Fibroid Warnings: Are You Seeing Them?

Kathleen Di Mond, 39, a mother of two in Oakland, NJ, had always had normal periods. So when her flow suddenly became very heavy and lasted for two weeks, and she developed excruciating back pain during her periods, she consulted her gynecologist. The diagnosis: fibroids. And the recommended treatment: a hysterectomy to remove the six golf ball-size growths in her uterus.

But Di Mond didn’t want to lose her uterus. Although she and her husband didn’t plan to have any more children, she’d just had her gall bladder removed, and she didn’t want to go through major surgery again. But the alternative her doctor suggested–do nothing and at menopause, the fibroids and their symptoms would probably disappear–wasn’t an option either. She couldn’t endure ten more years of living with heavy bleeding and pain.

This is what fibroids look like (yuck).

This is what fibroids look like (yuck).

After consulting another gynecologist, Herbert A. Goldfarb, M.D., assistant clinical professor of obstetrics and gynecology at New York University School of Medicine in New York City, Di Mond discovered that she could be treated with a minimally invasive procedure. This would shrink the fibroids and remove part of the uterine lining to control the bleeding. The surgery was done on an outpatient basis, and Di Mond was back to normal within a week.

Of the 600,000 hysterectomies performed each year, about 200,000 are done to remove fibroids. But many of these hysterectomies are unnecessary. Indeed, in most cases, fibroids don’t need to be treated at all, says Steven R. Goldstein, M.D., professor of obstetrics and gynecology, also at N.Y.U. Medical School in New York City.

If you’re among the 20 to 25 percent of women over 35 who have fibroids, you need to understand what’s going on–medically and from a consumer point of view. That way, you can make sure you get the right treatment–no less than you need but also no more.

Just what are fibroids? Why do they form?

Fibroids are masses of tissue that grow either inside or outside the uterus or within the uterine wall. They can range from pea-size (in which case you probably wouldn’t even know you had them) to the size of a full-term pregnancy. Only a minuscule .02 percent are cancerous, and having fibroids doesn’t predispose you to cancer.

Nobody knows exactly why fibroids form, but once they do, their growth is fueled by estrogen. That’s why they’ll often enlarge during pregnancy, though usually not enough to interfere with the baby, says Maria Bustillo, M.D., a reproductive endocrinologist at South Florida Institute for Reproductive Medicine in Miami. Conversely, after menopause, when estrogen levels diminish, fibroids tend to shrink.

What are the symptoms?

Often none–many women only learn they have a fibroid during a routine checkup with their doctor. Sometimes, if fibroids become large, they can cause nongynecological symptoms, such as constipation (if the growths are pressing on the large intestine) or frequent urination (from putting pressure on the bladder). And some women, like Di Mond, suffer a heavier-than-normal menstrual flow, as well as killer cramps and bleeding between periods.

Will fibroids cause fertility problems?

Very rarely the growths can interfere with the implantation of the fertilized egg on the uterine wall. But if you are having trouble conceiving, you should rule out other causes first, advises Dr. Bustillo; then, if fibroids am the problem, consider whether to undergo surgery or other treatment. Surgery, she points out, may actually worsen problems, since it can leave scar tissue in the uterus.

When do fibroids need to be treated?

Often, it’s your call. If the growths aren’t bothering you, you only need to make sure you have regular checkups to monitor them, says Dr. Goldstein. Nonsteroidal anti-inflammatory drugs, such as ibuprofen or naproxen, can relieve cramps. And if you’re bleeding heavily, your doctor may prescribe iron supplements to prevent anemia.

Are there any medications to treat fibroids?

Oral contraceptives, although they won’t cure fibroids, may be recommended to control excessive bleeding or bleeding between periods.

If you’re nearing menopause, which your doctor can check with a simple blood test of hormone levels, you might be a candidate for GnRH agonists (gonadotropin-releasing hormones). These drugs, synthetic versions of naturally occurring hormones, cause fibroids to shrink up to 50 percent. But they have many unpleasant and potentially serious side effects, including bone loss, hot flashes, and vaginal dryness. Also, GnRH agonists shouldn’t be used for more than six months, and once they’re discontinued, fibroids quickly grow back. This is why they’re usually recommended only during that brief “window” before menopause kicks in. The drugs may also be used for a few months before fibroid surgery, to reduce the size of the growths and facilitate their removal.

When is surgery the best option?

