as VERM finishes registering voters October 4, it'll start to work getting people to the polls November 2.
VERM members
- League of Women Voters
- Virginia Organizing Project
- Public Housing Association of Residents
- Quality Community Council
- Just Children
- Legal Aid Justice Center
- Sheri Iachetta, Charlottesville Registrar
- Michael Knight, WUVA 92.7 KISS FM
- George Loper, Democratic website guru
- Charlottesville Center for Peace and Justice
- Nila Saliba, Dem activist
- Stratton Salidis, transportation activist and two-time City Council candidate
What are George Bush and John Kerry's positions on issues? The VERM voter guide describes whether they strongly or somewhat favor/oppose an issue.


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Local Floral City Traffic School Reviews
We asked a handful of our Floral City, FL traffic school customers one very simple question:
"On a scale of 1-to-10: How likely is it that you would recommend our online Floral City DMV licensed traffic school to a friend, and why?"
Floral City, FL
It was easy to follow & understand
Traffic School Reviews
We consistently strive to offer our traffic school customers the best possible online learning experience - this includes providing live & friendly customer service, easy to use courses, educational content, fast processing, and affordable pricing. But don't take our word for it, here are some real, verified reviews that our past customers have left about TrafficSchool.com!


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0 Members and 2 Barbarians in a Horde are spying on this topic.
"What?" Angus said defensively, "Well I wasn't going to punch you, was I? That left him."
"Well, we're not in china, unless that landing was worse then I thought, so take us down from war standing Mary Sue."
"Mary, do you have any maps showing our objective? I kind of lost my bearings on the way down."
"Captain, were you given any additional instructions as per our return?"
"Someone's coming. Quick, hide! It might even be the Servants, by science!" "They're approaching fast, a few seconds at most!"
"I recommend that you stay down a while, Mr. Lucrum. There's a small chance you may have a mild concussion. Though under these circumstances that might not be an option, at any rate exercise caution." The doctor then went back to her locker and picked up the metal tube after examining it.


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Check BNN and Bulbanews for up-to-date Pokémon news and discuss it on the forums or in the Bulbagarden Discord server.
| From Cradle to Save
First broadcast
English themes
Japanese themes
From Cradle to Save (Japanese: ウソハチと忍者スクール!! Usohachi and the Ninja School!!) is the 156th episode of the Advanced Generation series, and the 430th episode of the Pokémon anime. It first aired in Japan on December 15, 2005 and in the United States on October 14, 2006.
|Spoiler warning: this article may contain major plot or ending details.
Ash takes a break to train with Donphan and Pikachu, and Donphan uncovers a young ninja named Evian. He's from the Pokémon Ninja School, where Trainers and their Pokémon study the ninja arts together, and he thought Ash and his friends might be behind a recent rash of strange events and robberies. After he apologizes, our heroes enroll in the school for day and try out ninja techniques with their teacher, Angela. Team Rocket secretly watches and waits—Jessie has big ninja dreams of her own!
Angela has everyone try to find her Kecleon, which is easier said than done for Ash. During the exercise, the students find a Bonsly and blame it for the thefts. Brock calms the crying Bonsly down and proves its innocence. The real thieves are Team Rocket, who swoop in to steal the students' Pokémon but are clearly outmatched. Jessie, never one to give up, still challenges Angela to a ninja battle and the real ninja easily wins. Then it's time for everyone to send Team Rocket bouncing on their way again.
With Team Rocket gone, Bonsly wants a battle with Brock. Brock sends out Forretress and uses Spikes to weaken Bonsly so he can capture it. Now he has a new Pokémon! A baby Pokémon! Who needs lots of attention and care... is Brock really ready to be a "father"? Our heroes continue on their way to the Battle Pike with their newest, youngest team member!
The stars illuminate the sky as the startling cries of a Bonsly can be heard all around. Ash and his friends are enjoying a relaxing picnic under the sun while May polishes her Egg. With that original fury overtaking the scene, Ash is ready to take on any adventure as Pikachu shows the same enthusiasm.
A practice battle between Pikachu and Donphan is about to begin, with Pikachu starting off with an electrifying Volt Tackle. The attack clashes into Donphan, but only after a few seconds of resistance, the attack is negated and Pikachu flies backwards. Donphan starts into a Rollout attack, hurtling towards Ash and Pikachu. They manage to dodge the attack, Donphan colliding with a nearby rock structure and revealing a hidden boy and his Ninjask.
