Obesity at the Pediatrician’s Office
Editor

The excellent medical history and women’s studies blog Nursing Clio is running a series of posts about female presidential candidates. They also recently featured a truly illuminating scholarly blog entry on the history and modern use of obesity and BMI in pediatric settings called “The Problem With Fat-Talk at the Pediatrician’s Office.”

Combined with the fact that some states require “BMI report cards” to be sent home by schools (a practice some argue is necessary for combating obesity but others say pose serious problems and the efficacy of which is unverified), pediatric use of BMI deserves careful attention from those concerned with medical ethics and public health ethics generally, and more specifically with the way that medicalization can reify stigmatized human conditions. This is even more the case than in the adult context given young people’s vulnerability to life-long patterns of body shame and disordered eating.

You may find the Clio blog entry particularly useful in thinking about the use and misuse of these measurements, and why they continue to find traction despite their oversimplification with respect to health. While IJFAB Blog has featured several blog entries on adult clinical uses of obesity and BMI, we don’t have any on pediatric contexts and so commend this to you.

For some of our past entries on adult obesity and BMI, see:

 

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Why YOU should submit your work to the ASBH FAB Affinity Group
Anna Gotlib

asbhThe American Society for Bioethics and Humanities  —  one of the largest conferences for all academics, clinicians, policy analysts, and others working in the areas of bioethics, medical humanities, medicine, medical education, and related disciplines  —  is ready to roll in Washington, D.C, from October 6-9, 2016.  Among its many features is the opportunity for Affinity Groups  — smaller organizations whose members have a particular clinical, academic, or other kind of focus  —  to meet, hear each other’s work, and engage in lively discussions, debates, and other activities centered around particular concerns or approaches.

The experiences of participants in such groups tend to bring them back.  Because ASBH is such a large, multivocal event, finding oneself in an environment where one is in focused conversations with a small group of like-minded colleagues who share one’s passions and concerns (and sometimes even projects) is not only professionally fruitful and fulfilling, but often just plain fun.  As it happens, I am the current organizer of just such a group:  Feminist Approaches to Bioethics.  And I think that you should submit your abstract for our meeting.  Now.

fabWhy Feminist Approaches to Bioethics?  If you are reading this blog post, you probably are already somewhat familiar with FAB and IJFAB  —  so just submit your work already!

If you are new here, first  —  welcome!  We are very happy to have you!

Second, please pardon all the acronyms (ASBH, FAB, IJFAB, and so on).

Third, please consider submitting your work for the following reasons:

  1.  The FAB Affinity Group is a welcoming, exciting, open-minded community of people interested in feminist approaches to medicine and related issues.  We WANT to hear your ideas, and we want to engage with them.  We don’t bite.
  2. Among all the general sessions and Affinity Groups at ASBH, we are the only group, focused specifically on feminist perspectives and approaches.  If you are, too, then we already speak the same language.  This matters!
  3. Participating in our group is a wonderful networking opportunity  —  especially for students and junior faculty and researchers.  It is also a great place for the more senior members to present work, to mentor younger colleagues  —  and, of course, to see old friends!
  4. All we ask for now is 250 words  —  surely you have a spare few hundred words lying around somewhere!

Thanks for reading this shameless promotional screed.  Below, I am posting the actual CFA, and please  —  do not hesitate to contact me with any questions or concerns.

 

FAB AFFINITY GROUP:  Call for Abstracts

In an ongoing effort to stimulate scholarship and encourage the growth of the field of feminist bioethics, the FAB Affinity Group would like to invite submissions for the American Society for Bioethics and Humanities (ASBH) 18th Annual Meeting October 6-9, 2016 at the Hyatt Regency Washington on Capitol Hill in Washington, D.C.  The theme is open, but should relate to issues within feminist bioethics, broadly construed.  Especially encouraged are papers that reflect works in progress, exploring new theoretical approaches to feminist bioethics, or analyzing advances in the biological sciences and medicine using a feminist framework.

Abstracts or proposals (250 words or less) should be emailed to agotlib@brooklyn.cuny.edu by August 1st.  Please include your full contact information.  All submissions will be reviewed by the FAB Affinity Group committee.  Applicants will be notified of the committee’s decision by August 15th.