When the pain or bleeding is seriously interfering with your life, Dr. Bustillo says. There are several surgical procedures, but they essentially fall into two categories: hysterectomy, in which the uterus is removed, and myomectomy, where a doctor removes only the fibroids. Unfortunately, for about 25 percent of women who undergo myomectomy, the tumors will grow back, according to experts. (It could be that a woman who formed fibroids in the first place is likely to do so again.) Not all these women face further surgery, however. If the rate of regrowth is slow enough, a woman may enter menopause before the fibroids become large enough to cause problems.

Assuming you don’t want more children, should you ever consider having a hysterectomy?

If you have numerous fibroids throughout the uterus, it may be the safest operation, says Dr. Bustillo. Removing many growths can cause significant blood loss and carries a greater risk of infection. And a hysterectomy is the only procedure that guarantees the fibroids won’t grow back.

Hysterectomies can be performed without removing the hormone-producing ovaries, so women can continue to benefit from estrogen’s protective effects against bone loss and heart disease. If your doctor wants to take everything, try to argue, suggests Dr. Bustillo, especially if you’re a number of years from menopause. Or find another surgeon.

How do you know if you have the right doctor?

For a start, “your gynecologist should be able to give you the pros and cons of each treatment option and explain why he or she is leaning toward a specific procedure for you,” says Dr. Bustillo. Then, if you have decided on surgery, you need to make sure your doctor has enough experience in the particular procedure you’re considering. All ob/gyns are surgeons-and all have been trained to perform hysterectomies and abdominal myomectomies (see “New Ways to Treat Fibroids,” below). But some of the so-called minimally invasive procedures require special skills; you want tube sure that your doctor is performing these at least several times a month.

Finally, even if you have a lot of confidence in your gynecologist, it might be smart to consult someone at a different practice, especially if you’re considering one of the new procedures, says Bryan Cowan, M.D., professor and director of reproductive endocrinology at the University of Mississippi Medical Center in Jackson. Not all doctors are convinced these are as low-risk as promotions–or your own gynecologist’s endorsement–might have you believe.

New Ways to Treat Fibroids

Dealing with these benign growths is something of a growth industry itself. In the last decade and a half, hysterectomies have given way to myomectomies, which in turn are now done three different ways. In addition, several nonsurgical removal procedures have been developed in recent years.

Abdominal Myomectomy

Doctor removes fibroids through a bikini line or, occasionally, midline incision, leaving the uterus and ovaries intact. Surgery requires a two- to four-day hospital stay.

Who should consider? Women who want to have more children, Also, women with large fibroids, because these can be difficult to remove through the small incisions of less invasive procedures.

What you should know You may have scarring, which can interfere with conception.

Hysteroscopic Myomectomy

A tube is inserted vaginally, and fibroids are shaved off with a wire-loop or vaporized with an electrical current. Outpatient procedure.

Who should consider? Women with small or moderate-size fibroids that protrude into the cavity of the uterus and cause significant bleeding; also those who may want to become pregnant.

What you should know Some doctors may not be sufficiently skilled to safely perform these procedures.

Laparoscopic Myomectomy

Fibroids are removed through tiny incisions in the belly button and other sites on the abdomen. Requires an overnight stay in the hospital.

Who should consider? Women whose fibroids are not too large or too many, can be seen easily, and are in the wall or on an outer surface of the uterus.

What you should know A controversial procedure: If the surgeon is not highly skilled in laparoscopic techniques, there’s a chance of bleeding and infection and a rare chance of perforation of the bowel, intestine, or blood vessels.

Laparoscopic Myolysis/ Resection and Ablation

Electrically charged needles are inserted into the base of the fibroids to cut off their blood supply, which causes them to shrink (myolysis). Then the uterine lining is burned away with laser or electrocautery, to prevent excessive bleeding (resection and ablation). Outpatient procedure.

Who should consider? Women who have small to moderate-size fibroids and only those who’ve completed their families, because destroying the uterine lining causes infertility.

What you should know About 10 percent of women who undergo this procedure will require another procedure afterward.

Uterine Artery Embolization

Radiologists bombard the blood vessels supplying the fibroid and uterus with tiny, synthetic particles, thereby cutting off nourishment to the fibroid and causing it to shrink. Though a new technique for treating fibroids, it has been used for bleeding and trauma.

Who should consider? Women who don’t plan to become pregnant (because blood supply to the uterus is diminished) and, some say, patients who should not be anesthetized because of heart problems.

What you should know Though popularly touted as a “breakthrough” and promoted by some medical centers, many gynecologists worry that such enthusiasm is premature. Uterine artery embolization has been available for only about three years, so there are no long-term follow-up results yet.

A Reminscence

arI took the bull by the horns. Tipper has been after me to display signs of my warrior self, and the holidays seemed a perfect time, and so I invited Janet Reno to Thanksgiving dinner.