The boy introduces himself as Evian, explaining that he is from the Pokémon Ninja School. They are then led through the nearby forest to the ninja school which is flourishing with young students and exuberant Pokémon. The students try to explain to their teacher Angela what they saw the night before involving the Bonsly. One of the boys looked out a window the night before, noticing fast movements through the forest and just seconds later hearing the screams and cries of Bonsly. Interrupting their conversation, Brock jumps towards the instructor, with clasping arms to meet just only a few seconds later, a substitution of herself with a log with similar clothing. She then reveals herself in a nearby treetop with all the students being amazed with her actions.
Nearby, Team Rocket is spying on the Ninja School with Jessie suggesting they become students of the school and become ninjas to ultimately capture Pikachu. Meanwhile, Ash and gang are in a training exercise involving underwater submersion while breathing through a bamboo stick. The underwater lesson then ends and transitions over to a stealth activity with each student trying to mask their position. Max secretly masks himself behind a tree as Ash and Pikachu attempt to hide underneath the ground but soon after reveal their location. The next lesson begins with Angela's Kecleon which camouflages itself and dashes off into the underbrush with the students to attempt and try to find its location. Ash and the young boy begin down a trail as he spots the Kecleon. His Ninjask then begins a Whirlwind which sends a burst of sand towards the forest and temporarily reveals the Kecleon. He then jumps towards it but comes to meet the ground. Ash then tries his chance at it directing Pikachu to launch a Thunderbolt attack towards the general direction but the attack comes to miss as the Kecleon snatches Ash's hat and begins up a nearby tree.
Ash and Pikachu dash for the stolen hat but come only to make direct contact with the tree. Another student of the school notices movement nearby and moves to reveal the Bonsly. The Bonsly then begins crying uncontrollably as Brock begins to calm it down. Ash goes to look up its data in his Pokédex. The three students that noticed the Bonsly the night before rush towards Brock and start arguing, which causes Bonsly to start crying again. Brock then grabs a Berry off a nearby tree and attempts to feed it to Bonsly, but it only knocks the Berry from out his hand. Brock then attempts to feed Bonsly with a bottle as it then begins devouring the food.
Bonsly finishes the food and then starts to cry again. A metallic projectile hurtles towards the ground and makes contact to reveal a single solitary rose. Team Rocket's voice can then be heard from the background setting the usual Rocket theme. Team Rocket is dressed in ninja attire and mysterious masks. Ash quickly sees through their disguises to reveal them as Team Rocket. With a quick phrase, Meowth then controls the new mecha, which then shoots a sticky fluid from its arms as the mecha begins to hoist the Pokémon into the air. Angela then calls upon her Shiftry as it dashes towards the sky and collides with the mecha, sending it hurtling towards the ground at great speed. With great haste, Ash, Brock, and May then call upon Combusken, Grovyle, and Marshtomp. Grovyle dashes towards Team Rocket and cuts the restraints, releasing the captured Pokémon. Shiftry then clashes with the ground which sends a tremor throughout the ground and towards Team Rocket. Combusken then launches a ferocious Fire Spin towards Team Rocket which leaves them charred. It's now Marshtomp's turn which sends a Water Gun towards Team Rocket and releases them from their position in the treetops. Seviper is then released from its Poké Ball as it masks the area with a thick Haze.
Jessie then dashes through the air and comes down with her net. After the smoke and dust clears, Angela goes to reveal that Jessie has only captured a substitution. With a new strange technique, Jessie then begins to run around uncontrollably creating many clones of herself. Angela laughs at Jessie's effort as she directs Shiftry with a simple phrase. Shiftry then starts off with a Double Team and then creates a Whirlwind effect rotating Team Rocket at a high speed. Ariados then entangles Team Rocket with its sticky web as a gigantic ball of web is formed with Team Rocket captured inside. As everyone moves into the attack stance, Team Rocket roll off into the distance and off a nearby cliff.
Brock begins to show is affection of love for Angela again as Bonsly then jumps and knocks Brock backwards. Brock then goes to battle for and attempt to catch the wild Bonsly. Bonsly begins to cry once again distracting Brock and Forretress, as Bonsly begins on the attack colliding with Forretress and knocking him backwards. Forretress then begins with its Rapid Spin attack, colliding with Bonsly and knocking it temporarily unconscious. Forretress then uses its Spikes attack and launches a barrage of tiny spikes around Bonsly. Brock goes to throw a Poké Ball towards Bonsly as the Ball begins to shake, Bonsly explodes from the Poké Ball and back towards the ground. Bonsly begins to fall backwards and makes contact with one of the nearby spikes which sends it flying upwards as Brock then attempts to catch Bonsly once more. As the Poké Ball shakes, everyone waits with anticipation with the catch of Bonsly. The ball finally finishes its struggle with Bonsly as that well-known catch sound is heard throughout the air.
