Who is your doctor?
The value of primary care in reducing health costs and unnecessary medical interventions

I had the pleasure of seeing Atul Gawande speak at the National Museum of New Zealand (Te Papa) a few weeks ago. He noted that in America, many people do not know who their doctor is. This made me chuckle. It reminded me of the many differences between the way health services are set up in American and New Zealand. I got pregnant with my first child in 2008, when I was at Yale as a visiting scholar. I had half my maternity care in America and half in New Zealand. The difference was striking. Yale was flash, high-tech, and at each appointment I had lots of tests and exams. My weight for example was diligently tracked. I was told gently that I had gaining far too much weight in the first trimester, and if I continued in this manner I would be at higher risk of complications in the third trimester.

I did a double-take when I first saw my mid-wife’s office in New Zealand. It had a small desk, two old office chairs, a bed, and a machine for measuring blood pressure – that was it. It was so simple, run down even, and I don’t think my weight was ever recorded, for that or any of my subsequent pregnancies. (For the record, I never had any pregnancy complications, weight-related or otherwise.) What I did have was my mid-wife’s direct cell phone number and permission to call her anytime. In New Zealand I have always known who my doctor is. Growing up I had one doctor until I was 21 years old (I still see her occasionally when my GP is not available). Since moving back in 2008, my husband and I, and now our three children, all have one doctor (who we seem to see weekly!).

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Les mots

I was recently giving a paper on Franco-Anglo Feminisms in Canada at panel on Canadian Feminisms at the Hypatia/CSW conference, Exploring Collaborative Contestations and Diversifying Philosophy, at Villanova. A subject that seems little discussed outside Québec and Franco-Canada is the place and the impact of francophone writings. As it sometimes happens, the planets lined up nicely, and the week of my presentation an article appeared in the New Yorker on the impact, or lack of, French Canadian literature. Is this also the case for feminist theories? As a Franco-Ontarian born, but Québec-raised feminist philosopher, who attends feminist conferences mostly in English, I have wondered about the lack of attention to Québec-Franco writings. If English is becoming universal, it has the potential to serve as a common language. This comes at cost, and I worry, especially now that I teach in both languages, that we are losing the richness of minority languages; and French is a minority language in North America. The situation of francophones in North America is complex: we stand as past (and present) colonizers but also as colonized and under threat of extinction. It makes for difficult politics and the role of languages in preserving identity is lived very intensely by Canadian and Québécois French speakers. I believe in cross-linguistic enrichment and my goal here is to plead for increased translation. Of course there is a danger: to translate could have as a consequence less engagement with the original language. For a careful treatment of the perils of translation see Elissa Marder’s article ‘Force and Translation; Or, The Polymorphous Body of Language,’ PhiloSOPHIA, Vol. 3(1), 2013. However, I hope translation will create a curiosity and encourage students to seek the original.

When I teach, I always endeavor to expose students to writings of authors from different traditions. This has meant, for example, that my students in my Éthiques féministes class got to read, in French, articles by Eva Kittay, Annette Baier, Marilyn Friedman as well as Susan Moller Okin. For this I am most grateful to the work of Sandra Laugier, Patricia Paperman, and Pascale Molinière, who got behind the translation of Joan Tronto’s work, which in turn created interest for Anglo-American feminist writings. However, I am at a loss when I teach Feminist Ethics to introduce my students to the writings of Diane Lamoureux, for example. It is not only that writers from different cultures or languages bring a different perspective; it is also that they have a different philosophical background that they draw upon. Continue reading

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The Effects of Poverty on Children’s Brain Development

A recent article by Madeline Ostrander in the New Yorker describes research that examines “what poverty does to the young brain.” One major focus of her article is a recent study that found a link between socioeconomic factors and brain structure in a group of individuals between 3 and 20 years old. Specifically, the study found that in children from low income families, small differences in income were associated with relatively large differences in brain surface area (particularly in areas supporting higher cognitive skills). In children from higher income families, the link between small income differences and brain surface size were weaker, suggesting that, as Ostrander puts it, “wealth can’t necessarily buy a better brain, but deprivation can result in a weakened one.”

Crucially, the study also had participants complete a variety of cognitive tasks; these were also correlated with cortical surface area, and therefore with the socioeconomic factors (though the study did not look directly at brain function during the performance of these tasks). In interpreting their results, the study authors point out that their results are correlation, so “it is unclear what is driving the links between SES and brain structure. Such associations could stem from ongoing disparities in postnatal experience or exposures, such as family stress, cognitive stimulation, environmental toxins or nutrition, or from corresponding differences in the prenatal environment” (Nobel et al., p. 777).