Please feel free to distribute this invitation as appropriate.

Thank you, and we look forward to seeing you at ASBH in October!

 

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Move Along — Nothing to See Here!
Anna Gotlib

I am not going to write a lengthy post about the story of drug testing kits (and their failure) linked below.  Please read it.  Because I think that it speaks for itself  —  loudly, predictably, shamefully….

Here is a taste:

In our own examination of those 212 cases — thousands of pages of arrest reports, court filings and laboratory-testing records, along with interviews of prosecutors, police executives, officers, defense attorneys and innocent defendants who pleaded guilty — we saw a clear story about both who is being arrested and what is happening to them. The racial disparity is stark. Blacks made up 59 percent of those wrongfully convicted in a city where they are 24 percent of the population, reflecting a similar racial disparity in drug enforcement nationally. Patrol units, not trained narcotics detectives, appeared to be the most prolific field-test users.

The kits, or the officers interpreting them, got it wrong most often when dealing with small amounts of suspected drugs. Sixty-three percent of the N.C.S. cases involved less than a gram of evidence. The smallest possession cases are the ones in which a field test can be of greatest consequence; if officers find larger quantities of white powder in dozens of baggies or packaged in bricks, they have sufficient probable cause to make an arrest regardless of what a color test shows. (Though in those cases, too, they are generally required to test the drugs.) It’s widely assumed in legal circles that these wrongfully convicted people are in fact drug users who intended to possess drugs. Barry Scheck, a founder of the Innocence Project, a nonprofit group that seeks to overturn wrongful convictions, says some who work toward exoneration have complained to him that those exonerated of drug charges often are just accidentally not guilty, and shouldn’t be added to the National Registry of Exonerations. The assumption is not entirely without basis — 162 of the 212 N.C.S. defendants had criminal histories involving illegal drugs. However, 50 had no criminal history involving drugs at all.

All of the 212 N.C.S. defendants struck plea bargains, and nearly all of them, 93 percent, received a jail or prison sentence. Defendants with no previous convictions have a legal right in Texas to probation on drug-possession charges, even if they’re convicted at trial. But remarkably, 78 percent of defendants entitled to probation agreed to deals that included incarceration. Perhaps most striking: A majority of those defendants, 58 percent, pleaded guilty at the first opportunity, during their arraignment; the median time between arrest and plea was four days. In contrast, the median for defendants in which the field test indicated the wrong drug or that the weight was inaccurate — that is, the defendants who actually did possess drugs — was 22 days. Not only do the innocent tend to plead guilty in these cases, but they often do so more quickly.

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End-of-life care, and counseling, varies with disease type
Editor

US News and World Report recently published an article summarizing the results of a study of Veterans Affairs hospitals. The study found that patients with cancer or dementia received better end-of-life counseling, more palliative care, and better end-of-life planning on the part of patients.  Patients with kidney disease, heart failure, lung disease, or general frailty did not receive as much palliative care or plan as well.

Is this a systemic failure? Why cancer and dementia? Are these conditions treated by health care teams that involve specialists in planning whereas others are not? Is it–perhaps wrongly–presumed by doctors treating kidney disease, heart failure, lung disease, and frailty that their patients will retain decision-making capacity, whereas oncologists and those treating dementia patients believe–perhaps rightly–that there is a good chance their patients will lost decision-making capacity? Why is such counseling not universally available, even in the VA? Or is it universally available, and only undertaken by certain patient groups?

Active duty military personnel routinely complete basic legal advance directives such as health care power of attorney, living will, do-not-resuscitate orders, etc. The VA’s website has a standard form for Living Will and Durable Power of Attorney for Health Care.  How is it  that advance care planning tracks diagnostic categories so closely?

Cruzan Gravesite

This image shows a picture of the headstone at Nancy Beth Cruzan’s gravesite. It has three dates on it: Born (July 20, 1957); Departed (Jan 11, 1983, the day of her accident); and At Peace (Dec 26, 1990, the day she was removed from life support and died).

