Is egg freezing feminist?

Janelle Taylor just posted the following two links to H-MEDANTHRO last week; the first is an editorial piece by Marcia Inhorn on CNN’s website exhorting women in their 30s to freeze their eggs (although with some reservations about the ways this technology might be used); the second is a response by Taylor and Lynn Morgan questioning whether that’s actually good advice: as they argue, freezing your eggs “represents an individualized, private, expensive, high-tech medical solution to what is fundamentally a collective, social problem”.  See also some of the comments on the CNN site (there are some thoughtful ones within the usual CNN comment drivel).

I wish we had a response from Inhorn to defend herself, as this feels a little unfair, but I wonder where you all fall on this debate.  This is a tricky question: should women embrace this technology as empowering them to balance both career and family, or will the net effect of egg freezing actually be to reinforce patriarchy?

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You are more beautiful than you think… but why does beauty matter?

In class, we’ve had occasion a few times in the past week to think about the double-edged nature of any message, from cholera statistics (Briggs) to Chevron’s greenwashing (Sawyer).  On the one hand, we have the explicit message, which might seem to run counter to the interests of those in power: cholera statistics may run counter to the government’s messages reassuring effective containment, or Chevron’s “Human Energy” campaign might call upon corporations to exercise responsibility in their use of natural resources.

But the covert subtext of these messages actually serves to reinforce systems of inequity. Briggs makes a compelling case that cholera statistics implicitly mark statistics as the most authoritative form of information in circulation, privileging the few Venezuelan institutions capable of generating statistics.  And Sawyer points out how entirely disingenuous and dangerous it is for Chevron to posit a false equivalency between the civic responsibilities of corporations (as “people”) and the civic responsibilities of ordinary consumers.

I’m thinking about this today as many of my Facebook friends, several of whom are self-described feminists, are posting a Dove commercial that is clearly designed to go viral- and it seems to be working.  It shows women describing themselves to a sketch artist, and then we see contrasting sketches resulting first from their self-descriptions, and then from how others describe them, which is invariably more flattering.  The tagline: “You are more beautiful than you think”.

I am immediately reminded of the point Kaw makes in her analysis of Asian-American cosmetic surgeries: the message in both of these examples is about gender, emphasizing that what should really matter for women is their physical appearance.  Watch the commercial again and you’ll see how clearly this is emphasized.  So if this ad is supposed to be empowering for women, it’s a kind of empowerment that clearly serves the interest of Dove.  If Dove really wanted to empower women, it would argue that physical beauty is really not that important anyway- but then they wouldn’t have a way to sell their product.  Or am I missing something here?

I think about this every time I see a bank advertisement announcing that they don’t care about the money, they care about you and your well-being.  This is not in the nature of banks, at least not those banks who are seeking to maximize profits for their shareholders.  But it is a very effective way for corporations (who are not actually human!) to package human values (altruism, compassion,  environmentalism, women’s empowerment) as a way of selling themselves to consumers.

What do you think? Is Dove’s message really empowering, and I’m just cynical?  This is the new mode of advertising, and in many ways I find it far more insidious than the overt commercials we’re used to.  For example, there’s a recent, feel-good Coke commercial designed for viral consumption that I also find incredibly sinister, but for other reasons.

More thoughts on unnecessary gluten avoidance

I was going to respond directly to Kristen’s post, but I don’t think WordPress lets you put hyperlinks in response comments.

It’s an interesting question, worth unpacking a little. If we agree that it’s important to respect phenomenological and subjective experience, does that mean that individuals should be free to adopt any medicalized identity as long as it doesn’t cause them harm (there are no clear negative health effects of avoiding gluten unnecessarily)? This is complicated by the way that illnesses do important work of identity formation, with illness subjectivities providing potential access to valuable forms of community and social capital- particularly in the age of internet fora and support groups (we’ve looked at this a little bit in class with Nguyen). It’s a fascinating new world of bottom-up creation of categories that are simultaneously illness and empowerment- Gillick’s analysis of jogging is a kind of precursor to this new proliferation of medicalized subcultures that are only taken up by the DSM once they reach a critical mass online. Are these conditions counterhegemonic, or just another example of technologies of the self ultimately serving the interests of governmentality? Lots of good possibilities for future research here.