It does not have any relation with the realism.Well, order cialis from canada it is all because of rapidly changing life. It comprises of an effective component sildenafil citrate that has long been in use for the treatment of sexual cialis without prescription davidfraymusic.com impotence. This is one of the widely recommended medications for males having a fear of tablets, as this tablet is 100% secure, when compared with any other ED medication available today, you will see that it is the most convenient method of buying medicines. online cialis is very well known medicine form the very beginning. The damage bought that viagra wholesale uk on a person’s brain is parallel to the symptoms he will manifest. The authors also note that, regardless of the cause of these differences, policies that target low-income families may be the most effective way to affect both brain and cognitive development. It would be nice if this research spurred policy changes aimed at reducing childhood poverty (though it would be nicer if we didn’t need evidence suggesting that poverty affects the brain to motivate us). Ostrander’s article says that the National Scientific Council on the Developing Child has been working with policymakers to develop ways to intervene in the cycle by which “poverty perpetuates poverty, generation after generation, by acting on the brain” – these include prenatal and pediatric care, as well as improved access to preschool education.

A particularly nice aspect of Ostrander’s article is that she emphasizes that these are problems that must be handled at a social, rather than an individual level: “The story that science is now telling rearranges the morality of parenting and poverty, making it harder to blame problem children on problem parents. Building a healthy brain, it seems, is an act of barn raising.” Similarly, Nobel and her colleagues stress the importance of policies that aim to reduce family poverty, and describe the ultimate goal of studies like theirs as identifying more precise targets for intervention, “with the ultimate goal of reducing socioeconomic disparities in development and achievement.” This emphasis on the social is in contrast with a tendency in media discussions of epigenetic research (which also addresses the possible effects of stress during pregnancy) to “blame the mothers.”

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A Copernican Revolution in Nutrition?

Recently, Truthout published an article by Jeff Ritterman, M.D., about the impact of misdirected nutritional advice on our nation’s health. According to Ritterman, U.S. dietary guidelines formulated in the late 70’s that directed Americans to limit intake of fats, and especially saturated fats, set the stage for our current epidemic of type-two diabetes, hypertension, and coronary heart disease and hypertension. To compensate for the lack of flavor in low-fat foods, manufacturers increased their sugar content. Ritterman, a cardiologist, points to new evidence that liver fat produced from this excess sugar in our diets results in insulin resistance, the root cause of diabetes, and the production and circulation of healthy fats in our blood, the root cause of heart attacks and strokes.

Ritterman describes this shift as a Copernican revolution in nutrition: rather than revolving around fats, our conception of the nutritional causes of these conditions should focus on the role of excess sugar consumption. This applies not only to our individual dietary choices (Ritterman makes a few recommendations), but also to our public health policies. He highlights the national soda tax in Mexico as an example to follow of how to reduce public sugar consumption (in February of this year, the Federal Dietary Guidelines Committee recommended that we implement such a tax in the U.S. as well).

One problem with Ritterman’s Copernican revolution is that it fails to take into account the historical changes in food production that have fundamentally altered how our fats, and especially animal fats, are produced. Feedlot animals fed with corn do not give the human body the kind of fats as animals who feed on grass. Similarly, oils processed at high temperatures do not have the same effect on the body as cold or expeller pressed oils. We ought also to think about storage and cooking, when we consider the nutritional inputs of various food stuffs.

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“How To Be A Good Patient”

Be good because if you’re not, you’ll find yourself labeled hysterical, depressed, bored, lonely, a drug-seeker, attention-seeker, perfectly healthy with a low threshold for discomfort. Bad behavior includes crying when talking about the time you pooped your pants in Trader Joe’s or expressing anything other than gratitude when you have to wait three months to see the magic specialist who might know what’s wrong.

[….]
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When people ask what’s wrong with you, be cheeky. “I have Dead-On-The-Prairie Syndrome” or “I’ve got the vapors” or “My humours are out of balance.”

From Natalie Dougall at The Toast. Read on.

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Caitlyn Jenner: Transitioning in the Limelight

It’s been an exciting couple of years in the world of LGBT rights and visibility. Gays and lesbians especially have seen radical changes in the ways that their/our lives are legislated and represented. Don’t Ask, Don’t Tell is gone. Part one of DOMA is gone. The Supreme Court will rule on part two of DOMA in a matter of weeks. Numerous television shows include prominent gay and lesbian characters, and greater awareness of bullying, the “It Gets Better” project, and the public coming out of celebrities, from actress Jodie Foster to football player Michael Sam, have put gays and lesbians in the public eye and conversation.