21 years ago, Emmanuel et al. published their influential article “Advance Care Planning As A Process” in which they joined a growing chorus of ethicists calling for routinization of advance care planning, and discussion even with patients who do not have terminal illnesses followed by regular updates of advance care documentation.  When this Editor teaches advance directives and prospective autonomy, the subject follows on the heels of discussion of the case of Nancy Cruzan, who was a young healthy woman at the time she was found face down in a watery ditch and rescuscitated after an unknown period of time without oxygen.  She never recovered from the persistent vegetative state in which she found herself.

Cases like Cruzan’s, and advice such as that given by Emmanuel et al., direct us to the general importance of giving some indication of our wishes to our likely surrogate decision-makers and/or to our physicians regardless of our disease state.  And yet whether or not  this has been done appears to track particular disease states within the VA hospital system.  Lack of adequate palliative care and advance care planning remain serious issues with end-of-life care in the United States. This is a problem bioethics and medicine have yet to adequately address, and it remains complicated by the motley assortment of health care delivery systems in the U.S. As the U.S. News article notes,

Outside the VA system, patients may not get their choice of whether they get end-of-life care or not. Currently, Medicare patients have to choose whether to get palliative care or continue with curative care — they can’t have both, according to Dr. F. Amos Bailey. He is a palliative care physician at the University of Colorado School of Medicine in Aurora.

None of us are getting out of here alive. We have no control over whether we die, but we could have some over how. Should more of us be able to exercise it? What kinds of systemic factors inhibit that, and what kinds of systemic changes would make it possible?

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Telling Tales: Narratives About Black Men and Obesity

EDITOR’S NOTE: This entry was originally published on IJFAB Blog December 19 of 2014.  In the early hours of July 5, 2016, Alton Sterling of Baton Rouge, LA was shot dead by police. He was a father, selling CDs outside of a convenience store. Cellphone video shows that the encounter escalated rapidly, and that police at one point shouted that Sterling had a gun.  Louisiana is a permitless open carry state.  What led police to escalate this encounter so rapidly? The investigation may reveal more information.  However, the notion that certain narratives of danger and threat are more likely to be associated with certain bodies bears consideration. To that end, IJFAB Blog re-presents this piece on just that issue. 

Rebecca Kukla and Sarah Richardson recently published a piece in The Huffington Post, “Eric Garner and the Value of Black Obese Bodies,” in which they examined a seeming paradox revealed in the cases of Eric Garner, Michael Brown, and 12-year old Tamir Rice. I seek here to add additional context regarding medicalization, narratives about black bodies, and how those bodies function as “public texts” (in Karla Holloway’s words), texts which tell tales. Though this conversation will focus on black men’s bodies, there is much to be said about how black women’s bodies are read by the public and by police. Bodies tell tales, and black bodies tell particular tales. Of course, these tales are not necessarily true or helpful.

Let us begin with Kukla and Richardson’s piece. As you may recall, Garner died as a result of an illegal chokehold used by a police officer on him to subdue him for allegedly selling cigarettes illegally while Brown died as a result of being shot multiple times by a police officer after an altercation which began with the officer instructing Brown to walk on the sidewalk instead of the street.   Rice was shot fatally by a police officer immediately after the officer arrived at a park where Rice was sitting with a toy gun. 

There are three sets of images. On the upper left, three stages of the fatal encounter between Eric Garner and police. In the first, it is clear that Garner is standing back from a police officer in front of him as one comes up behind him. In the second, the officer behind Garner has wrapped his arm around Garner’s neck in a chokehold. The officer in front is holding Garner’s arm, apparently to prevent him from removing the chokehold. In the third, Garner is down on the ground with one police officer still choking him and three others handcuffing him. It is at this point that witnesses say he began to repeat “I can’t breathe.” The text says “Rest In Peace Eric Garner.” All of these pictures of the encounter show how big Garner’s body was (quite large compared with those standing next to him). In the second set of images, on the upper right, we see two pictures. One shows Michael Brown in his high school graduation picture months before he was shot. His gown is forest green and he has a serious expression on his face. In the second picture, he is wearing a red sleeveless t-shirt and jeans. The t-shirt says Nike Air, and his face is serious. He is standing on the front porch of a house. Both pictures show that he was a large-bodied, though not morbidly obese, young man. In the final image, below the others, we see a photo of Tamir Rice, 12 years old, smiling at the camera. The text is as though the image were taken from a newscast, and says “Police Shooting Investigation.”

