Push vs. Pull factors: very different messages for improving activity levels and promoting health

Many folks who even casually attend to advertising and inspirational messages about fitness–“fitspo”–will notice that messages divide into the categories of push messages (disincentives to being less active) or pull messages (incentives to being more active).

fitspo - jogging

This message shows a slim, well-muscled young woman running across a beach in revealing exercise clothing (sport bra and tight short shorts). While this may seem like practical exercise clothing, the text makes it apparent that revealing her body to the gaze of others is a major goal. The text says “It takes 4 weeks for you to see your body changing. It takes 8 weeks for friends and family. And it takes 12 weeks for the rest of the world. KEEP GOING.” The emphasis here is on external appearance and feedback from external sources. Imagine this same image with the text “Do you ever wonder how fast you can run?”  The identical clothing will then send a very different message.

Push messages often rely heavily on shaming for being less active and all too often focus on attractiveness of body size/shape, factors which are not actually relevant to health in the way that fitness, nutrition, and physical activity are, and which are conveyed in ways which can actually encourage people to damage their bodies in the quest for health: “You will never become your sexy self sitting on the couch” or “Pain is just weakness leaving the body.”  These messages feature visuals of idealized slim, fit bodies with visibly defined muscles and without any visible indicators of disability.  They are almost always Caucasian bodies. They are sometimes posed in very sexualized ways that emphasize receptivity to the male gaze and/or sexual availability, lips parted and back arched.  Such images are photos not of exercise, but of the results of exercising.  They lure you in large part by making you ashamed of how you are now, thus their classification as push messages.

fitspo - no room for the week

Upon viewing a message with the bold words “THERE IS NO ROOM FOR THE WEAK” dominating the image of a slim headless woman running through the countryside, one can practically here the shaming voice in one’s head “and you don’t want to be weak, do you?”

Pull messages are rarer.  These tend to involve body positivity and reminders about how good exercise and movement can feel for a variety of body types and ability levels. These are internal rewards that involve very little or no shame.  Buzzfeed recently ran a listicle (an article that is a list) gathering 13 such messages. I present it for your consideration as a non-shaming, healthier way to, well, promote health. Here are some examples for contrast with the push messages provided above. Note how they may still inspire and motivate, but use very different messages to draw people toward exercise for reasons that promote internal sources of motivation and welfare: “Moving around feels good”; “Aren’t you kind curious how long you can actually hold a plank for?” If you  view the listicle, you will notice that the bodies also show a broadly different variety of shapes and sizes and visible disability.

fitspo - moving around feels so goodfitspo - curious

In a similar vein, consider the British campaign “This Girl Can” which this Editor would consider another example of a Pull message rather than a Push message.  It seems to say “come on over here and sweat and jiggle and move your fleshy meatsack of a mostly-water self… doesn’t it look like fun?”


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The poetry of hands-on healing, and the failure to do so
Alison Reiheld

In 2013, Rafael Campo–then associate professor of medicine at Harvard–won the Hippocrates Open International Prize for Poetry and Medicine.  First, let us be grateful that there is such a thing, a thing to draw beauty out of what isn’t always. Second, let us be grateful for the poem it rewards, reposted below in its entirety.  I found it merited more than one reading.

Morbidity and Mortality Rounds

 By Rafael Campo


Forgive me, body before me, for this.

Forgive me for my bumbling hands, unschooled

in how to touch: I meant to understand

what fever was, not love. Forgive me for

my stare, but when I look at you, I see

myself laid bare. Forgive me, body, for

what seems like calculation when I take

a breath before I cut you with my knife,

because the cancer has to be removed.

Forgive me for not telling you, but I’m

no poet. Please forgive me, please. Forgive

my gloves, my callous greeting, my unease—

you must not realize I just met death

again. Forgive me if I say he looked

impatient. Please, forgive me my despair,

which once seemed more like recompense. Forgive

my greed, forgive me for not having more

to give you than this bitter pill. Forgive:

for this apology, too late, for those

like me whose crimes might seem innocuous

and yet whose cruelty was obvious.

Forgive us for these sins. Forgive me, please,

for my confusing heart that sounds so much

like yours. Forgive me for the night, when I

sleep too, beside you under the same moon.

