Obesity: Two Articles

First, from Scientific American: Turning the tables on obesity and BMI: When more can be better.

“While obese and unhealthy people suffer from the highest mortality, people with normal BMI can also be quite unhealthy and be near the upper or mid range of the mortality scale. Conversely, an obese person can be metabolically healthy”

F1.large_Second: You Are Your Bacteria: How the Gut Microbiome Influences Health

“Scientists suspect that the make-up of the inhabitants of our guts might help explain why some people develop metabolic disorders and others do not, and why some people put on weight while others stay thin.”

 

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Urban Pakistani Women Can Dial-a-Doc

“A telehealth service gives free medical advice to women lacking healthcare access in the country’s biggest city.”

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Ethical Considerations in Reporting Back Biomonitoring Results

Biomonitoring is a technique for assessing exposures to chemical substances in the body through testing blood, urine, semen, amniotic fluid, breast milk, saliva, hair, and fingernails and other human tissues. Examples of chemicals that can be tested for include lead, pesticides, Bisphenol A, phthalates, and PBDEs (flame retardants).

Biomonitoring is becoming more popular and increasingly sophisticated, raising significant ethical concerns. Guidelines across different Research Ethics Boards lack consistency. As well, there is often no reference range of safe levels of exposure for many of the chemicals tested, making it difficult to interpret results. Biomonitoring can accurately assess exposure but cannot predict an individual’s likelihood of becoming ill, which is usually what study participants are most interested in knowing. When the risks of chemical exposures are unknown should researchers inform participants of their individual results?

Under the traditional clinical model of biomonitoring, researchers only communicate individual results if exposure levels are deemed significantly high or if there is a clear link between exposure level and health outcome, such as in the case of lead. Results can usually only be individually communicated by physicians, who are able to explain health risks.

However, the clinical model has significant limitations. Investigators become gatekeepers of individual information. Individuals are treated as mere sources of scientific data with no claim to share in the study’s results. As well, it does not allow individuals to carry out precautionary action if they turn out to have high chemical body burdens.

Study participants are in many cases starting to demand to receive their individual results, despite the lack of knowledge about individual health effects due to exposures. Research has shown that most individuals find disclosure of test results beneficial, regardless of the actual result or accompanying psychic distress. As well, negative effects of reporting back can be mitigated through appropriate protocols and communication techniques.

Alternative models of reporting back allow individuals more control over their results. Newer biomonitoring studies that report back individual results as part of community-researcher partnerships emphasize participants’ right to know and right to act, and fuel activism and policy changes.

Under the emerging model of community-based participatory research (CBPR), reporting back individual and aggregate study results can empower individuals and communities to act on scientific research. CBPR encourages as much dissemination of information as possible and asserts that the collected data belongs primarily to the study participants. An example of this model is the First Nations Biomonitoring Initiative, which will provide a baseline of chemical body burdens on First Nations reserves in Canada, with control over all resulting data retained by the participating communities.

As well, some activist groups are carrying out biomonitoring research with the explicit goal of improving chemical regulation and policy. This “citizen science” aims to raise awareness of the risks of chemical exposures and engage individuals in collective action. Citizen science is advocacy driven and treats all exposures as significant. For example, Sharyle Patton, from the environmental advocacy group Commonweal, found that migrant farm workers in California developed a strong activist community as a result of participating in biomonitoring research.

Despite the limitations of biomonitoring there are compelling reasons to report back biomonitoring results. Providing individual results can lead to increased awareness of everyday exposures to toxic chemicals. As well, there is potential for increased political engagement as a consequence of learning about chemical body burdens. Receiving biomonitoring results can therefore be an important tool in campaigns to improve regulation of toxic chemicals.

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Embryo Sex Selection Shouldn’t Be Illegal

This commentary was initially posted on August 16, 2013 on the Impact Ethics blog and is reposted here with permission of the authors. Visit impactethics.ca

Stephen Wilkinson and Eve Garrard respond to Alana Cattapan’s blog post calling for the continuing prohibition on embryo sex selection.

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Alana Cattapan raises many important questions about our objections to the current legal prohibition on embryo sex selection within IVF (not sex-selective abortion), in the UK and other relevantly similar countries. We are grateful for this opportunity to comment.