Bonsly begins to cry more and more as Brock tries to feed it. With Brock's newly obtained Bonsly, the sun sets as our heroes march off into the distance.
Major events
- For a list of all major events in the anime, please see the timeline of events.
Pokémon debuts
TV episode debuts
- Pikachu (Ash's)
- Meowth (Team Rocket)
- Wobbuffet (Jessie's)
- Mime Jr. (James's)
- Donphan (Ash's)
- Grovyle (Ash's)
- Combusken (May's)
- Squirtle (May's)
- Forretress (Brock's)
- Marshtomp (Brock's)
- Bonsly (Brock's; new)
- Seviper (Jessie's)
- Starmie (Jessie's; flashback)
- Ninjask (Evian's)
- Shiftry (Angela's)
- Kecleon (Angela's)
- Bellsprout (student's)
- Tangela (student's)
- Ariados (student's)
- Pidgey (×3)
- The English title is a pun on the idiom "from cradle to grave".
- The ninja outfits worn by the characters at the ninja school are similar to those worn by Koga and Aya in The Ninja Poké-Showdown.
- The next episode is set in Fuchsia City, where Koga's Gym is located (although in the anime, it was in a forest outside the city itself).
- Angela addresses Rock Smash as "Ninja Rock Arts." While Rock Smash is technically a Fighting-type move, the move resulted in rocks hitting Team Rocket.
- Starting with this episode, in some season 9 episodes, the English ending theme is played instrumentally without vocals.
- One of the female students bears a notable resemblance to Delia Ketchum.
Dub edits
In other languages
|Mandarin Chinese
|Fra vugge til frihed
|Het Wiel Van Redding
|Kehdosta rautaan*
|European French
|Un nouvel ami *
|Stolz und Tapferkeit
|בית הספר לנינג'ה
|निंजा तकनीक Ninja Technique*
|La scuola per ninja
|꼬지지와 닌자 학교
|Fra vugge til brav
|Brazilian Portuguese
|Do Berço para a Luta
|Спасение малыша
|Latin America
|Salvado desde la cuna
|El guardián del bosque
|Från vaggan till Brock!
|This episode article is part of Project Anime, a Bulbapedia project that covers all aspects of the Pokémon anime.
- Advanced Generation series episodes
- Episodes written by Aya Matsui
- Episodes storyboarded and directed by Yūji Asada
- Episodes storyboarded by Yūji Asada
- Episodes directed by Yūji Asada
- Episodes animated by Masaaki Iwane
- Episodes animated by Akihiro Tamagawa
- Episodes by multiple animation directors
- Episodes focusing on Brock
- Episodes in which a main character obtains a new Pokémon


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New Haven, Conn. – The Bulldogs finished play at the Princeton-Farnsworth Invitational Sunday, with sophomore Marc Powers dropping the final of the A singles draw.
Powers, the No. 1 seed in the A draw, had been relatively untested in his first three matches of the weekend, cruising to victories in straight sets each time. On Sunday afternoon, however, he came up against the No. 2 seed Eddie Bourchier of Penn State. Bourchier, who won his first two matches convincingly, had to rally back on Saturday against fellow Nittany Lion Bryan Welnetz after dropping the first set 3-6. He took control of Sunday's match-up with Powers, pulling out a 6-3, 6-2 victory.
The other Yale outfit to see action in a final also fell Sunday, with the C doubles duo of sophomore Zachary Dean and freshman Tommy Ratchford losing 8-4 to Buffalo's Kalanin/Hove pairing.
The Bulldogs return to action Friday at the USTA Invitational in Flushing, N.Y.


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A Nano Stained Glass Collaboration in Madison, WI
Looking for ideas for NanoDays next year? I recently spoke with Greta Zenner Petersen, the Director of Education at the University of Wisconsin-Madison MRSEC, about their collaboration to create a permanent art-and-science installation for the newly renovated Madison Children's Museum. The story is not just a great example of a NanoDays activity, it's also an example of a local partnership between three very different organizations.
The MRSEC worked with staff from the Madison Children's Museum and all 800 students and teachers at the Aldo Leopold Elementary school to create a 5' round window decorated with nanoparticle stained "glass." The window is now permanently installed in the arts wing of the new children's museum building.
Each Aldo Leopold Elementary class signed up for a 30-minute (kindergarten) or 60-minute (grades 1-5) time session to learn about nanotechnology and stained glass and to contribute to the window. The activities took up a total of 6 - 7 days over a period of a month and involved the work of a number of people.
