World No Tobacco Day

Today is the World Health Organization’s World No Tobacco Day

WHO World No Tobacco Day

I’m not entirely comfortable with the WHO’s approach, though I agree with the goal.  Another poster asks, “Are you being manipulated?” which could suggest tobacco users are gullible, weak-willed followers.  It’s standard to refer to tobacco use as an epidemic and that has been the case for decades, but I struggle with drawing a line between what is and what is not an epidemic.  And, I’m skeptical about the lure to imitate movie smokers nowadays, but that could be an ethnocentric view: I grew up in a culture where the damage caused by smoking was well-known and taught to us at an early age — making movie smoking nothing more than character development — and at a time when TV and radio ads were banned.  It was a long way from 1950:

1950-cigarettes-that-soothe-your-throat

On a related note, this seems like the perfect opportunity to link to Quit Tobacco International, a project focused on tobacco use in India and Indonesia and founded by, among others, anthropologists Mark and Mimi Nichter.  From the site:

Over the next two decades, deaths due to tobacco will soar to 4.2 million annually in Asian countries, nearly twice that of more developed regions. The wealth of research knowledge and lessons learned about tobacco cessation from high income countries cannot be simply transferred into low and middle income countries (LMICs) given the vast differences in cultural norms, tobacco products and use patterns and health care and public health systems.

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Cosmetic surgery and ethnicity

The Atlantic has featured a couple of good articles about this topic recently,  so I put together a roundup of related pieces:

The K-Pop Plastic Surgery Obsession from The Atlantic (24 May 2013).  This thorough article includes some quotes from anthropologist Eugenia Kaw and a reference to her work Medicalization of Racial Features: Asian American Woman and Cosmetic Surgery.  From the article: “Dr. Kang’s philosophy is about helping nature along. ‘I always try to copy the natural look, give face the ideal shape it should have been born with,’ he said.”

SBS Dateline (Australia) had a segment on the K-pop cosmetic surgery phenomenon a couple of months ago:

This Reddit thread about the 2013 Miss Korea contestants is interesting as some comments come from people living in Korea, trying to give a perspective from inside the culture.  They also reference this story from China in which a man sued his beautiful wife for marrying him under false pretenses, after she gave birth to a less-than-lovely child and then revealed she had had about $100K worth of surgery before meeting him (sounds like an urban legend to me).

Looking beyond Korea, in 2011 the New York Times published the article Ethnic Differences Emerge in Plastic Surgery. It’s not an academic or researched article;  it basically groups together a bunch of generalizations by surgeons about immigrant surgery preferences.

The Atlantic went back to the cosmetic surgery topic for today’s article Bringing Beverly Hills Cosmetic Surgery to the Middle East.

And to return to my home country, I offer you this Gawker post from 2011: A Guide to the Fake Faces of Real Housewives.  Perhaps there’s something to be said about trying to look like those seen as successful  trendy role models among those of your subculture — whether they be pop stars, actors, or trophy wives — and the dominant story isn’t that people are trying to look Caucasian, at least not anymore.

Correlation versus causation, in a graph

We’ve mentioned the relationship between ice cream and murders before, but here’s another correlation example.  Internet Explorer drives people to murderous rages!

47D7zGq

Source: Chris Blattman (click to visit his site)

To the often misinterpreted data of correlation, I’ll add another form of misleading evidence often found on the Internet: the personal anecdote.  I haven’t used Internet Explorer in almost a decade, and I haven’t gone on a single homicidal rampage in that time.  It must be true!

Questions around personal genomics

The breadth of topics studied in medical anthropology — or anthropology in general — is so broad that when I choose to write about a wealthy, industrialized nation issue like personal genomics, I feel a pang of guilt that I’m not posting about malaria and insecticide resistant mosquitoes or the new UNICEF cholera toolkit.  It’s that diversity of topics that keeps me hooked, though, so here we go!