Law and Morality: Our report, Eugenics and the Ethics of Selective reproduction, isn’t about the ethics of IVF sex selection per se, but about the defensibility of a legal prohibition on IVF sex selection.  We hold that, while some instances of sex selection are morally problematic, the case in favour of a ban is insufficiently strong.  Using the powers of the state to impose legal restrictions on people’s reproductive behaviour is a serious, and potentially dangerous, business and something to be done cautiously and only for compelling reasons.  Sometimes there are such reasons – we don’t support an entirely laissez-faire position – but, in the case of sex selection, a conclusive case hasn’t been made.  We don’t claim that sex selection is desirable, or even that most cases of it are morally acceptable.  Our conclusion is just that the case for legal prohibition is insufficiently strong to overturn the presumption of reproductive freedom.

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Choosing Surrogacy and Remaining Child-Free: Reflections on Two Recent Stories about Reproductive Choice

Last week, late night talk show host Jimmy Fallon announced the birth of his daughter, Winnie, via a surrogate. Fallon reports struggling with infertility as a couple for 5 years, and is (understandably) over the moon for his daughter: “…if there’s anyone out there who is trying and they’re just losing hope … just hang in there,” Fallon said. “It’s all worth it.”

Source: Splash News

Source: Splash News

The other major story about parenting is Lauren Sandler’s cover story in the August 12 issue of TIME magazine about the increasing number of couples who have chosen not to become parents – or, in the words of one woman quoted in the story, to remain “child free.” Sandler cites a 2010 Pew research study that notes that the rate of women who have never had a child has risen to 1 in 5, up from 1 in 10 in 1970.

Photo-Illustration by Randal Ford For TIME

Photo-Illustration by Randal Ford For TIME

Both of these stories should be lauded for bringing issues of reproduction and choice to the national conversation. Despite the frequency of infertility, many couples, and women in particular, feel alone in their struggle, and Fallon’s public disclosure about their difficulties may offer solidarity with and for these women. And by offering a cover story on women who have chosen not to raise children, Sandler’s story validates an often neglected topic.

Yet in both cases, important details are omitted. News commentators have acknowledged that surrogacy is a “complicated” process, but “complicated” hardly scratches the surface of the issue. Laws regarding surrogacy contracts vary from state to state, ranging from barring the practice entirely to endorsing it via state statute (and everything in between). Importantly, there are significant ethical questions raised about the practice of surrogacy: some argue that contract pregnancy exploits women by commodifying the act of gestation — paying someone to carry a baby to term (Krimmel, H T. “The case against surrogate parenting.” The Hastings Center report 13.5 (1983):35-39.). Others have argued that these arrangements in fact empower women by recognizing the “socially useful enterprise” that is gestation (Purdy, Laura M. “Surrogate mothering: exploitation or empowerment?.” Bioethics 3.1 (1989):18-34.). Additionally, as with many assisted reproductive technologies, surrogacy is only available to those who have the social and economic means to enter into such arrangements, and as a result this method of childbearing is limited to the “haves” among us.

Fallon’s public jubilation about his daughter is considered natural and appropriate; whereas the option to remain child free in a decidedly pronatalist culture still remains a curiosity. 38% of the people surveyed in a 2009 Pew Research Center poll thought that the increasing number of women choosing not to have children was “bad for society,” and although the most educated women surveyed were those least likely to have a child, the proportion of those with advanced and professional degrees remaining childless dropped from 31% in 1994 to 24% in 2008. And once those women become mothers, traditional gender roles still remain prevalent in the American psyche: a 2011 survey revealed that only 16% of respondents thought it was ideal for a young child to have a mother (note – not parent) who works full time, with 42% agreeing that a mother who works part-time would be perfect. Interestingly, one of the criticisms of Sandler’s article was that men were largely absent from the story, not in terms of procreative partners but rather as social commentators. As Amanda Marcott commented, until men also see themselves as complete beings without having to be a father, we won’t know whether or not gender roles are truly liberated from tradition. It is this liberation from tradition that will enable us to celebrate any reproductive choice, from surrogacy to remaining child-free, as one that is authentic and enduring.

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Rethinking Sex Selection: A Feminist Critique

This commentary was initially posted on August 13, 2013 on the Impact Ethics blog and is reposted here with permission of the author. Visit impactethics.ca

Alana Cattapan argues the harm done to women through sex selection is sufficient reason to continue the prohibition.