It was awkward, of course. I knew Janet was planning to spend the weekend deciding whether to call for an independent prosecutor for the fundraising scandal. To some it would seem a mighty cynical invitation. Everyone knows that she doesn’t have much of a family to go to, and that she’s kind of a workaholic, and that if I phrased it right it would be almost impossible for her to decline. But I also knew that an evening spent with the Gores is not soon forgotten –of course, the conversation is zesty (topsoil erosion; auto emissions; Dick Gephardt’s alleged history of clinical depression) and the food terrific, but what I thought might really help Janet in her decision is if she could see me among my loved ones, maybe then it would be easier to see why it was so necessary for me to raise $43,000 from some Buddhist nuns.

But my family was warned: It was just a simple family gathering. And Janet was just an ordinary guest, like one of the kids’ college friends who lives too far to return home for Thanksgiving.

“It’s so wonderful to have you in our home,” Tipper said warmly.

“It’s nice to be here,” Janet answered. “But, you know, under the circumstances, I’m not sure it’s really appropriate. Maybe I should — ”

Tipper waved her hands frantically in my direction. “Al! Al!” she cried. “Don’t you want to show Janet some pictures of your dead sister?”

“Um, I guess,” I answered. To be honest, I wasn’t in the mood. Also, I was pretty sure Janet had seen the pictures; I show them to all new Cabinet members as a routine “Get-to-know-Al” type thing.

“Janet,” Tipper cried gaily, “you really must see how beautiful she was, to get a sense of the tragedy of her death. Not that you have to be beautiful or anything for your death to be a tragedy. I’m sure it’s just as sad when someone plain dies — oh, I don’t mean ‘plain,’ really — maybe just ‘tall’ — well, I don’t mean that either — Al, where is that photo album?”

Time for me to step in. “Janet,” I said, “I think what Tipper meant is that we all appreciate what you and your people at Justice are doing to regulate the tobacco industry. If only you had been around when my sister started smoking . . .” I gave Janet’s shoulder a little squeeze. When my hand stopped throbbing, it was time for dinner.

Dinner was uneventful, except for Sarah mentioning to Janet that in a recent survey, she was the “second-most-admired woman in America.”

I rolled my eyes. The family was laying it on a bit thick. They meant well, Rusty, but my idea wasn’t to put on a big display. And it was clear that Janet was uncomfortable.

“Tipper, a wonderful meal. I’m sorry to rush off, but I have some briefs to read and an FBI report . . . ” She looked a me nervously, then stood up.

Suddenly, Little Al burst into tears. “What’s wrong, son?” I asked. “Are you still in pain from your serious, and to me life-transforming, car accident?”

He shook his head. Tears streaming down his face. Nose running. Squinched-up mouth: “Please, tall lady, please don’t take my daddy away.”

An awkward moment. Janet coughed nervously.

“I had a lovely time. Good night.” She started for the door. But Little Al was faster. Falling to his knees, he clasped his arms around her shins.

“Please, giant woman. Don’t send Daddy to jail!”

It was quite a sight, Rusty. Little Al attached to the Attorney General. Tipper trying to pry him off. And both of them being dragged across the hardwood floors by a Janet Reno intent on leaving.

Say what you like about her, Rusty. She’s the physically strongest AG in recent times. Only Bobby Kennedy could’ve licked her, I think, and then only because he wouldn’t have fought fair.

Tipper finally disentangled Little Al from Janet’s legs. We apologized profusely. “This is what it’s like having family,” Tipper said, adding quickly, “Not that not having a family is a bad thing.”

Janet looked around awkwardly, then leaned toward me. “Don’t worry,” she said. “I’m not going to request a special prosecutor.”

Little Al looked up at her, eyes shining. “God bless you, big lady,” he said.

She smiled gamely, ducked her head, and walked out the door. Tip and I were arm in arm as we watched her giant frame disappear into the mist.

“It’ll be a merry Christmas this year,” I said.

“It certainly was,” Tip replied. “I like getting my presents early.”

Yes, the holidays are a magical time, Rusty. Sometimes, though, they just need a little push.

Remember When Fiber Was Rare?

IS YOUR HOME OFFICE LOOKING a bit dated? No satellite linkups for videoconferencing? No broadband cable directly linking you to Kinko’s? Why not move to Celebration, Florida, a new high-tech community of the future, brought to you by the Walt Disney’ Co. and AT&T?

slfvLet’s look at the specs as described by its creators, then try to imagine life inside this “feature-rich communications tapestry.” Celebration, which might be a good name for a new GM car or a Kentucky Derby-winner, is a planned acre community developed by the Celebration. Co., a Disney subsidiary, and serviced by AT&T’s latest fab stuff. Residents will be able to access a variety of online interactive services, such as shopping, banking, and community information.