We’re at a point where genetic testing for various disorders is becoming more common and where it’s not prohibitively expensive to get one’s DNA genotyped.  This year, I asked for it as a birthday present; in a couple months I should have my report from 23andme. Since a number of factors went into my decision, I thought I’d use them to frame a post about the individual considerations of genotyping and sequencing.

Why do it?

For me, the answer is pure curiosity and that I like the idea of contributing my data set to ongoing research. I have no biological offspring, so I’m not looking for risk factors that may be passed to them.  My ethnicity and family tree are known and I don’t expect any surprises, but neither would they bother me. There’s also the possibility for customized medical treatment in the future, and of knowing right now if I’m more or less sensitive to some medications.

first world problems

I bounce with nerdy excitement thinking of some things I could learn, even if the knowledge doesn’t have much practical application. For example, the American Red Cross won’t take my blood because of a remote possibility that I was exposed to Creutzfeld-Jakob Disease  in the early 1990s. This test won’t tell me if I was exposed or not, but it can reveal if I have an A at both copies of rs17571, which is correlated with ten times greater risk of contracting the disease if I was.  Neato!

What about privacy?

I’m not prepared to join the ranks of people who have released their genetic information online, yet.  Micah wrote about the shocked reaction of Henrietta Lacks’ family when the HeLa genome was published and while DNA may be unique, I don’t feel it’s ethical to reveal genetic information about my parents or possible information about my sibling without consent.  Dan Vorhaus at Genomes Unzipped has a good post about his decision to take his genetic information public and how he approached his family. The potential for the abuse of that information by others is too great, and I when I decided to have the test done I weighed the chances for stigma and discrimination, not only based on what genetic knowledge we have now but what we might learn in the future. I’m too hacker-aware to believe my data will be truly private or anonymous anywhere, so that was part of my calculation. I decided not to consider the more remote possibilities, such as those in the prequalification reading for enrollment in the Personal Genome Project:

More nefarious uses are also possible, if unlikely. DNA is commonly used to identify individuals in criminal investigations. Someone could plant samples of DNA, created from genome data or cell lines, to falsely implicate you in a crime. It’s currently science fiction — but it’s possible that someone could use your DNA or cells for in vitro fertilization to create children without your knowledge or permission, or to create human clones.

What if the test shows something terrible?

A lot of what we know now is limited to correlations and increased chances.  I disagree strongly with congressmen who think that someone who learns that he has a genetic risk factor will “panic first and ask questions later”, which seems like a reductive and wrong guess at human behavior, especially among those who are proactively seeking that information. Some very intelligent and knowledgeable people  — James Watson and Steven Pinker among them — have chosen not to learn if they have a variant associated with a higher risk of Alzheimer’s Disease (read Pinker’s great article about his personal genomic explorations). I want to know all I can.  Maybe I feel confident because I’ve immersed myself in genealogy recently and have seen a lot of long-lived ancestors, but I think that I can handle it.  There’s a big difference between increased risk and a certain future, after all.

What’s the anthropological angle?

There are several:

  • This piece from the Yale Journal of Biology and Medicine nicely summarizes Margaret Lock’s talk on this topic at the 2009  Society for Medical Anthropology meeting.  From the article, “…Lock believes that it is now time for anthropologists to be more accepting of this reality and even aid the integration of the genomic era by examining the many issues that arise because of its associated activities, such as the social implications of genetic profiling, the ownership and moral dilemmas of engineering hybrid crops and livestock, and the societal perception of the newly formulated concept of man’s own hybridity.”
  • There is a question of ownership and advocacy to explore. Myriad Genetics has patents on genes BRCA1 and BRCA2, which have been in the news lately because of Angelina Jolie. These patents prevent other companies from testing for mutations on those genes, keeping the price high. The ACLU took this issue to the Supreme Court last month and a decision is expected in summer, but as our genetic knowledge expands, ensuring access to diagnostic testing seems like an issue we’d care about.
  • The field of anthropological genetics and the more broad molecular anthropology. One of the features 23andme promotes is an estimation of what percentage of a subject’s DNA came from Neanderthals. I’m a bit wary of that one.
  • Every aspect of human experience from avoiding or seeking testing, to how results impact one’s identity and risk perception, to watching for the creation of new social categories based on genetic factors, to whether this is just reinforcing the hegemony of “Western” medicine.