In a recent report on “Eugenics and the Ethics of Selective Reproduction,” published in July 2013, Stephen Wilkinson and Eve Garrard step into much-contested terrain, challenging orthodoxies of pre-implantation genetic diagnosis (PGD). In their essay on sex selection—which caught the attention of media outlets throughout the United Kingdom (herehere & here) —the authors argue that there is no ethical justification for the UK prohibition on sex selection using PGD.

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Artificial Meat

Peter Singer writes about “the world’s first cruelty-free hamburger.”

Samples of in vitro meat, grown in a laboratory at the University of Maastricht Photograph: Francois Lenoir / Reuters/REUTERS

Samples of in vitro meat, grown in a laboratory at the University of Maastricht Photograph: Francois Lenoir / Reuters/REUTERS

Here is a bit more background about the science from the New York Times.

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Just Because It’s Monday: Two Stories That Will Not Make Your Day

If you are looking to be inspired or uplifted by today’s post….Well, let’s just say these two stories might not be what you are seeking.  Instead of offering an analysis, I will just say this:

With respect to the twenty-six cent fiasco:  While this might be explained away as an “administrative error”, or a “policy decision,” or whatever other kind of excuse-making by the medical insurers (and their political supporters) in the United States, it nevertheless stands as nothing less than a  crime perpetrated  in slow motion, in bright daylight, on paper.  And as a nation that bears witness to it, and millions of other death-by-insurance disasters, Americans  are out of excuses.  The politicians currently threatening to shut down the government rather than allow the Affordable Care Act (ACA) to be fully enacted have only the bogey-man of creeping socialism and “death panels” to peddle — and their audiences ought not be buying.  For those who are not yet certain which way to lean, it is long past time to choose sides.  I must turn to Hannah Arendt yet again, who reminds us that “[t]he sad truth is that most evil is done by people who never make up their minds to be good or evil.”

With respect to Russian anti-gay hysteria:  I am not sure what to say here that is not obvious, or that has not already been said by others.  As a native of Russia, I am distressed, embarrassed, horrified — but not surprised.  The lack of democratic history, the general puritanical leanings of the inheritors of several generations of Soviet sexual, social, and political rigidity, combined with a decided rightward drift of the increasingly totalitarian government make for a nation that wears its hatreds on its sleeve.  The fact that it is members of LGBT communities who are on the receiving end of official Two Minutes Hate, or, really at this point Hate Week, is exactly what it appears to be:  a deliberate and paranoid grasping of a sociopolitically floundering nation for what it knows best — official national villains and moral aliens, ready-made to “other” and expel.  What makes the Dmitri Kisilev story particularly repulsive and frightening, however, is his unambiguous essentializing of certain kinds of human beings as physiologically, fundamentally defective:  not just their sexual preferences and behaviors, but their very bodies themselves.  This Deputy General Director of the Russian State Television and Radio Broadcasting Company (RTR)  (since 2008) has said that “I think that just imposing fines on gays for homosexual propaganda among teenagers is not enough.”  [Gay people]  “should be banned from donating blood, sperm….their hearts, in case of the automobile accident, should be buried in the ground or burned as unsuitable for the continuation of life.”  Gay people, Kisilev thus insists, ought to be effectively excluded from not just the rights of citizenship, but from the shared physical and moral universe of human beings.  Their very organs, their blood, are not fit for human use.  And he says this openly, on “Vesti,” which is one of Russia’s most popular news shows.  And gets applause.

What is happening politically in Russia right now is a general disaster in the making.  What is happening to the Russian LGBT communities right now is a specific, growing, and imminent catastrophe that requires immediate and decisive response from the world community.  And from the community of bioethicists, broadly construed.  So, fellow bioethicists:  Thoughts?  Ideas?  Comments?  Please share.  We have seen this before.  We probably do not have much time.

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Zero-Sum Game? A Consideration Of Dependency Workers and Dependent Persons

Image: Carol Simpson
Image Credit: Carol Simpson

Recently, Craig Klugman wrote a thought-provoking blog entry over at bioethics.net on long-term care options for elderly persons.  While humane ones do exist that are designed for human flourishing, such as a new chain of purpose-designed communities where elderly folks have access to developing new skills in the visual and performing arts, these are often very expensive.