Forgive me for my dreams, for my rough knees,

for giving up too soon. Forgive me, please,

for losing you, unable to forgive.


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Keisha Ray on Racial Disparities on Pain Management

Over at the American Journal of Bioethics blog, bioethicist and new IJFAB blogger Keisha Ray has published an excellent piece on racial disparities in pain management titled INEFFICIENT PAIN MANAGEMENT FOR BLACK PATIENTS SHOWS THAT THERE IS A FINE LINE BETWEEN ‘INHUMANE’ AND ‘SUPERHUMAN’. Ray takes note of recent research on this topic:

Black people are less likely to receive adequate pain management and are less likely to be prescribed pain medication, including after experiencing injuries typically thought of as very painful, such as bone fractures. In a study conducted at University of Virginia, in which researchers studied white medical students’ views of black patients, they found that many students held false beliefs about the biology of black people, which could explain disparities in pain management. For example, researchers found that some white medical students believed that black people have thicker skin than white people, black people’s blood coagulated quicker than white people, black people have stronger immune systems than white people, and that black people’s nerve endings were less sensitive than white people’s nerve endings. Other than these views being troublesome simply because of their false nature and not being grounded in science, many of the medical students who held these beliefs also had false beliefs about black people’s ability to feel pain, believing that they feel less pain than white people. The worry is that these unscientific views could be used to develop treatment recommendations by future physicians and are currently used by some practicing physicians to treat their black patients.

Over at the Washington Post, this information was helpfully tabulated for readers as follows. The alert reader will note odd variations in frequency of beliefs, such as an increase in the 2nd year of medical school in the belief that blacks age more slowly than whites (from 21 the first year to 28 the 2nd year) followed by a decrease to well below that (3rd year: 12; Residents: 14). The claim that “Blacks’ nerve endings are less sensitive than whites” similarly increases from 1st to 2nd year before dropping back. Several of the beliefs about biological differences between black and white patients actually spike between 3rd year and residency. This editor wonders if there may be some connection to the well-documented jading that occurs during medical school.

black pain

While undertreatment of pain in black patients of course raises issues of cruelty, non-maleficence, and justice, Ray makes an additional and important point about the seeming permissibility of inhumane treatment for those seen as superhuman:

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FAB Congress 2016 Program is now available

Still considering whether to attend FAB Congress 2016, meeting jointly with the World Congress of Bioethics in Edinburgh this June? The final program for FAB Congress is now available for download.

Long may it serve.

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White Anxiety and Black Bodies
Mary Rawlinson

This morning I opened the New York Times to discover a photograph of 16 African-American women who are graduating from West Point this year, posing in their dress greys, as is tradition. My first thought was “Wow, 16 African-American women in one class at West Point!” My second thought was “You go girls!” They had their fists raised to their shoulders in a gesture of sisterly solidarity.

Rawlinson - west point cadets

Sixteen women of color in West Point dress greys stand on the steps of a building. Two stand on a railing, sabers crossed above the stairs and above the heads of the other women. All have one fist raised. IMAGE CREDIT: Twitter, May 7 2016.

Then I read the caption: “One Photo, Sixteen Clenched Fists, and Riven West Point.” Apparently, a white Iraq veteran turned blogger decided that the clenched fists were meant to invoke the “Black Lives Matter” movement, which he accuses of advocating the murder of policeman and, even, of all whites. Putting aside this mischaracterization of that movement, who is he to make this interpretation of these young women’s gesture?

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Join Me in Welcoming the New IJFAB Blog Editor, Alison Reiheld!

I am pleased to announce that Alison Reiheld is assuming Editorship of the IJFAB Blog. While I hope to still make the occasional contribution, I am stepping down as part of the journal’s transition to its new institutional home at MSU.

The blog could not be in better hands, and I’ve every expectation it will thrive under Alison’s oversight. Please, to this end, send her contributions at Blog@IJFAB.org!

