You Dirty Rat [Poison] (What’s wrong with the 11th Amendment)

So you think since the snorefest of the 9^th and 10^th Amendments is in our rearview mirror, we’re finally destined for a really impactful Amendment? Maybe you’re right. But I think you may have jumped the gun slightly on that hypothesis.

Amendment XI: The Judicial power of the United States shall not be construed to extend to any suit in law or equity, commenced or prosecuted against one of the United States by Citizens of another State, or by Citizens or Subjects of any Foreign State.

Truth be told, when I thought up the idea of arguing against each of the 27 Constitutional Amendments, I didn’t realize how many were so damn boring. Even the much bandied about Bill of Rights has some real stinkers: III, VII, IX, X. The 11^th Amendment smells a lot like those four, so I’m not going to spend much time on it. Stick with me, though, and you’ll be rewarded with much more exciting topics beginning next month.

In a nutshell, the 11^th Amendment takes a page from the playbook of a mom fed up with her kids’ incessant squabbling. It tells the states, “You’re old enough, deal with that shit yourself!” The Amendment prohibits federal courts from hearing certain lawsuits against states. It was initially written to quell a bit of vagueness and controversy over a portion of Article III of the Constitution that allowed federal courts to hear disputes between a state and citizens of another state . . . blah, blah, blah.

The thing is, though—as we’ve discovered is par for the course with most Amendments—over the decades and centuries, numerous judicial rulings have furthered the interpretation of this Amendment. These rulings become case law, clarifying vagueness in the Amendment. An Amendment whose purpose was, likewise, to clarify a vagueness of the Constitution. A persistent cycle of clarification.

Frankly, I have no clue what ultimate impact this Amendment has today. Hopefully you don’t come here for Constitutional expertise. I’m guessing you read for my borderline incoherent ramblings, speculative arguments, numerous tangents, and maybe a chuckle or two. With this post, I can guarantee none of the above, save a single, lengthy tangent that will herein commence.

Earlier, I listed the real stinker Amendments of the Bill of Rights with their Roman numerals: III, VII, IX, and X. As I did so, I was reminded of pharmacy school and having to memorize which clotting factors warfarin (Coumadin^®) inhibits. Like the Amendments, clotting factors are generally referenced with Roman numerals. Turns out warfarin inhibits factors II, VII, IX, and X—off from those four boring Amendments by only one little hash mark. What I had totally forgotten, was that the drug also works by inhibiting proteins S and C.

S & C . . . U.S. Constitution . . . Coincidence? Yeah, probably. But maybe I’m just now discovering some sneaky, hidden message connecting the drudges of the Constitution and its Amendments to warfarin and its ability to prevent clotting? Not saying . . . just saying.

You may have heard people say warfarin is essentially rat poison. They’re not wrong. Rat poison works by thinning our little rat friend’s blood to such super high levels that he hemorrhages and dies. If you were to ingest too much warfarin—or rat poison—you too would bleed out internally. Or, I guess, the term would be bleed in internally. Whatever, you get the idea—dangerous stuff. So keep your pooches far away from any piles of colorful little pellets.

But at a proper dosage, warfarin does its job extremely well. And it has for quite some time. If there were anything even close to equally as good, people would make the switch. This is because warfarin requires periodic (usually monthly) blood draws to test your INR and determine whether the dose is still right. Warfarin has what’s known as a “Narrow Therapeutic Index”—meaning that just a small change in the amount of drug in the body can lead to serious issues. A little too much drug can cause the blood to be too “thin” (precipitating bleeds), while too little drug leads to blood that is too “thick” (allowing clots).

Within the last decade or so, a new class of drugs has come to the market that works differently than warfarin, but just as well for most of the drug’s indications. These new Factor Xa Inhibitor don’t require inconvenient blood draws every month. Therefore, patients whose only option would previously have been warfarin are often now started on these meds instead. Some patients initially started on warfarin are switching over as well. Likely due to this dwindling market share, production was recently ceased on brand name Coumadin^®—a drug that had been on the market since 1954.

You may be thinking this is a whole lot of talk about a medication in an argument against Amendment XI. Right you are! But I see correlation between warfarin and the Constitution that should tickle the fancy of those of you who love incoherent ramblings and speculative arguments. Warfarin’s concentration must be maintained within a “Narrow Therapeutic Index” to be efficacious. Perhaps the interpretations of the Constitution and its Amendments have ventured outside the legal version of a “Narrow Therapeutic Index.”

It’s been the best thing around for a very long time. A foundation seemingly forever. Bettering the lives of countless individuals. All three phrases describe the Constitution. Warfarin also has all these attributes, but is saddled with the pesky inconvenience of blood draws. Something just as efficacious came along. Only safer. More convenient. And with it, Coumadin^® slipped permanently into that long good night.

Could our longstanding Constitution go the way of Coumadin^®? Should we construct a new, up-to-date document rather than persisting blindly with the tried and true?

So, you still think since the snoozefest of the 9^th and 10^th Amendments is in our rearview mirror, we’re destined for an impactful Amendment XI? Yeah, fine—whatever. Don’t have a stroke over it (another warfarin reference), or file a state-law based case about it (it can’t go to federal court). Either way, I can guarantee the Amendments will [mostly] be better from here on in. So, I guess, yeah, come to think of it . . . You’re Probably Right.

[044] June 09, 2021