There are three sets of images. On the upper left, three stages of the fatal encounter between Eric Garner and police. In the first, it is clear that Garner is standing back from a police officer in front of him as one comes up behind him. In the second, the officer behind Garner has wrapped his arm around Garner’s neck in a chokehold. The officer in front is holding Garner’s arm, apparently to prevent him from removing the chokehold. In the third, Garner is down on the ground with one police officer still choking him and three others handcuffing him. It is at this point that witnesses say he began to repeat “I can’t breathe.” The text says “Rest In Peace Eric Garner.” All of these pictures of the encounter show how big Garner’s body was (quite large compared with those standing next to him). In the second set of images, on the upper right, we see two pictures. One shows Michael Brown in his high school graduation picture months before he was shot. His gown is forest green and he has a serious expression on his face. In the second picture, he is wearing a red sleeveless t-shirt and jeans. The t-shirt says Nike Air, and his face is serious. He is standing on the front porch of a house. Both pictures show that he was a large-bodied, though not morbidly obese, young man. In the final image, below the others, we see a photo of Tamir Rice, 12 years old, smiling at the camera. The text is as though the image were taken from a newscast, and says “Police Shooting Investigation.”

 

On the one hand, Kukla and Richardson note, each of these black males was depicted as a “giant, brutish King-Kong-like black man threatening our cities.” The officer who killed Brown in Ferguson, MO, Darren Wilson, was 6-foot-4 inches tall and weighed 210 pounds, vs. Brown’s identical height and 292 pounds. Wilson described him grabbing Michael Brown’s arm as “like a five-year-old holding onto Hulk Hogan.” The officer who shot 12-year old Tamir Rice estimated his age at 20, not 12.

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The First MSUD Undergraduate Women in Philosophy Conference, and the Climate for Women in Philosophy
Carol Quinn

In April 2016, my colleague Liz Goodnick and I hosted our first Undergraduate Women in Philosophy conference at MSU Denver. It was a tremendous success. We thought that this would be a great way to help positively change the climate for women in philosophy. Before discussing our fantastic conference, here’s a brief accounting of the climate for those who might not be aware.

Those of us who are in philosophy, and especially those of us who are women philosophers, know firsthand about the often-hostile climate for women. Most female-identified philosophers have either been subjected to some form of sexual harassment or know someone who has. Yet, as one of my mentors from graduate school, Linda Martín Alcoff, notes, many instances go unreported: “Women in our profession are, as a group, afraid to complain, loathe to complain, absolutely committed to not complaining.”

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A gently crumpled conference program

Many of us are aware of the high-profile sexual harassment cases in philosophy departments in recent years. And all it takes is a few minutes of reading the blog, “What is it like to be a woman in philosophy?”  to get a good sense of the discouraging climate. Alcoff recalled reading the blog in a coffee shop near NYU and “tearing up” (see “A Call for Climate Change for Women in Philosophy”). As she puts it, the blog is “over-full with stories of disrespect, harassment, sexual objectification, even an attempted rape at an APA conference.”

In September 2013, New York Times’ “The Stone” presented a five-day series written by women philosophers on the appalling climate for women. Sally Haslanger, who was a contributor to the series, blames “bad actors” in positions of power. Alcoff, who was also a contributor, suggests that the principal issue “is not about harassment or come-ons but the thousand daily cuts that collectively dissuade women from staying in, the aggressive and peremptory dismissals in seminars, the a priori rejections and derision of feminist philosophy…” and on and on.

I recommend reading the March 15, 2016 report “Women in Philosophy: Quantitative Analyses of Specialization, Prevalence, Visibility, and Generational Change” by Eric Schwitzgebel and Carolyn Dicey Jennings: http://www.faculty.ucr.edu/~eschwitz/SchwitzPapers/WomenInPhil-160315b.pdf. Most disturbing is not just the small percentage of full-time female philosophy faculty, but also the percentage of women philosophy faculty by rank, which reflects “the higher attrition rates, lower promotion rates, and lower rates of senior recruitment for women.”