Just to be provocative, if you’re OK with claims of gluten intolerance whether or not there’s a biomedical justification, how do you feel about pro-ana? Or about body integrity identity disorder, the conviction that one is healthy apart from the burden of a limb that does not feel like it belongs on your body?

The bioethicist Carl Elliott (always worth reading) wrote a great essay on BIID several years ago, and pointed out that the disorder really grew only once people were able to discuss it laterally on the internet, unmediated by the medical establishment. It’s as if the discourse actually created the symptoms in people’s bodies, in a kind of Sapir-Whorf effect.

There are lots of examples of this. This American Life just did a nice piece on the strange world of ASMR, a condition (labelled and given its properly medical-sounding acronym not by doctors, but by the online community) that makes videos like this intensely pleasant to watch. Do new illness communities develop because individuals first have symptoms, and can now discover similarly-wired people on the internet, or does the category to some degree create their somatic experience?

Hope vs. cost: the biotechnical embrace revisited

Earlier this month, I posted about the unnecessary suffering at the end of American lives that is sustained through what DelVecchio Good has called the “biotechnical embrace”: a mutually constructed ideology of hope between doctor and patient which justifies pushing experimental treatments, even when they are excruciating, expensive, and almost certain to be unsuccessful.  Both the article and the piece you read by DelVecchio Good hint at hospital economics (and incentives from biotech and pharma) as partial factors driving this ideology forward- this comes up peripherally in Cohen’s work on kidney transplant recipients as well.

Last year, Memorial Sloan-Kettering Cancer Center in New York, one of the premier cancer centers on earth, chose not to stock a ridiculously expensive medication used as a last-ditch treatment for advanced colorectal cancer.  This seems like an obvious decision, since the new drug, Zaltrap, works about as well as the much cheaper (but still overpriced) Avastin.  But the act of a major hospital rejecting an expensive drug is in fact astoundingly rare; so rare, in fact, that the doctors felt compelled to write an op-ed in the Times defending their decision- and pointing out the absurdity of a system in which cost is almost never a factor.

NPR has a quick overview of the issue.  I’m posting it for two reasons: first, the last few sentences, in which the doctors admit that if there had been even a tiny increase in Zaltrap’s efficacy over Avastin, they would have felt compelled to stock it.  And second, for the comment section, in which the ideology (and ethical mandate) of hope is questioned by patients, their families, and the medical staff who watch them suffer.

Who owns HeLa?

We have mentioned Henrietta Lacks a few times in class, the individual whose cells have done more than anyone else’s in the advancement of modern medicine.  The HeLa cell line, the first “immortal” cell line ever developed, has been used to develop the world’s most important vaccines and cancer medications, as well as spurring advances in gene mapping, cloning and IVF.  But all of this was done without her or her family’s consent, and her family was unaware of the cell line until 20 years after Lacks’s death.  Now HeLa has been sequenced, and her genetic information published- once again, without her family’s permission.  This is legal, but is it ethical?

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Rebecca Skloot, whose book brought the story of Henrietta Lacks to popular attention a few years ago, has written a nice editorial about just how problematic the publication of HeLa is, and how poorly the law has kept up with the implications of advancements in genomic technology.  If HeLa shows a predisposition toward Alzheimer’s, for example, this may have repercussions for the life insurance her descendants can get.

Haiti, Fukushima, Chernobyl: What do we learn from disasters?

It is now two years since the Tohoku earthquake and subsequent triple meltdown at the nuclear plant in Fukushima.  Sarah Phillips, an anthropologist who has spent most of her professional life studying Chernobyl and the Ukraine, has a very thoughtful piece on how similar the two nuclear disasters turn out to be.  It’s a long article, so here’s the tl;dr:

Pripyat

“Fukushima is Chernobyl. Independent of the system (Japanese, Soviet), nuclear technology requires disregard for the public, misleading statements, and obfuscation in multiple domains (medicine, science and technology, governance). As anthropologist Hugh Gusterson notes, “The disaster at Fukushima has generated cracks in what we might call the ‘social containment vessels’ around nuclear energy—the heavily scientized discourses and assumptions that assure us nuclear reactors are safe neighbors.” Comparing the nuclear accidents at Chernobyl and Fukushima shows that “peaceful” nuclear technology is anything but.”

