IJFAB Blog

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. Apart from these, men who are taking medicines for blood pressure drugs, antihistamines, antidepressants, and tranquilizers. generic cialis opacc.cv Sometimes everything 5mg cialis online would be fine and other times I would find it incredibly difficult to get or maintain an erection. It is important for individuals levitra online australia to know about these drugs to ensure safety in your health. You can even ask your doctor for alternative options if you are buy levitra no prescription not able to afford oral medicines. Barbe, M.D. “We applaud the states that have already eliminated sales taxes on these products, and we urge every state to follow suit.”

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 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.

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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!

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

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).

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.

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.
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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?”

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.

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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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.

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