More often, facilities which provide in-patient nursing care still significantly “warehouse” their residents, providing medical care but treating the elderly as people waiting for death rather than persons who can still grow and learn and contribute. National Public Radio has an ongoing investigative news series called “Home or Nursing Home: America’s Empty Promise to Give the Elderly and Disabled A Choice.” In that series, NPR reporters chronicle many of the same kinds of difficulties Klugman discusses in his blog entry.  Long-term care facilities have notoriously high staff turnover rates, in part due to difficult working conditions but also due to low pay.  In-home careworkers are similarly poorly paid. 90% of these direct care workers are women, and earn an average of approximately $17,000/year. This is due in part to the fact that the federal law governing wage and overtime protections, the Fair Labor Standards Act (FLSA), explicitly does not cover home care workers. Even facility-based care workers receive very little pay.

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More on the Burka Avenger

Pakistani orphans watch an early screening of the first episode of the animate Burka Avenger Series, at an orphanage on the outskirts of Islamabad, Pakistan on March 25, 2013. (Muhammed Muheisen/AP)

Pakistani orphans watch an early screening of the first episode of the animate Burka Avenger Series, at an orphanage on the outskirts of Islamabad, Pakistan on March 25, 2013. (Muhammed Muheisen/AP)

The Ridiculous Burka Avenger Backlash
“Faiza S. Khan on why we should be praising the Pakistani cartoon superhero, not criticizing her clothing choices.”

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Suboptimal Breast-Feeding

In his July 11, 2014 Op-Ed piece in the New York Times, Nicholas Kristoff quotes The Lancet’s most recent nutritional survey as indicating that 804,000 children die annually from “suboptimal breast-feeding,” more than the WHO’s estimate of deaths from malaria.  Kristoff recounts taking a dying infant and its “teenage” mother to a hospital in Mopti, Mali.  After the doctor “repositioned [the mother’s] arm” and “helped the infant to latch on to her breast,” Kristoff reports, the “baby came alive.” The doctor, Amidou Traoré, states, “The mother doesn’t know how to breast-feed properly . . . We see lots of cases of child mortality like this.”  Later, Kristoff asks Shawn Baker, a public health expert, where he would invest a billion dollars if he had it. Baker replies, “To me, the next big win in saving kids’ lives is breast-feeding promotion. It’s absolutely unacceptable that more than 800,00 kids are dying annually of suboptimal breast-feeding.”

Image credit: New York Times

Image credit: Ben Solomon New York Times

As Kristoff notes, “predatory marketing by formula manufacturers” may be partly to blame, but the research he quotes suggests more intimate trauma. Even a young unprepared girl can figure out how to put her baby to her breast without the tutelage of a doctor and the World Health Organization. Women in Mali and elsewhere fed their babies long before the intervention of modern medicine.  Where are the mothers and midwives who would pass on their knowledge? Why does so young and unprepared a girl have this infant? Where is her village? Why is she all alone and dependent on the random kindness of a traveling Westerner? If this research and testimony is reliable, what physical and social traumas have caused this alienation from maternal practices and why aren’t these men focused on that violence, rather than reducing the problem to the absurd idea that a woman can’t figure out how to hold her baby without a man’s help?

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“Surrogacy” and Parental Licensing

Christine Overall insists that the well-being of children born of “surrogacy” arrangements should be of paramount importance and, most certainly, should take precedence over the wants of prospective parents. This commentary was initially posted on July 18, 2013 on the Impact Ethics blog and is reposted here with permission of the author. Visit impactethics.ca

“Surrogacy” is not illegal in Canada; paying or offering payment to a “surrogate” mother is. According to Section 6 (1) of the Assisted Human Reproduction Act (AHCR Act), “No person shall pay consideration to a female person to be a surrogate mother, offer to pay such consideration or advertise that it will be paid.” This prohibition notwithstanding, the plan is to permit reimbursement for legitimate (receipted) expenses. Section 12 (1) of the AHR Act stipulates, “No person shall, except in accordance with the regulations, … (c) reimburse a surrogate mother for an expenditure incurred by her in relation to her surrogacy.” As the relevant regulations have not been crafted, this exception to the legal prohibition is not yet in force. Meanwhile, there are many media reports of cases of paid and altruistic “surrogacy” in Canada (click here for more information).

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