What it means to have a culture-bound syndrome

If you tell a distressed woman that her suffering is a culture-bound syndrome, perhaps citing examples that she would find bizarre, you shouldn’t expect a pleasant and understanding response. It sounds dismissive, like saying it’s “all in her head” or a manipulative tactic to garner sympathy.

There have been a flutter of articles about culture-bound syndromes in the wake of the DSM-5 publication, and a piece on the The Guardian (Are mental illnesses such as PMS and depression culturally determined?) seems to have inspired this one on Jezebel and then this one on Slate.  There are many good links in the articles and I recommend clicking if you’re interested in the topic.  But what comes through to me in some sections of the writing and definitely in the comments is the attitude that if an illness is culture-bound, it’s not real.  Many of the comments are defensive, daring others to say that what they’re experiencing is a lie.  This can be complicated by a mainstream understanding that something “cultural” is something shared, yet (to use the main example from the articles) not every woman in Western cultures has PMS or experiences it in the same way. Does this mean that those who do are exaggerating for effect or making it up?

No.  However, we start to wade into the swamp of the “really real” where I so often find myself lost. I know I’m not alone in struggling to understand what it means for someone to have a culture-bound syndrome and I’d make a mess if I tried to unpack a lot of theory.  However, I think it’s a common mistake to see these syndromes as only a way of expressing emotions that don’t have another path of release. I’m more inclined toward the notion of local biologies, where societal and cultural expectations play a role, but so can genetics and epigenetics, diet, and environment.

We do a disservice by pointing out the culture-bound syndromes of others without inclusively evaluating those that might be our own (not at higher levels of study, but certainly in lower levels and mainstream articles). It wrongly puts Western culture in a position of rationality and superiority, smiling at the quaint confusion of others, rather than questioning our own socially accepted conditions that are proving to be non-universal and WEIRD (Western, Educated, Industrial, Rich, and Democratic).

The ‘baby bump’ as public property

What is it about a pregnant woman’s belly that inspires strangers to stare at it, touch it (sometimes without asking permission), and comment upon it? On Slate today, Jessica Grose is creeped out by our obsession with celebrity pregnancies, pointing to a recent New York Times article about pregnant celebrity fashion entitled Pregnancy Takes a Turn on the Red Carpet. Her views are doubtlessly shaped by her own experience:

People I passed on the street wouldn’t meet my eye, they’d stare right at my stomach. Once, a man leered at me, which felt much more invasive than cat calls did before I was with child. I suppose it’s because I had no control over the way my body looked, and I felt much more vulnerable than usual because I had a helpless baby I was supposed to be protecting.

Grose finds the flaunting of bellies — or at least the media’s treatment of it — to be extremely objectifying.  The NYT article relates the history of celebrity demi-moorepregnancies, mentioning Demi Moore’s famous Vanity Fair cover from 1991 as a turning point that brought bellies into the open. It talks about a “revolution” that empowered celebrity women to appear at award shows when they were visibly pregnant and seems to take the position that this is universally liberating, especially now that there are more fashionable options. Grose points out that an essay by Renee Ann Cramer cited in the article draws a very different conclusion. In that essay, “The Baby Bump is the New Birkin“, Cramer writes:

Tabloids and glossy magazines watch and judge these pregnant bodies. Given that celebrities provide models of fashion that everyday women try to emulate, the sexy new baby bump establishes standards of pregnant and post-baby female beauty that are unattainable — perhaps even undesirable — to most. What’s more, press coverage of celebrity moms predictably replicates tired tropes and existing power gaps in class, race, and gender.