A “comprehensive, digital, fiber-to-the-curb optical network” will provide voice, data, and video communications in the community. From their homes, residents with technical jobs could, perform such complex, job-related tasks as downloading CAD files. People would even be able to vote from home–a nightmare for politicians who opposed the motor-voter law. Would democracy in the 2 1 st century mean a bunch of slobs lying in bed voting for president?

Here’s the kicker: Through product and services contributed by AT&T, the first 300 Celebration families. will have the option of becoming voluntary participants in a living laboratory. What?! Are we mice (no, not that mouse) 6r men?

Nonetheless, signing up for the lab could solve your current office problems. You can’t beat fiber to the curb, can you? All you have to do is find Celebration, which is not yet even a dot on the Rand-McNally atlas but is said to be “near Orlando”–obviously a fabulous place to entertain clients with children.

I’ve never been a fan of planned communities, such as the James Wilson Rouse-developed Columbia, Maryland, but I do like experiments. In college I was mesmerized by architect Paolo Soleri, who was building a community (Arcosanti) in the Arizona desert. The problem with Celebration is the term living laboratory, which makes it sound as if you’ll be stuck there–like the poor souls who spent two years inside the biosphere.

Now, if you’re talking about a time-share in Celebration, I could, see spending a few weeks a year playing with technology while the sun warms my Northern bones. And, of course, it is possible to live in Celebration without joining the experiment. Eventually, Celebration is expected to house 20,000 people, and only 300 families will be treated as mice.

Yes, you anticipated the next question: What will these virtual mouse people be like? Very difficult to say at this point in time, since the first house is not yet finished (sales begin in November for Spring 1996 occupancy). They could sit inside all day surfing the Net at supersonic speeds. They could be virtual workers whose children can’t get enough Disney. Or they could be Disney World employees who take the monorail to work. Or maybe people who just want to start from scratch with a state-of-the-art office.

Of course, there’s a good chance the whole experiment will just fade away. Telephone and media companies have made it a habit in the past few years to announce pilots of extravagant new delivery systems (I’m thinking of US West’s interactive shopping venture in Omaha, Nebraska), only to pull the plug before anything happens.

In any case, I won’t be there. I’m not cheerful enough to live in a town called Celebration, no matter how sophisticated the infrastructure. If someone were to wire Arcosanti, however, then I’d have to think twice. Just as long as they don’t call it a living laboratory. EeeeeeK!

Carpal Tunnel Victories And What It Brought To Tech

In August 1994 HOC reported on Compaq’s courtroom victory over a woman who claimed a Compaq keyboard had given her carpal tunnel syndrome, a repetitive strain injury (RSI). Since then, three similar lawsuits brought against IBM have collapsed, and the Clinton Administration’s proposed ergonomic standard for companies is under fire from a Congress hostile to government regulation.

Linda Urbanski, one of the three whose cases against IBM floundered (she did, however, settle with Apple in a related suit) is now going back to college to get a degree in human services. A 100-words-a-minute typist before the injury that left her thumbs, wrists, biceps, and shoulders thick with pain every day, she says, “I will never be able to go back to the business world and earn the living I did.”

ctvMaybe she will. Although the possibility of compensation for the estimated 1,000 to 3,000 RSI sufferers currently in litigation has grown bleaker, there’s now a laser light at the end of the tunnel. A new medical device may bring relief–without painful surgery and months of recovery–to the 18 million people afflicted with RSI.

Looking Into Lasers Developed by California-based LaserMedics, the Microlight 830 device produces a laser light that penetrates deep into skin tissue. One researcher, Dr. Alan Lichtbraun of the American College of Rheumatology, has used it to treat clients with RSIs, arthritis, sciatica, and other problems. Patients are exposed to the laser two to four times per treatment, 33 seconds each time. This goes on once or twice a week for five or six weeks. The laser stimulates a chain of chemical reactions that soup up the tissue’s healing properties, regenerate damaged nerves, and reduce inflammation.

Researcher Dr. Larry Goldfarb, a New Jersey chiropractor, cites a four-year study of more than 3,600 patients that shows the laser was effective in 98 percent of tendonitis cases and removed pain in 76 percent of the cases overall. Although the treatment is still docked in the experimental stage, a spokesperson for LaserMedics says the company is hopeful that the Food and Drug Administration will approve the Microlight 830 for widespread treatment sometime in 1996.