There are very few women full professors in philosophy. Equally disturbing is the appalling lack of women philosophers of color. Haslanger notes that, “change needs to happen on multiple fronts for us to make progress.”

This brings me to MSU Denver’s First Undergraduate Women’s Philosophy Conference. Since graduate school, I have been trying to find ways to improve the climate for women in philosophy. While I had a wonderful, supportive dissertation advisor, Sam Gorovitz, our department certainly was no stranger to the above-mentioned problems. One of my earliest efforts was helping to found, with my mentor Linda Alcoff, a women’s “support” group. At a recent visit to my alma mater, I was delighted to see that the group is still thriving. Some female graduate students told me that the women’s group has made a tremendously positive impact on their time in graduate school, noting that they wouldn’t survive without it.

In this spirit, my colleague Liz and I founded MSU Denver’s Women’s Philosophy Group a couple of years ago to help recruit and mentor female-identified students. Our first ambitious project (all the more so that I was on sabbatical) was to organize and host our First Undergraduate Women’s Philosophy Conference on April 22-23, 2016. We knew that this had the potential to be an important event. It was just a matter of pulling it off. The conference, the only one of its kind so far as we are aware, would provide a supportive space for undergraduate female-identified students to present and comment on philosophy papers and build community. We received financial support from our philosophy department, our Institute for Women’s Studies and Services, our women’s philosophy group, our philosophy club, and from our wonderful provost, Vicki Golich.

 

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Our keynote speaker, Elizabeth Brake, Arizona State University, gives a talk entitled “Love and the Law.”

We didn’t expect such a tremendous response. We received fifty submissions from across the United States and Canada. Several students, both female and male, helped serve as blind reviewers. Two students in particular did an exceptional job in helping us pull off such a fantastic conference, Haley Burke and Alexa Brown.

Our budget only allowed for eight presenters and commentators, and a small honorarium for our keynote speaker, Elizabeth Brake (Arizona State University), who gave a terrific talk entitled “Love and the Law,” arguing for state support of personal relationships, including friendship, polyamory, and companionship for the elderly.

The conference was well attended with fifty-plus in the audience. Male-identified allies served as chairs and commentators. We hosted a banquet the night before. We started the conference with a workshop on the climate for women in philosophy, at which we distributed a list of online resources. University of Northern Colorado’s Nancy Machett gave a particularly inspiring talk at the workshop about “The unplanned and unexpected yet in my view utterly marvelous experiment that occurred at Oxford between 1937-1945. This was long before anyone was worried about the lack of women in philosophy.” As Machett explained, five remarkable women philosophers turned up at Oxford at that time: Mary Midgley and Elizabeth Anscombe (arriving in 1937), followed by Iris Murdoch (1938), Philippa Foot (1939), and Mary Warnock (1942).

 

 

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Student speaker, Caroline Blaney, Hunter College, presents her paper “Platonic Pedagogy in the Meno: Virtue is not a Divine Gift.”

The feedback from the conference was amazingly positive. For example, one respondent noted that, “It was really powerful to be in a room of women philosophers and feel like part of a community.” And: “Exceptionally beneficial to hear from and engage with a group of fellow women who share a passion for philosophy.”

There were three main concerns about the conference, as indicated by the evaluations, which we would like to correct before our Second Annual Women’s Philosophy Conference. First, the conference should be longer, to allow for more participants. Second, the conference should be more affordable to allow more students to participate, and finally, there should be more people of color participating.

Liz and I recently applied for a small grant with the APA to help remedy the first two concerns. With APA funds, we can extend the conference to two full days and offer small stipends to student participants and a larger award to the student with the best paper. The third concern (including more female-identified students of color) will be addressed by encouraging women of color to submit papers in our next Call for Papers, to invite a woman philosopher of color to be the keynote speaker, and to advertise to historically black schools, Hispanic-serving institutions, and departments such as African American Studies, Chicano/a Studies, and Native American Studies.

We are looking forward to hosting our next conference in April 2017. I hope that some of you will encourage your female-identified students to participate. As one conference attendee noted, this conference matters.