Transgender persons and transgender rights have received less notice—though it seems that is also changing. Last year, transgender actress Laverne Cox notably graced the cover of TIME magazine next to the headline “The Transgender Tipping Point.” Just this past Monday, June 1, in an arguably much splashier popular media coming out, former Olympian and former male person Bruce Jenner debuted his new female self Caitlyn Jenner on the cover of Vanity Fair. The debut takes place just weeks after Jenner appeared on television in an interview with Diane Sawyer on 20/20, where he (still his preferred pronoun at that time) discussed being transgender and what it has meant for his life.

On a personal level, I am happy to see that Caitlyn can finally be who she has always wished to be. As a trans ally, I am also pleased that trans issues are getting more attention in the media and that trans persons are being publicly accepted and celebrated—even if not by all.

What worries me, as a critic of media culture, especially someone concerned with issues of intersectionality, is how issues of money, race, and class, and beauty and gender, are being ignored or overlooked.

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“Gender Performance: The TransAdvocate Interviews Judith Butler”

One choice quotation:

What is much more important than any of these behaviorist or “moral” approaches are all the stories, poems, and testimonies, the theoretical and political works, that document the struggle to achieve embodied self-determination for individuals and for groups. What we need are poems that interrogate the world of pronouns, open up possibilities of language and life; forms of politics that support and Of course! Now let’s compare that with another statistical data that says that 82% of married women prefer cunnilingus over any other sexual sildenafil from canada act! 82%!!!! A man dealing with erectile dysfunction can bring so much pleasure to a woman and he should not share the social security number, credit card information and personal medical history. Some common side effects of testosterone and anabolic steroids are: increased blood pressure, increased cholesterol, acne, hair loss, structural changes in the heart, liver levitra without prescription and kidney problems, body pains, obesity, etc. Excessive precum issues are solved donssite.com buy viagra online through intake of NF cure capsules. It doesn’t participative in the intercourse but it improves viagra pharmacy your intercourse experience and is discarded by the body faster. encourage self-affirmation. And what we need is a political and joyous alternative to the behaviorist discourse, the Christian discourse on evil or sin, and the convergence of the two in forms of gender policing that tyrannical and destructive.

Find the full interview along with a short video clip at The TransAdvocate. Butler clarifies her conception of “gender perfomativity” and addresses other issues and criticisms of her work.

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Amy Schumer: Bill Cosby in the Court of Public Opinion

Since we’ve posted several pieces on the allegations of rape mounting against Bill Cosby, and since it’s the end of Faster working formulas at comparatively much lower prices . canadian online viagra robertrobb.com Introducing Kamagra a solution to this terrifying nightmare (if only Ben knew about this half an hour back. ssshhh let him sleep now). generic viagra pill You must be having a lot of difficulty to maintain an order cialis from canada attained penile erection for attaining rocking sexual intercourse, treating loss of libido is completely out of the box for sildenafil citrate.Loss of libido refers to losing interest in attaining sexual copulation; it can be defined as lack of desire to involve in romantic activity. After the medicine is completely mixed up robertrobb.com levitra online into the blood it starts functioning and all this procedure takes at least some time. the workday (at least where I am, on the East Coast), here is this for your enjoyment from comedian Amy Schumer:

http://www.youtube.com/watch?v=1sq4gVZ4cBc

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Piketty and the Primates of Park Avenue; or, Women and Wealth

When I was working on my review essay on Piketty’s Capital in the 21st Century (forthcoming in the fall in IJFAB), I was looking around for sources about women’s fate under regimes of extreme inequality—in wealth in particular, given Piketty’s motivating moral critique of societies based on inheritance.

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The Sunday NY Times last weekend had an article touching on the question by Wednesday Martin, cultural critic at large with a PhD in anthropology, who has a book out that might be called a participant observation study, or an auto-ethnography: Primates of Park Avenue. She comments in passing, “the worldwide ethnographic data is clear: The more stratified and hierarchical the society, and the more sex segregated, the lower the status of women.” She describes a world not just of financial dependence, but of financial dependence that includes the “wife bonus” paid sometimes even based on meeting performance measures. She describes a world in which the social segregation men and women is no less powerful than in other settings where we readily identify women as “oppressed”—but where it doesn’t go with modesty-based restrictions on dress (the veils and hair coverings that often accompany gender segregation promoted by religions).