An Ounce of Prevention In the future, judicial and legislative reluctance to compensate RSI sufferers may be rendered irrelevant by alternative keyboards. Microsoft reports that it has sold more than 200,000 of its Natural Keyboards since their introduction in September 1994. Lexmark, Apple, and Key Tronic have also enjoyed success with their adjustable keyboards. And Graphics Technology has found an eager audience for its SimpleTouch, a device you clip over the front of your monitor to turn it into a touchscreen, much like an ATM.

Alternatives to keyboards may help, too. In support of industry gurus who predicted that voice applications would be the “killer apps” of the 1990s, Apple’s Plain Talk, Dragon Systems’s DragonDictate, IBM’s Personal DictationSystem, and others are sporting drastically slashed price tags. And prices for speech-recognition software could drop below $500 within another year. All this will someday make the jam-your-fingers-down-hard keyboard seem as archaic as dentistry without Novacaine.

The Highway To Nowhere

AT 1:30 in the morning on May 22, freshman Republican Kay Granger of Texas trudged wearily down the long hallway of the Russell House Office Building to a meeting with Bud Shuster, chairman of the House Transportation Committee. The House was debating a controversial Shuster proposal to add $12 billion more to proposed transportation spending, a cheeky power play that frantic House leaders warned would demolish the fledgling budget deal.

thwtnwShuster told Transportation Committee members such as Kay Granger –who, as a candidate, had relied on Shuster’s promises of money for a major highway expansion in her district — that he expected their support. Rep. Granger sat across from the 65-year-old chairman, perhaps the most feared chairman in the House, and told him she had made up her mind: She would oppose him. “For all of us, what you bring home for transportation is very important to whether or not you get elected,” she explained, a point her apprehensive staffers had repeatedly stressed to her. “But in this case, I said the most important thing was to do what I said I was going to do: balance the budget.”

So it went for Shuster, who suffered eight defections from his committee early that morning and lost barely — by just two votes. For all the complaining by conservatives about the budget deal, it was Shuster, transportation-spending czar, who mounted the most serious challenge to it. The Republican leadership was able to contain him — and the traditional congressional appetite for spending on pork-barrel projects that he represents — but perhaps only for the time being. Shuster will be back in March when the House takes up a revised transportation-spending plan.

Shuster is exactly the kind of committee chairman Speaker Newt Gingrich hoped to make obsolete after the 1994 elections: a congressional baron who skillfully uses the power of his chairmanship to bend members to his will and frustrate the larger goals of the leadership. Committee chairmen did get shoved aside in the early days of the GOP Congress, but now they’re back, and for Bud Shuster that creates the possibility of making increased transportation spending a GOP congressional priority.

Shuster dresses with the pin-striped precision of a Fortune 500 CEO — he made a killing in the computer industry before coming to Congress in 1972 — and carries himself with an affable ease, but he is a man who savors a good old-fashioned barroom brawl. His fitness regime is itself worthy of a heavyweight champion; he eschews the three-martini lunches and steak dinners of the Washington establishment, instead rising early to jog on the Mall, and he is a fixture in the House gym.

His tangles with the House leadership reflect a formidable pugnacity. He openly blasted the leadership’s balanced budget deal, calling it “UNACCEPTABLE” in an intemperate memo sent to each leader. Shuster presides over the largest committee in the House, and he rallied its 73 members to pressure Speaker Gingrich to keep his word and grant a vote on Shuster’s spending proposal earlier this year. A harried Gingrich talked about ousting Shuster, but he nonetheless relented and granted the vote. Majority Leader Dick Armey was furious, and this proved to be one of the key unilateral Gingrich decisions that precipitated the aborted coup against him a few months later.

Shuster says now that the leadership never intended to have a fair vote. He claims that he was ahead by a margin of 40 that afternoon, and it was only after calls from President Clinton, an emergency GOP conference that night, and prolonged arm-twisting that he was beaten back. “There were four members on the floor ready to change their votes [to yea],” Shuster griped. “And they were gaveled down. I was promised a fair shot — only as long as they were sure I’d lose.”

FOR the rank and file, the spending proposal presented one of the most wrenching dilemmas of this Congress. Shuster’s committee Republicans believe he keeps “The List” — that is, a list of special transportation projects requested by members — and follows their votes with great care. “The first thing I heard was that Transportation was a black-dot committee — vote against them and that stain is with you forever,” recalled New York Republican John McHugh. “It’s legend.”

For those who have defied Shuster, the expectation of less money to bring back home is automatic. Mississippi Republican Mike Parker, a Shuster critic, has to depend on the Senate Majority Leader, a fellow Mississippian, to protect his projects. “If Trent Lott dies, I’m going to jump into the grave with him,” Parker says, flashing a broad grin. “As a matter of fact, I’m trying to get him to watch his diet. And if he starts smoking, I’ll kill him.”