Looking at a media culture that reeks of TMI and TMZ, I’m inclined to say, “Who cares?”, but the answer seems to be “almost everybody but me”. Baby bump speculation sells magazines and raises hit counts, encouraging us to evaluate the celeb as a mother-to-be, not as woman, a person, or on the basis of whatever qualities brought her to the public eye. Let me throw in a plug for a professor at my alma mater, Erin Meyers of Oakland University, whose recent book Dishing Dirt in the Digital Age: Celebrity Gossip Blogs and Participatory Media Culture analyzes the digital obsession with celebrity gossip and who has looked at the “bump watch” in particular.

Celebrities aside, some of the comments on Grose’s article suggest this is part of an oversharing trend that extends to posting photos of urine-sensitive pregnancy tests with positive results on one’s Facebook page. Think of Janelle Taylor’s The Public Life of the Fetal Sonogram: Technology, Consumption, and the Politics of Reproduction. It’s not uncommon to get a first glimpse of a friend or relative’s child long before birth as a shared sonogram image. When I researched the social construction of pregnancy in the virtual world Second Life, among the phenomena I considered were products that give the fetus a more active role. These include transparent belly or uterus add-ons that show the growing baby (giving the pregnancy a whole new level of visibility) and some known as “tummy talkers” that simulate monologues by the fetus reminding the mother to eat properly and rest, expressing love, or warning others nearby to be careful not to push into Mommy. Though these are not universally used, they’re common enough that dozens of brands exist.

Celebrities set trends but they also follow them; if they reveal their pregnancies in ways that ordinary women might, the scrutiny and judgment they receive is magnified. Grose felt that she garnered unwanted attention when she was visibly expecting. I can’t guess whether she shares that feeling with the majority of today’s American  mothers, though signs point to women inviting others to bear witness to their pregnancies earlier and earlier in their progression. The female body remains a battleground for agency, no matter how famous one happens to be.

Registration open for Transform 2013

Each year, the Mayo Clinic Center for Innovation holds a stimulating, innovative multidisciplinary conference focused on how to transform the experience and delivery of health care.  Last year I attended the sessions at Mayo Clinic’s location in Second Life and wrote about it here. I’ve watched some of the presentations repeatedly and they always provide new ideas for my brain to chew.

Registration is now open for the 2013 Transform conference, which will be held September 8-10 in Rochester, Minnesota.  There is a $200 per person registration discount until the end of May. It’s not something I can afford to attend in person, but if you can I’ll be jealous! I’m hoping that it will be streamed in Second Life again.

In the meantime, you can access archived video from the past four years of the conference.

Roundup on race and IQ

Jason Richwine’s 2009 Harvard dissertation IQ and Immigration Policy has been all over the news for the past few days, after the circulation of a controversial Heritage Foundation report on immigration with which he was involved.  A lot of thoughtful people have written on the topic and provided a better analysis than I can in a short blog post. So instead, I’ve collected a reference list of a dozen links for anyone who wants to read more. I’m trying to focus on articles that discuss the science and philosophy of the issue, not politics or whether his dissertation was properly reviewed.