With best regards,

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Pro-Life Feminism: A Catholic feminist philosopher considers the consequences of punishing women for seeking abortions

In 1986, an article was published in Commonweal encapsulating a view that to some people seems deeply incongruous.  The author of this article was Sidney Callahan and the article was entitled “A Case for Pro-Life Feminism.” The views Callahan laid out remain as profound calls to look to the circumstances within which choices to terminate pregnancy occur, and to target them rather than only the procedure itself. Callahan argued in part that the availability of abortion as a solution to these problems allows society to continually fail to address the reasons that it is hard for women to have and raise children.  Whether or not you agree that abortion is immoral, Callahan’s ethical redirect can be a valuable tool to add to one’s mental repertoire.

Rebecca Bratten Weiss, a farmer and philosopher and instructor at Franciscan University in Steubenville, has done just this. She responds to the kerfuffle over Donald Trump’s discussion of punishing women for seeking abortion, and to a similar set of issues raised by a new law in Poland, by redirecting our attention away from abortion toward the circumstances in which choices to abort take place. It is worth a thought.  You can find it over at Patheos.

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Anne Drapkin Lyerly, Carleigh Krubiner, and Ruth Faden pen a passionate call to look broadly at pregnant women’s health, through the lens of the Zika virus outbreak

Over at the Baltimore Sun, Anne Drapkin Lyerly, Carleigh Krubiner, and Ruth Faden have penned an excellent op-ed on the need for further research on pregnant women.  They write:

Pregnant women are at the crux of Zika’s most devastating consequences. Their needs must be uppermost in Zika prevention plans. While this will not be easy, the knee-jerk response that research with pregnant women is too complex to contemplate is not acceptable.

Current recommendations for women to delay or avoid pregnancy are unfair and unrealistic. In many areas hit hardest by Zika, women have limited access to contraception; there are, moreover, high rates of unplanned pregnancy worldwide. Preventing pregnancy may be the right course for some women, and preventing Zika in women before they get pregnant is critical. But these responses cannot be the whole answer.

You may remember that 2 of these authors–Lyerly and Faden–published a call for responsible inclusion of pregnant women in research in the second issue of our own International Journal of Feminist Approaches to Bioethics, back in 2008, along with Margaret Olivia Little. Lyerly, Little, and other bioethicists also co-authored a piece in the Hastings Center Report on the way that risk is conceptualized in the treatment of pregnant women.  Both bear on this issue and you may wish to check them out as well.

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Thought-provoking Guardian article on narratives (including patient testimony) and literature on medicine

Over at The Guardian, Andrew Solomon has a worthy article called “Literature about medicine may be all that can save us: A new generation of doctor writers is investigating the mysteries of the medical profession, exploring the vital intersection between science and art.” Solomon notes that,

Language is integral to medicine. It is hard to cure a condition you cannot describe, and few treatments for those conditions go without names of their own. Even veterinarians, trained to diagnose animals who cannot put their complaints into words, begin by labelling the illness and proceed by specifying the treatment. The emerging field of narrative medicine proposes that patients can be treated correctly only when they can tell the story of their illness, often in the context of a more extensive autobiography. A doctor usually begins by getting the patient to describe their pain, and often arrives at diagnosis as much through that interaction as through anything he can observe. Illness is temporal, and language helps to chart its course, even when x-rays, MRIs, CAT scans and other images can represent its current state. A picture is not always worth a thousand words; sometimes, it is the words that tag the problem. You tell the doctor how you felt yesterday and how you feel today; the doctor tells you how you should feel tomorrow. That interaction is part of the cure; it is why a physician’s bedside manner can have such an enormous impact on his efficacy. We are embodied, but our minds order the brokenness around us by imposing vocabulary on it. In fact, there is some evidence that people who can speak more fluently receive better medical care; patients deprived of language are often subject to abuse.

patient phys comm

This image shows a man in a blue dress shirt and striped blue tie, wearing a white coat. His mouth has a bandaid over it. He is standing next to a woman in a pink sweater and dress shirt. Her mouth also has a bandaid over it. Both are white. The man is raising one eyebrow much higher than the other as though confused or inquiring. The woman is raising both eyebrows. This is an add from the American Academy of Orthopaedic Surgeons. The text reads “Talk much with your doctor? Communication between doctors and patients can be powerful medicine. But too often, both parties come up short. Patients should come to appointments prepared with questions written down in advance and a list of all current medications and allergies. Doctors can do more, too, starting with listening better and using language patients don’t need a medical dictionary to understand…” IMAGE SOURCE: http://newsroom.aaos.org/PSA/print/Patient-Physician-Communication/patphyscomm2007.htm

Privileging narrative this way both centers (re-centers?) patient experience and testimony even in a world replete with clinical signs and markers–imaging, bloodwork, hands-on movement of limbs, blood pressure, heartbeat, skin discoloration, etc.–and highlights the bare fact that patients who cannot communicate in ways that doctors find effective may have worse outcomes.