Shuster, for his part, dismisses the notion of retribution, with a statement that sounds a bit like a threat. “I defy anybody to step forward and say I threatened them with retaliation, because it didn’t happen,” he has said.

But some who have provoked him in the past have felt his wrath, such as Democratic Sen. Bob Graham of Florida. After deriding Shuster’s pilot projects a few years ago as “giant hogs,” Graham discovered that 14 such projects in Florida had been scratched. Graham, not surprisingly, quickly placated Shuster and preserved the projects.

Indeed, Shuster is so formidable a figure in the House that I could find only a handful of Republicans willing to talk about him. Is Shuster simply out of place in the fiscally conservative Republican Congress, I asked the quotable Rep. Ernest Istook of Oklahoma. “I’m not prepared to answer that,” he answered curtly, before ducking onto the House floor.

Why did you vote against his amendment? I asked another Republican.

“I’m going to respectfully decline this interview,” he answered.

“How about talking on background?”

“I’m going to respectfully decline this interview.”

“OK, let’s go off the record.”

“Thanks anyway.”

Even among the reform-minded freshman and sophomore GOP revolutionaries, there is a keen awareness of the popularity of transportation projects and the benefits of good rapport with Shuster, the rainmaker. Rep. Joe Scarborough (R., Fla.), who had said he would not have voted for Shuster’s transportation bill “if he ran a road from Pensacola to Key West and called it the Joe Scarborough Highway,” needed a half-million for dune repairs and had found the usual channels no help. So he approached Shuster, whom he’d never met, “ready to kowtow.”

“He said, ‘Fine,’ Scarborough recalls. “It was over so fast I thought I’d misunderstood him. But the next day, the call came: ‘You’re taken care of.”‘

The need for these kinds of projects among his fellow Republicans will give Shuster crucial leverage in the spring when he makes his pitch for more spending. It’s a pitch that will come straight from the heart — no one doubts Shuster’s faith in all transportation projects, great or small, necessary or frivolous.

Shuster makes an impassioned case for the Republican Party’s long-standing commitment to infrastructure, from Lincoln and the transcontinental railroad to Teddy Roosevelt and the Panama Canal to Eisenhower’s Interstate Highway system. He is armed with statistics to pinpoint America’s growing infrastructure deficiencies relative to other industrialized nations. And he knows how important such projects can be back home — from experience.

Altoona, the biggest city in his hardscrabble district in central Pennsylvania, had been built around commerce generated by the Pennsylvania Railroad early in the century. Residents bristled at having been passed over for a much-needed highway connection to the Pennsylvania Turnpike. When Shuster finally secured the necessary funding for the four-lane road in 1994, he achieved, as one resident told me, “sainthood.”

The road is named the “Bud Shuster Highway.”

But that’s not all Shuster has tried to bring home. In 1992, his support for a $30-million automated sidewalk in Altoona to bridge the railroad bed running through downtown caught the attention of humorist Dave Barry. (“I don’t know about you, but as a taxpayer, I am outraged to discover that, in this day and age, Altoona residents are still being forced to walk around on regular low-tech stationary sidewalks,” Barry wrote.)

A lingering distaste for that sort of pork among Republicans is an obstacle to Shuster’s plans. As are the various ethics charges he faces. Shuster is under federal investigation for allegedly intervening to procure monetary compensation for two campaign contributors who surrendered land for the $10-million-multi-lane tunnel in Boston known as “The Big Dig.” The feds are also investigating his close relationship with a top aide of 22 years, Ann Eppard, now a transportation lobbyist with regular business before his committee (Shuster has not denied sleeping at her $823,000 waterfront home in Alexandria). But if Shuster is nervous, he doesn’t let it show. When a dogged reporter from the Capitol Hill newspaper Roll Call staked out Ann Eppard’s home and was spotted by the pair as they left one morning, Shuster drove around the block and returned — to invite the reporter in for a cup of coffee. He breezily dismisses the various charges and investigations with a one-word summary: “Baloney” (made, of course, of pork).

Meanwhile, Shuster is busy preparing the renewal of his transportation-spending battle with the leadership in 1998. He negotiated an extension of current spending levels contingent upon a renegotiation during election year, a canny bit of maneuvering. At election time members feel particularly compelled to bring home, well, concrete achievements. And next year anticipated budget surpluses will be up for grabs. Shuster believes the argument that the balanced budget hangs in the balance won’t be as convincing next year, and the coffers will open for him.