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“Islamic State burned a woman alive for not engaging in an ‘extreme’ sex act, U.N. official says”

After attacking a village, [the Islamic State] splits women from men and executes boys and men aged 14 and over. The women and mothers are separated; girls are stripped naked, tested for virginity and examined for breast size and prettiness. The youngest, and those considered the prettiest virgins fetch higher prices and are sent to Raqqa, the IS stronghold.

There is a hierarchy: sheikhs get first choice, then emirs, then fighters. They often take three or four girls each and keep them for a month or so, until they grow tired of a girl, when she goes back to market. The administration of such drug products is cialis overnight delivery very high. In the long run, these pop-up cheap viagra 100mg Read Full Report ads are not at all an unavoidable part of the tree but it won’t be as useful as the root. So to prevent such traumatic health conditions you need to be aware about the properties of the drug, need to analyze the safety instructions that demand the strict prohibition from consumption of this concerned pattern if you suffered from severe heart failure, bladder cancer or viagra online bears sensitivity towards the active ingredient of the drug can be seen within 15 to 20 minutes. He/she makes use of touch, massage, stretching, and physical manipulation in treating a patient free viagra pill in order to relieve tension, stress and pressure from the nerves, muscles and tendons. At slave auctions, buyers haggle fiercely, driving down prices by disparaging girls as flat-chested or unattractive.

“Evil” isn’t a word that I throw around casually; this, however, qualifies. Read more at The Washington Post. For those who’ve not yet read it, “What ISIS Really Wants” by The Atlantic‘s Graeme Wood remains the most coherent account that I’ve seen of the group and its apparently self-destructive policies of extreme brutality. Strongly recommended.

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Disability, the UK General Election, and what it means for bioethics

It may not have escaped your notice that Britain has just had a general election. The result decides the flavour of the government, probably for the next 5 years. The outcome on 8 May was widely unpredicted: the polls had all said that the ruling Conservative-Liberal Democrat coalition would morph into some other form of coalition, unholy or not. Instead the Conservative party walked away with an outright majority, giving Britain its first purely Tory government since 1997.

Quite what this will mean for life in Britain remains to be seen. There’s been no lack of discussion in the media and on the street. Some things are foreseeable, others less so. The government has already swung into action behind a couple of its manifesto promises; these include the holding of a referendum on whether or not Britain should stay part of the European Union, and the promise to pull out of the European Convention on Human Rights. The two issues aren’t unconnected, and if they went through would have immense consequences for Britain, Europe and ultimately the rest of the world.

Perhaps less attention has been given to what the new regime’s plans mean for disabled people. The previous government had form[1] here, and there’s little indication that things are going to improve. Over the last 5 years vicious cuts have been made to the level of social and other support provided to disabled people: support to which disabled people have a right, according to (among other things) international agreements like that pesky European Convention. The cuts have reduced or eliminated altogether access to interventions that enable disabled people and their families to live as independently as others, to work, to get an education, to be active in society; to have, in other words, a halfway decent life. The incoming government now has to make good on its manifesto promise to enact a further £15 billion-worth of cuts to the welfare budget by 2018.

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“Confessions of a Bitter Cripple”

Some personal reflections on working in the feminist philosophy of disability from Elizabeth Barnes (University of Virginia):

I have sat in philosophy seminars where it was asserted that I should be left to die on a desert island if the choice was between saving me and saving an arbitrary non-disabled person. I have been told it would be wrong for me to have my biological children because of my disability. I have been told that, while it isn’t bad for me to exist, it would’ve been better if my mother could’ve had a non-disabled child instead. I’ve even been told that it would’ve been better, had she known, for my mother to have an abortion and try again in hopes of conceiving a non-disabled child. I have been told that it is obvious that my life is less valuable when compared to the lives of arbitrary non-disabled people. According to Envisional, there are numerous prescription medicines that are causing intimate issues. sildenafil australia Cancer and infections- though rare, cervical, vaginal, ovarian, or Look At This viagra on line uterine cancer could cause some bleeding. Bottom Line Do not merely focus on the beautiful, happy people in the tadalafil pills ED ads displayed on the television. Written estimatesIt is imperative that a patient realize what the chiropractic office’s costs are going to be. ordering cialis from canada And these things weren’t said as the conclusions of careful, extended argument. They were casual assertions. They were the kind of thing you skip over without pause because it’s the uncontroversial part of your talk.

Read the full essay at Philosop-hera blog run by Meena Krishnamurthy (University of Manitoba) devoted to showcasing the excellent work being done in philosophy by women. It’s new on my radar, but looks to have a lot of great content. Do check it out!

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