Troy Dassler, a first grade bilingual teacher at the school who has participated in the MRSEC's Research Experience for Teachers program, was the liaison with Leopold Elementary. Troy pitched the idea to teachers, got the appropriate approvals from the school, and coordinated the classroom sign-up up. He also handled school-related logistics such as reserving a classroom (so the students could rotate in to a single classroom rather than having MRSEC and Museum staff go to each classroom), helping with set-up and take down, and making sure staff had places to store materials.
Greta and Tracy Stefonek-Puccinelli, a Post-Doctoral Associate at the MRSEC, presented a modified version of the Nano Stained Glass program to each of the classes in the school. Greta, Tracy, and one of their undergrad research assistants also created sheets of nanoparticle stained glass (actually hardened plastic with tiny particles of silver and gold in it) that students used to decorate the window.
Angela Johnson, the arts coordinator at the Madison Children's Museum, came up with the original idea and handled the arts education and museum side of the activities. She got the necessary approvals from the Museum, gathered many of the art materials, and led the hands-on activities in the classroom.
Greta mentioned a few things they changed as they went along:
- They added a rule that the student's contributions needed to be the size of their palm or smaller (or entire hand for kindergarteners). During the first classes, some students created large nanoparticle stained glass pieces, which would not have left enough space on the window for everyone to contribute.
- They asked students to sketch their idea on paper first, to encourage them to plan their window contribution before using the nanoparticle stained glass.
- Once students finished their window contribution, they could make a take-away card containing a small piece of nanoparticle stained glass. Originally, there was an option to make a sun-catcher and a take-away card, but students who took longer to create their window contribution were disappointed that they didn't have time to make the sun-catcher. Greta and Tracy prepared some pre-made take-away cards, and had extra coloring sheets for students who finished the take-away card early.
You can download the presentations Greta, Tracy, and Angela used for the classes, as well as the class sign-up sheet and the invitation to a Collaborator's Night event at the Museum, at the bottom of this blog post. For more information about the activity, you can also see the NISE Net's Nano Stained Glass cart or classroom activities.
Specific questions or want to learn more? Get in touch with Greta directly.


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Smartphone Upgrades Slow as 'Wow' Factor Fades
Fewer Customers Trade in Devices—A Potential Problem for AT&T, Apple and Others
Fewer people are upgrading their smartphones—a trend that could make it harder for companies from AT&T Inc. to Apple Inc. to keep up the pace of revenue growth.
The rates at which American cellphone users have traded in their devices for more advanced models have declined over the last few years, according to analysts at UBS AG. They turned negative last year, when about 68 million people upgraded their phones in the U.S., down more than 9% from a year earlier....


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VANCEBORO � Craven County prawn farmers Don and Kim Ipock stocked Carolina�s Freshwater Prawn Farm�s three ponds with juveniles last weekend to grow a fall harvest that has a committed buyer � a first in their seven-year aquaculture venture.
VANCEBORO � Craven County prawn farmers Don and Kim Ipock stocked Carolina�s Freshwater Prawn Farm�s three ponds with juveniles last weekend to grow a fall harvest that has a committed buyer � a first in their seven-year aquaculture venture.
Economic development consultants hired this year by Craven County to help draft a strategic growth plan included aquaculture in a recent report building Craven�s agricultural offerings.
The Ipocks and Charlene Jacobs, president of the American Prawn Cooperative, agree it has real possibilities.
But for the Ipocks and other family farmers building the cooperative prawn marketing group since incorporating in 2008, it has not been easy.
Prawn are basically a freshwater shrimp belonging to the genus Macrobrachium, which have been farmed mostly in the rivers of Malaysia and Thailand for years and are now farmed in Hawaii, China, India, and many subtropical areas of the world.
Don Ipock boasts that his Spruill Town Road farm�s pond-raised, grain-fed, pollution and chemical free, prawn are environmentally friendly, of jumbo size and lobster-like texture, resulting in a clean and high quality meat. The controlled and free range environment also contributes to the quality and demand for the low in fat, iodine and sodium product.
Jacobs� family will seed its two-pond prawn operation near Clinton in Sampson County this weekend, and she said, �We�ve had to do a lot of educating the public here just about what prawns are although we have clients in California, Chicago and New York who already know what a prawn is and who want it and need it.�
Cooperative Extension programs at North Carolina State University and Mississippi State University have helped to research and develop the best prawn for regional production, Don Ipock said, and, along with the N.C. Department of Agriculture, guide owners of farms where tobacco was once its cash crop to transition to a new crop.
The cooperative members help each other with various parts of production including the harvesting and together have used rural development grant money to build a processing center in Walstonsburg in Green County to fast freeze the catch.