John Kasich, leader of the balanced-budgeteers, concedes that even he isn’t willing to count Shuster out. The pressure for transportation spending never recedes, he told me, describing the coming showdown in medieval terms. “There is always going to be a Washington establishment attacking our majority, trying to get us to be like the Democrats,” Kasich says. “People are coming over the walls. We’re standing on the top, and we keep knocking the ladders down. . . . Bud almost got over the wall last time. And he’ll be back. We’ll just have to try to knock the ladder over again.”

Shuster responds that it won’t be just him on the ladder, but governors and mayors and “an overwhelming majority” of House Republicans. “We’re on the side of the angels,” he says with a devilish chuckle. “And we’re gonna win.”

Conservative History Isn’t All Shiny Apples

THE great Restoration statesman the Marquess of Halifax is now usually remembered with the disparaging title of “Halifax the Trimmer.” Not only was he (as we would say) “pragmatic” in his own political allegiances, but he invented The Character of a Trimmer in a pamphlet of that name in 1684. When, said his lordship, a boat was weighed down by too many people on one side or the other, “it happeneth there is a third opinion of those, who conceive it would do as well, if the boat went even without endangering the passengers.” Those passengers, therefore must rely on the Trimmer to move back and forth between the two sides so as to keep an even keel. Yet in his own day, said Halifax, “the poor Trimmer hath now all the powder spent upon him alone, while the Whig is a forgotten or at least a neglected enemy; there is no danger now to the state (if some men may be believed) but from the beast called a Trimmer.”

mohBy what strange quirk of human nature, then, does it happen that in our time the Trimmer has come to be more honored than the party man? If the media consensus is to be believed, the danger to the state comes from the beast called a “Partisan” — while the Trimmers of the Clinton Administration are all triangulating away like mad to keep the Partisans from capsizing us. As Congress recessed last month, for example, Alison Mitchell sadly announced on the front page of the New York Times the “Return of Partisanship to Capitol Hill.”

As the 105th Congress ended its first session tonight, it could boast of one paramount, bipartisan achievement: the midsummer legislation to balance the budget and cut taxes. But the ill will, stalemate, and destruction of the session’s closing weeks point to a return to sharp partisanship next year.

Who are the guilty men of this Partisan Congress? Interestingly, those who are blamed for bringing back hated Partisanship are those who take up contrary positions to those which the New York Times consistently identifies as the right ones. The Republicans were at fault for killing campaign-finance reform and the nominations of Bill Lann Lee to head the civil-rights division of the Justice Department and William Weld to be ambassador to Mexico, while the Democrats were guilty of opposing their President on free trade. The reader is invited to share in the writers’ longing for an ideal world in which everyone would be as far-sighted as the New York Times.

Meanwhile, in the Washington Post, Dan Balz was singing the praises of current British political discourse, to which the new Conservative leader, William Hague, had made a remarkable contribution by admitting that his party had suffered its worst defeat in over ninety years because it “was regarded as out of touch and irrelevant.” Balz does not reflect that Hague could hardly have acknowledged less and might have acknowledged a lot more; that “was regarded” was a typical politician’s use of the passive voice in order to avoid assigning responsibility. No matter, it was enough to send Balz off into raptures:

What if the Republicans, after 1996, had acknowledged that, in their haste to undo the Great Society, they had alarmed many of the voters who had put them into power? What if they had really owned up to the fact that the hard edges of their conservatism in the 104th Congress had triggered a public backlash that hung like a dead weight upon Dole’s campaign?

And what if neither of these things is true? Balz never considers this possibility because for him, and for the journalistic Trimmers whose ever-growing numbers he would join, it is true ex hypothesi: all moral failing and most electoral non-success must be the results of deviations from the Golden Mean, that tolerant, secular, “compassionate,” Great Society Lite habit of mind that the journalistic consensus has made its own.

The irony is that Balz is right in claiming that “neither party in America works very well these days.” But much of the reason for this state of affairs is that both parties are terrified to go beyond that same journalistic consensus, lest they be identified as “extremists” or unduly “hard edged.” We all are Trimmers now.

What was it that turned the Trimmer from a reviled turncoat into the “pragmatic,” “non-ideological” hero of our time — the Colin Powell or the Bill Bradley to whom so many in the press look to usher in a new, “non-partisan” political era? Perhaps the sea of cant on which our politics has been floating since Vietnam and Watergate is just unusually stormy and requires a lot of trimming. But if so, the job of the Trimmer is an easy one so long as he continues to occupy his usual place of journalistic safety. What could be easier than to stand to one side and tweak the party men with one’s own disinterested avoidance of party conflict? What could be nicer than to gain a reputation for high-minded principle by promoting such issues as campaign-finance reform, gun control, punishment for tobacco companies, and stepped-up production of racial pieties?