  • Heritage study co-author opposed letting in immigrants with low IQs from The Washington Post. This article seems to have been the spark that lit the fire of this controversy.  “Toward the end of the thesis, Richwine writes that though he believes racial differences in IQ to be real and persistent, one need not agree with that to accept his case for basing immigration on IQ. Rather than excluding what he judges to be low-IQ races, we can just test each individual’s IQ and exclude those with low scores.”
  • What We Mean When We Say ‘Race Is a Social Construct’ from The Atlantic. “When the liberal says ‘race is a social construct,’ he is not being a soft-headed dolt; he is speaking an historical truth.”
  • Why People Keep Misunderstanding the ‘Connection’ Between Race and IQ also from The Atlantic. “Among rich kids, good opportunities for developing the relevant cognitive skills are plentiful, so IQ differences are driven primarily by genetic factors. For less advantaged kids, though, test scores say more about the environmental deficits they face than they do about native ability.”
  • Two from the American Anthropological Association: RACE – Are We So Different? and the 1998 AAA Statement on “Race”  “At the end of the 20th century, we now understand that human cultural behavior is learned, conditioned into infants beginning at birth, and always subject to modification. No human is born with a built-in culture or language. Our temperaments, dispositions, and personalities, regardless of genetic propensities, are developed within sets of meanings and values that we call ‘culture.'”
  • Race And IQ. Again. on Andrew Sullivan’s The Dish. “But please don’t say truly stupid things like race has no biological element to it or that there is no data on racial differences in IQ (even though those differences are mild compared with overwhelming similarity). Denying empirical reality is not a good thing in any circumstance.”
  • Six Reasons Why Race-and-IQ Scholarship is an Intellectual Dead End from studentactivism.net, largely a response to Sullivan [via @savageminds] “Let’s say it were discovered that one American racial group was, once all the effects of nutrition, healthcare, education, income, parenting, and every other environmental factor were controlled for, on average innately slightly less intelligent than another. Would that finding justify discriminating against the less intelligent group in employment, education, or any other realm of endeavor?”
  • Should Research on Race and IQ be Banned? from the Scientific American Cross-Check blog.  “Irony Alert: It just occurred to me that two recent films, The Great Gatsby and Django Unchained, feature villains who spout pseudo-scientific theories of white superiority. The films imply that these theories are ludicrous relics of our racist past and that no modern person could possibly believe them. If only.”
  • The IQ Test from Slate. “’I have never worked on anything even remotely related to IQ, so don’t really know what to think about the relation between IQ, immigration, etc,’ Borjas told me in an email. ‘In fact, as I know I told Jason early on since I’ve long believed this, I don’t find the IQ academic work all that interesting. Economic outcomes and IQ are only weakly related, and IQ only measures one kind of ability.'”
  • Flynn, Ceci, and Turkheimer on Race and Intelligence: Opening Moves from Cato Unbound (2007). Don’t miss the links to response essays at the bottom of this article. “Take, for example, health care. Patients differ enormously in intelligence level, and these differences have life and death consequences for them. Individuals of lower health literacy, or IQ, are less likely to seek preventive care even when it is free, use curative care effectively when they get it, understand and adhere to treatment regimens, or avoid health-damaging behavior.”
  • A Talk with Jason Richwine from The (Washington) Examiner.  (speaking about making an even more controversial statement in a 2008 panel) “What I emphasized was that ethnic group differences in IQ are scientifically uncontroversial. That being said, there is a nuance that goes along with that: the extent to which IQ scores actually reflect intelligence, the fact that it reflects averages and there is a lot of overlap in any population, and that IQ scores say absolutely nothing about the causes of the differences — environmental, genetic, or some combination of those things.”
  • And finally, a 2009 Guardian review of Stephen Jay Gould’s The Mismeasure of Man. “This book should make any sensible person wary of attaching too much value to IQ tests (there’s some glorious stuff on the quixotic allotment of IQ ratings) and should make anybody very suspicious of statements about ‘group IQ’ or the presumption that some races are innately more clever than others.”

Meeting the needs of child trafficking survivors

When a child has endured sexual trafficking, his or her problems can endure for a lifetime. Seeing this as a public health issue, the Johns Hopkins Bloomberg School of Public Health, the Advisory Council on Child Trafficking, and Goldman Sachs 10,000 Women organized the “Symposium on Meeting the Needs of Child Trafficking Survivors” earlier in May.

Seventeen videos of presentations from the symposium are available online. I’m grateful whenever an organization shares material like this so that more of us can learn from it. The few videos I’ve watched so far are interesting and thought-provoking.

Michael J. Fox as a public figure with Parkinson’s… a fictional one

I don’t watch many sitcoms, but the upcoming Michael J. Fox Show will have a spot on my DVR.  You’ve already seen the trailer above, haven’t you? It’s sweet, irreverent, and funny.  The dinner table moment that starts at 3:10 in the video just slays me.

Outside of interviews and cameos, we rarely get to see disabled people on television. I have to believe that a beloved actor with Parkinson’s disease will ensure that the details about his condition are portrayed with reasonable accuracy. It’s refreshing to see a representation of someone living with a degenerative disease; not coping, not surviving, but living.