Ipock said, �I recently returned from a California trip to a Monterey Bay Aquarium seafood show representing the cooperative as the liaison to a broker, who is originally from North Carolina. Part of our agreement with him was to have visits to put a face on the product.�
�The overall objective of the California trip was to establish relationship with Del Monte Meat Company to strengthen relationships through the event that they invited area restaurant chefs to attend and a number of vendors who carry their product, there, in New York and around the country,� he said.
Jacobs said there are other prawn farms in the area �and we could have had more farms but are very particular. We don�t need anyone who won�t follow our best management practices. It�s very strategic in harvesting and processing.�
Setting up the business, cost wise, is small scale enough that it is possible for smaller farmers, he said. �The cost is within the thousands, rather than millions of dollars.�
The attraction to prawn farmer in part is because the cost could allow some small farms that lost tobacco allotment money to remain in farming. There is also the ecological impact of freshwater prawn farming has less waste products than some other animal agricultural and even aquaculture operations so the water can be recycled.
Jacobs said that although the less densely populated prawn ponds that produce less waste, also produce fewer numbers, but they grow a bigger prawn.
The commitment Ipock brought back from Californiabrokers is that they will take every prawn they can grow that are 12-count to a pound or bigger.
�We are not interested in mega numbers, because we now have the Californiamarket and we also have buyers in New Yorkwho want to come and get them live off the pond bank,� Jacobs said.
There are several restaurants and bed and breakfast operations that are steady local buyers and APC member farmers are hoping they continue to buy and spread the word locally about this relatively new domestic crop.
Although temperatures are not consistently warm enough for more than one crop a year in Eastern North Carolina, Jacobs said, �our harvest is growing yearly. 2012 was our best year yet.�
Of the 16, two-acre ponds stocked, she said, �Each should produce at least 800 to 1,000 poundsper acre,� or a total of about 29,000 pounds.
They are hoping for warm weather and an even better crop this year.
Sue Book can be reached at 252-635-5665 or email@example.com. Follow her on Twitter@SueJBook.


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WESLEY - Voyager Edition
WESLEY - Voyager Edition
WESLEY - Wisconsin, USA.
▼ Scroll down for info and Image details / Click image above to enlarge
Archival Pigment Print Photograph: Images printed on museum quality paper (Hahnemühle Photo Rag paper. 308g/m²; made of 100% cotton; matte surface).
27.5 x 13 in. (70 x 33.2 cm.), Edition of 30
43.3 x 20.4 in. (110 x 52 cm.), Edition of 20
59 x 27.8 in. (150 x 70.7 cm.), Edition of 10
Each print is issued with a Certificate of Authenticity, signed by the artist.
No Frame: Print arrives rolled and wrapped into acid-free protective glassine. The size refers to the paper size, the image is printed with a 1 cm. (0.39 in.) white border.
Frame With Mat: Print is classically framed with a solid wood frame and mat board. Solid wood frame is black oak or natural white and 0.79 in. (2 cm.) thick all around; mat board is natural white and 1.9 in. (5 cm.) thick all around.
Frame With No Mat: Print is classically framed with a solid wood frame. Solid wood frame is black oak or natural white and 0.79 in. (2 cm.) thick all around; Paper used with this option is Fujicolor Crystal Archive best to print under acrylic glass.
Print is framed using UV protective acrylic glass (light and shatter-proof)
Wall mount system is included with framed options.
Final size of the artwork with frame and mat board is: 33 x 18.5 in. (84 x 47 cm.) / 48.8 x 25.9 in. (124 x 65.9 cm.) / 64.5 x 33.3 in. (164 x 84.8 cm.). Final size of the artwork with frame is: 29.1 x 14.5 in. (74 x 37 cm.) / 44.8 x 22 in. (114 x 55.9 cm.) / 60.6 x 29.4 in. (154 x 74.8 cm.). Final Size of print only is: 27.5 x 13 in. (70 x 33.2 cm.) / 43.3 x 20.4 in. (110 x 52 cm.) / 59 x 27.8 in. (150 x 70.7 cm.)
Upon reception of the work we will mail the Certificate of Authenticity to the shipping address. When you receive the artwork please send a mail to: email@example.com with the purchase reference number, in order to receive your Certificate of Authenticity.
Every image is produced individually and we start the production immediately after we confirm the payment. Estimate 2/3 weeks for arrival to the US and Europe. 3/4 weeks for the rest of the world.
FOR CUSTOM SIZES OR FRAMING, SPECIAL PROJECTS, OTHER METHODS OF PAYMENT, IF YOUR COUNTRY IS NOT LISTED AS A SHIPPING OPTION OR ANY OTHER INQUIRY PLEASE CONTACT US: email@example.com