Yet the true Trimmer can never really have any other principles so long as his first principle is keeping an even keel between Left and Right. It is therefore hard to know whether it is to the Trimmer’s credit or discredit that he less often proves true to his one ostensible principle of moderation than to his many unacknowledged ones, which are generally liberal. For the most notable journalistic Trimmers of our time — E. J. Dionne and David Broder of the Washington Post, for example, Jonathan Alter and Matthew Cooper of Newsweek, Joe Klein of The New Yorker — are nearly all liberals whose compromises with the failures of their creed are mostly rhetorical. These are men (for some reason, women are less likely to be apologetic about their liberalism) who have learned how to salve their consciences by clinging to the “compassion” of their liberal youth while at the same time claiming credit for the “moderation” of their middle age.

But liberal habits of mind die hard. Consider E. J. Dionne’s taking the Republicans to task last summer for charging Democrats with attempting to revive “class warfare” by insisting on a high rate of capital-gains tax for “the wealthiest,” who were to have received 18.8 per cent of the “benefits” under the Republican plan but only 2.6 per cent under Clinton’s. “Once upon a time,” wrote Dionne, “class warfare meant ‘soaking the rich.’ Now you’re in the trenches with bearded Marxists if your tax cut for the wealthy isn’t big enough. Strange, but this is Washington in 1997.” To Dionne, of course, that money is the government’s, and it is absurd for the government to “offer” or “give” it to rich people. He doesn’t see that logically you’re in the trenches with the bearded Marxists whether you propose to start soaking the rich or, as in Washington in 1997, not to stop soaking them.

Characteristically, however, he is generous with his advice to Republicans, who, he says, “are missing their best case for a tax cut” by not agreeing to Democratic proposals to extend the $500-a-child tax credit to non-taxpayers. Recalcitrance on this point he takes to be nothing less than “incomprehensible.” (Revealing word!) Tax relief for those who pay no taxes is not tax relief but a handout from government — that is, from some genuine taxpayer. But once again Dionne sees all that money as belonging to the government in the first place, so that the tax credit would be for him a handout in either case. That is why what would seem to be an elementary distinction between giving people back their own money and giving them some of somebody else’s is “incomprehensible” to him.

The Trimmer’s gestures to the right, though sincere, depend for their magnanimity upon such incomprehensibilities as these. Indeed, if you think about it, it is quite touching that someone like Matt Cooper can continue to be polite to Republicans when he takes it for granted that the story of the Reagan years is precisely as it is in the Democratic playbook: “overzealous military spending and excessive tax cuts led to $5 trillion worth of debt.”

One of the most revealing things Cooper ever wrote was in his consideration in The New Republic of the improbable candidacy of Richard Lugar for the Republican nomination in 1996. “The most pressing question,” he wrote, “is not whether Lugar will be elected President, which is doubtful in the extreme. It’s whether Lugar will win the mantle of the thinking man’s candidate.” Why this should have been a “pressing question” to the political junkies who read The New Republic is very far from clear: why it was pressing to bien-pensant journalists is much more clear. Identification of “the thinking man’s candidate” (Cooper helpfully reminds us that this was Paul Tsongas in 1992 and Bruce Babbitt in 1988) — a candidate whose chief virtue, it is not too much to say, is his unelectability — is necessary for those whose business it is to find and praise politicians who stand for a show of bipartisanship and cheerful pragmatism.

THESE qualities are all very well in their place, of course, but one ought to be suspicious about those who value them for their own sake and independently of context. That is the sure path to Clintonian posing, which is only a more successful version of the “thinking man’s” vacuous tributes to any sort of bipartisanship and pragmatism, when in fact the Partisan may be in any given instance (and often is) far more pragmatic, and the pragmatic the result of partisanship. But Clinton has shown us how liberalism in the post-Reagan era has learned to sustain itself by trimming against the list to conservatism. In 1996 it was nearly impossible to find any single issue on which Clinton had a substantive disagreement with his Republican opponents; but on every issue he pledged to go more slowly and to protect those, such as children or old people, whom he portrayed as being otherwise vulnerable to Republican rashness.

Thus the Trimmers in the press have become, after a period of fashionable skepticism and ennui, largely converts to the Clintonian notion of the “vital center” epitomized by “soccer moms.” What is there left now for the poor toothless beast of a Trimmer to try to set to rights but such few shreds of “partisanship” as remain –Jesse Helms, for instance, or an unexpected stiffening from Orrin Hatch over the appointment of Mr. Lee? Until such time as we can learn once again to hate the Trimmer, there will be no good times for anybody in following American politics.