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A few members of the audience engage with the presentations

 

Participating in conferences of this sort, having more female-identified philosophy faculty (especially senior faculty) serving as positive role models, mentors and advocates, and actively recruiting female-identified philosophy students, including female students of color, will help make a positive difference for women in philosophy. That, and (to quote Alcoff) waiting for the “recalcitrant members of the old guard” to retire.

 

 

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Access to Health Care for LGBT patients in the US

PRIDE_simple_blogheader1-1

This image shows the logo of the University of Wisconsin – Madison medical student group, PRIDE in Healthcare. The logo is a rainbow colored 7-pointed star with a banner across it bearing the group’s name. Their webpage states: “Our name stands for Promoting Recognition of Identity, Dignity, and Equality in Healthcare. Our main goals are to improve the conditions of healthcare for lesbian, gay, bisexual, and transgender (LGBT) people—and for those who may not identify as LGBT, but who do not have strictly hetero-normative sexual practices, sexual orientation, or gender identity. We also hope to increase quality and quantity of LGBT content in medical education, to raise awareness of LGBT health disparities and their causes while cooperating with professional and community members, and to provide a social forum for LGBTQ/allied students and professionals in the health sciences.”

As LGBT pride month in the U.S. draws to a close, The Courier-Post brings us an article on LGBT patients’ access to health care, with obstacles ranging from stigmatizing treatment and discrimination to lack of access to health insurance due to employment discrimination:

A 2010 survey of LGBT patients found that 70 percent of transgender and gender nonconforming patients and nearly 56 percent of gay, lesbian and bisexual patients said they experienced some form of discrimination in health care, including harsh or abusive language, physical abuse, or rough handling. Some said their providers denied care, or refused to touch them.

For more on this, the Editor of IJFAB Blog suggests you read the 2014 Kaiser Family Foundation’s report on access to health care for LGBT patients and/or the Institute of Medicine’s 2011 report on the health of LGBT patients.

You might also find something of value in past IJFAB Blog entries on LGBTqi issues, including several that deal specifically with trans health care access.

 

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Not the parity we want: Disordered eating and normative appetites in North American men and women
Alison Reiheld

Editor’s Note: This blog entry is based on a paper presented by Prof. Reiheld at FAB Congress 2016 in Edinburgh.

Philosopher Sandra Bartky persuasively argued for a Foucauldian framework conceptualizing femininity as a disciplinary regime that creates docile bodies through dieting, exercise, and comportment. Women, to be feminine, should take up as little space as possible. The very notion of appetite is highly regulated in femininity as evidenced by women’s constant attention not only to what they eat but also to how they are judged by others for the signs of appetite which they display.  Women who eat non-normatively still conform to norms insofar as they socially excuse their eating: “I have been hitting the gym hard, so I can afford a little cake” or “I didn’t have lunch today, so I think I will indulge a bit.”  These attitudes and social interactions underpin disordered eating by those seeking to conform to norms of femininity, with all the negative health consequences that implies for the person who disciplines themselves in this way.

masculinity-word-association1

This image is a word cloud (word association) for “masculinity” as found on the internet. The words most commonly found with “masculinity” are larger: stronger, confident, tough, provider, aggressive, independent, violence, strength, and athletic… these are a few of the most prominent. They are also non-coincidentally the components of RW Connell’s analysis of hegemonic masculinity.

While feminist bioethics have long been concerned with how femininity norms lead to disordered eating and body image in women and girls, similar pressures from masculinity norms are increasingly brought to bear on men and boys. The burgeoning field of masculinity studies has, in parallel, analyzed norms of masculinity which govern masculine behavior.  Sociologist R.W. Connell popularized the concept of hegemonic masculinity, a notion that not only promotes dominance by men and the subordination of women, but does so in part by enforcing very clear norms of masculinity which justify dominance, norms which often involve strength and aggression.