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Dwarfism, Chemical Limb Lengthening, and Informed Consent

According to a recent article in the popular press, a California based biotech firm, BioMarin Pharmaceuticals, has completed Phase 2 of a clinical trial for a drug that would partially suppress the expression of the Achondroplasia gene in a child’s long bones. The results of this phase of the study show children with Achondroplasia are able to gain about 2 centimeters of height per year by undergoing frequent injections of the drug and complications of the intervention are described as “mild to moderate.”

Considering the context of Little People of America’s 60 year history and 7,000 members, it should not be terribly surprising that this attempt to develop a so-called treatment for the most common form of dwarfism has stirred up a backlash that is nearly as passionate as Deaf culture’s initial response to the cochlear implant. However, these complex identity politics of the dwarfism community probably won’t produce arguments that are persuasive to most average-stature parents. After all, Dr. Hank Fuchs, who serves as BioMarin’s Chief Medical Officer, has explained the supposed motivations of the study just this past week by stating: “By addressing the root cause of Achondroplasia with vosoritide treatment and normalizing annualized growth velocity in children with Achondroplasia, we ultimately hope to improve the medical complications of disproportionate bone growth.”

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Feminist Swag: Sellouts or sell out?

Have you ever wanted to tell the world you are a feminist without speaking? Have you ever wanted a t-shirt that shows what intersectional feminism can by by depicting Rosie the riveter as women of color, women wearing headscarves, tall women, short women, skinny women, fat women, women rocking wheelchairs?  Do you want a shirt for your pet?  Or perhaps some socks so you can flash some feminism when you bare your ankles? A onesie for a kid you know? Unisex t-shirts? Women’s t-shirts? Up to size 3XL?

IJFAB Blog does not endorse this product or line of products. We are not trying to get you to buy their stuff.

prettyBut we live in a world where where JC Penney recently sold a t-shirt in the girls’ section that says “I’m too pretty to do homework so my brother has to do it for me.”  There was a bit of a firestorm about it at the time, and Penney’s ultimately pulled it from the shelves. But at no point in the product design or ordering process did anyone apparently put the kibosh on it internally. Such attitudes are still accepted in this actual world.


we can do itAnd in this actual world, we do indeed need more t-shirts like the one at left, which is marketed by Feminist Apparel as “Intersectional Rosie.” Every woman is dressed like Rosie the Riveter.  From left to right, you see a black woman rocking a natural, a very short white person with long blonde hair, an Asian woman with hair in a pony tail, a tall muscular woman who may be white, a white woman with white-blue hair in a wheelchair, a brown-skinned woman wearing a headscarf, and a fat white woman with a bouffant hairdo.

On the other hand, this IJFAB Blog editor notes that there is always a fine line to be walked when we are selling feminism, or buying products that we buy because of our ideology. This is sometimes called “femvertising.” Nonetheless, a world in which there are messages walking around on people’s bodies that counteract dominant narratives about gender and about women and about ability and about race… surely that world is better than one in which there are not?  What do you think?

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Bathrooms, Binaries, and Bioethics: Jamie Nelson takes on the American debate over gender and bathroom access
Alison Reiheld

Jamie Lindemann Nelson, PhD. Professor of Philosophy at Michigan State University.

Jamie Lindemann Nelson, PhD. Professor of Philosophy at Michigan State University.

With a blogpost over at Michigan State’s Center for Ethics and Humanities in the Life Sciences, feminist bioethicist Jamie Lindemann Nelson has dipped her toes into the acid bath that is the American debate over gender and bathroom access.  Nelson has long drawn attention to bioethics’ shameful silence on trans* issues. In “Bathrooms, Binaries, and Bioethics,” she takes on the medical and moral confusions implicated in, and at the root of, the USA’s current debate over bathroom usage.

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