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Writing fiction as a philosopher and bioethicist
Carol Quinn

Editor’s Note: At the 2016 FAB Congress in Edinburgh, Prof. Carol Quinn agreed to join IJFAB blog as a regular contributor. Her first contribution draws on one of the features about her that distinguishes her from so many other philosophers: she has also begun to think about how to make fiction philosophically interesting and has co-authored her first novel in this vein. She has a contract for a second work of fiction to be solo-authored. It is worth considering how fiction can take our work out of academia and its narrow readership to a broader audience much as Mitch Albom’s Tuesdays With Morrie broached the topic of death and dying in the 1990’s for a mass audience. 

Quinn book cover

This image shows the cover of Prof. Quinn’s book The Rashoman Tea and Sake Shop. A hand-drawn image depicts a classic Japanese-style building warmly lit from inside.

I recently published my first novel, The Rashomon Tea and Sake ShopA philosophical novel about the nature and existence of God and the afterlife, in April 2016 (Rock’s Mills Press). It is available on Amazon and elsewhere. The novel is coauthored with my former student, Kyle Cottengim, and his wife, Kait.

We came up with the idea for The Rashomon Tea and Sake Shop during the fall semester of 2013. I was teaching my course God, Sex, and Gender.  One of my longtime favorite students, Kyle, was in that class, as well as newcomer, Mason “Thorne” Cassidy. The class was always very lively, but the three of us would routinely get into heated debates. I invited Kyle and Thorne to continue our conversations outside of the classroom.

We would regularly meet, often right after class, at a little Mexican joint across the street from campus. Whatever topic we discussed, we discovered that we were each passionately convinced of our own version of the truth, though sometimes one of us managed to sway the other to our side.

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New AMA Code of Ethics and other measures, including on feminine hygeine products and eating disorders, adopted at AMA meeting
Editor

Last week, during the distraction of FAB Congress and World Congress of Bioethics, you would be forgiven for not taking note that the American Medical Association–also having its annual meeting at the time–voted to accept a new version of its Code of Ethics. You can find more about it from Morning Consult and Healio.  As Healio notes, the first AMA code of ethics was approved in 1847.

The measure was one of many adopted at the AMA meeting, including–but not limited to–a call for more resources to combat Zika virus, a call for school start times no earlier than 8:30 am based on adolescent sleep research, policy recommendations on gun safety and background checks which explicitly mention the shooting in Orlando, equal health care access for eating disorders, and a measure calling for the elimination of sales tax on feminine hygeine products such as tampons. “Feminine hygiene products are essential for women’s health, and taxes on them are a regressive penalty,” said AMA President-Elect David O. Barbe, M.D. “We applaud the states that have already eliminated sales taxes on these products, and we urge every state to follow suit.”

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Tweeting a FAB Congress 2016 narrative

The most excellent Kelly Danielle, who has recently become involved with FAB and was at FAB Congress in Edinburgh, volunteered to “storify” FAB 2016 tweets.

storified fab tweets 1As you may know, twitter presents the most recent tweet first. This can make it hard to follow tweets unless you are doing so in real time. Storify is a web service that takes a series of tweets and presents them in the order they occured so that they can be more easily accessed in a classic narrative format the human mind often prefers.

If you want to follow tweets about papers/sessions you could not attend for any reason–not at FAB, or in another session, etc.–this may prove really helpful for you. It was for me!  I live tweeted all of the sessions I attended but one, and really appreciated seeing other perspectives on those same talks AND perspectives on talks that I missed.

 

storified fab tweets 2Many people who tweeted included images of presenters or their slides for at least some tweets about a particular presentation.  You can find the storified tweets here.

Many thanks, Kelly Danielle!  We appreciate this initiative.

For the next few days, you can follow the World Congress of Bioethics at #IAB2016 on Twitter.  The IAB has been very supportive of FAB, underwriting our Congress expenses, helping with publicity and management and registration, and retweeting many of our tweets as a very real form of endorsement. You can follow them as an organization @IAB2016 (#IAB2016 will capture anything anyone at the World Congress of Bioethics tags as such).

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FAB Congress in full swing!

Kate Hunt opening slide

Kate Hunt stands at the podium at the Edinburgh International Conference Centre with the first slide of her presentation on gender and health, which was the opening plenary session of FAB Congress 2016.

FAB Congress kicked off this morning with an excellent talk by Prof. Kate Hunt at University of Glasgow in Scotland. Hunt is the Associate Director at the MRC/CSO Social and Public Health Sciences Unit.

Hunt’s paper described gender differences in health between men and women, busting some myths about the effect of masculinity on health behaviors and confirming others about the effects of gender on how seriously health was taken.  For instance, men who had symptoms of breast cancer had to wait much longer for referral to a specialist than did women who had symptoms of breast cancer, while women who had symptoms of bladder cancer waited quite a bit longer than men for referral to a specialist. Hunt also described a public health initiative she was involved in to get older obese men interested in improving their health (which may or may not mean weight/size) to engage in better health behaviors. This program worked in cooperation with Scottish Premier League football (soccer) teams to bring men in to take insider tours of the facilities, train in the facilities, walk up and down the stadium steps, engage in support groups with each other, and more. 12 month follow up showed that the results were almost entirely sustained for nearly all participants, rare with such initiatives. Hunt points out that this worked by harnessing masculinity to good health behaviors. Masculinity should not be conceived of as a simple obstacle to wellness.

sarah ssaali

Sarah Ssaali delivering her talk at the 2016 FAB Congress in Edinburgh Scotland on June 13, 2016

Many papers followed including a cornucopia of ideas in the new Rapid Pitch format in which multiple participants deliver their arguments in very short papers, leaving time for the audience to have a discussion knitting the ideas together.

Several afternoon paper panels also took place including one by members of the RinGs working group from Ghana and Rachel Tolhurst, who spoke about her work in India with the ASHA program, India’s community health worker (CHW) program. When discussing approaches to gender and health care systems, Tolhurst stressed that “Intersectionality… is critical in not creating a hierarchy of suffering.” Other panelists involved with RinGs, which looks at how gender plays a role in research into health systems, included Sarah Ssaali, Senior Lecturer in the School of Women and Gender Studies at Makerere University in Kampala, Uganda. Ssaali asked, what if the health system you create endangers those you intend to serve?  She discussed how difficult it can be to convince people that systems appearing to be gender neutral are in fact not gender neutral at all, noting that men–who are the majority of policy makers in Uganda as in European and North American nations–can become defensive when one makes gendered power analyses of health systems. Ssaali also discussed other aspects of research in her nation, including attempting to interview female participants who needed the permission of their custodial male relative in order to participate, and older women who cannot bear to discuss reproductive health matters with young male researchers.  While feminist values might lead us to judge male custodial permission for adult females perfectly capable of making their own decisions to be oppressive, Ssaali points out that disrupting this patriarchal hierarchy can leave a household in disarray and put women at risk. And yet going along with these traditional social structures seems to validate them.  “We try to be culturally sensitive to not harm participants, but this is at the risk of entrenching patriarchy,” said Ssaali.

Ssaali’s colleague David Musoke also prevented his research on gendered division of labor within community health workers in Uganda, as determined by analysis of photos of their work that 10 workers (5 male and 5 female) took over a 5 month period. It revealed that even though the CHWs had similar job descriptions, women tended to do more childcare, were seen as or thought of as being more available in the community, and were far more likely to support female patients regarding reproductive health. By contrast, males were able to cover large areas during community mobilization due to their ability to drive motor vehicles in ways that women were generally not trained in or allowed to do. This also enabled them to serve as a motorcycle ambulance service.  Male CHWs were also much more likely to be involved in manual activities related to maintaining safe water and so forth. Thus, gender affected the actual performance of ostensibly gender neutral CHW duties. Musoke notes that those hoping to do research in these communities and use CHWs as intermediaries should be aware of the ways that gender affects their work.

These are just a few of the excellent papers delivered on the first day of FAB.  I very much look forward to the second and third!

If you are not able to attend FAB Congress, or are just not able to attend all sessions simultaneously due to being merely human, you can follow a lot of us (including myself: @AlisonReiheld) who are live tweeting the conference at #FAB2016.  Just go to twitter.com and search for the hashtag, or go here.

And now, from Edinburgh, where it remains this light until well after 10 pm, good night!

castle at 10 pm

Edinburgh Castle from Castle Terrace at 10 pm, June 13, 2016.

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