Fukushima

This week, in Maternowska’s Reproducing Inequities, we have also been reading about Haiti and the spectacular failures of development organizations to effect significant or lasting change for poor Haitian women.  It has now been more than three years since Haiti’s massive 2010 earthquake, and life for many Haitians is not better.  The cholera epidemic that began in the country in October 2010 continues to claim Haitian lives.  The same patterns Maternowska identifies for Haiti’s reproductive health and family planning policy have played out in the wake of Haiti’s natural and unnatural disasters: a lot of money spent very unwisely, and then a discourse that blames Haitians and “culture” for the lack of results.  We are left with the sense that Haiti, like other regions of extreme poverty, is hopelessly undevelopable, and so funding is limited to basic humanitarian interventions addressing immediate needs, rather than addressing the underlying structural factors that relegate Haiti to perpetual vulnerability to the next disaster.

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Paul Farmer and Catherine Maternowska both identify this sense of hopelessness for what it is: a disavowal, a racist cop-out, and a justification for continuing the same development strategies that fail to address the actual long-term needs of poor people, despite overwhelming evidence of their inadequacy.  The real tragedy that emerges from reading Maternowska, or following Farmer’s tremendous success in the country with his clinic and with Partners in Health, is the recognition that developing Haiti and alleviating poverty is not actually that difficult.

Should we rage against the dying of the light?

The reading assigned for today by Mary Jo DelVecchio Good looks at the political economy and culture of hope that serve as a legitimizing ground for what she terms the “biotechnical embrace”.  She notes that even as the medical system promotes and naturalizes experimental treatments that have very low success rates, the same medical personnel that maintain public optimism are privately critiquing the practice.  Here’s an excerpt from a resident:

“Being given high doses of chemotherapy and a bone-marrow transplant is not a natural event.  Sometimes oncology in general kind of bugs me, in that it seems – especially for bone-marrow-transplant patients … I was feeling, Why are we doing this?

A recent article in the LA Times asks the same question.  Even as the rates of Medicare patients who are choosing to spend their final days at home or in hospice are going up, an increasing percentage of these patients are spending all but their final weeks undergoing invasive, expensive and painful treatments.  With the encouragement of both doctors and support groups, and an individualist and even moral discourse of “winning battles” and “never giving up”, Americans tend not to go gentle into that good night.  And yet 9 out of 10 Americans say that when the end comes, they would rather die at home, with treatments focused on comfort rather than extending their lives.

There is one group that does not seem to buy into the ideology of hope for their own terminal care: doctors.  A recent Radiolab episode explores the disparity between what we want doctors to do for us, and what they want done for themselves- see doctor’s responses below when asked what treatments they would want given a scenario of irreversible brain injury without terminal illness:

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Who are the weird?

There’s a fascinating article making the rounds of various blogs this week, which does a nice job of summarizing the interesting findings of a young group of psychologists looking at cross-cultural variation in a series of games and perceptual tests that have long been assumed to measure universal human qualities.  Over and over again, they are finding that Western subjects respond in very different ways than most people to these kinds of tests; in fact, Western subjects are outliers, even though the vast majority of our data on human behavior and psychology (96% of psychology studies) is limited to the study of Western populations.

This is not exactly news to most anthropologists (or to anyone; the paper the article is discussing came out a few years ago and was widely discussed then as well), but the article does not let the discipline off the hook, accusing the anthropological stance on cultural diversity of being incoherent in that we want to maintain two incompatible claims.  On the one hand, anthropologists extol cultural relativism as a basic principle, emphasizing that cultural differences are real and significant and need to be respected.  On the other, undergraduates come away from an anthropology class with the sense that we are also all underlyingly the same.

This strikes me as a fair critique to a limited extent, but the quandary of the anthropologist is less severe than that of those social sciences (psychology, economics) that want to assert the existence of an analytically accessible mind underlying and separable from cultural variables.  I think many of these kinds of social scientists will come away from the article shaken, but not despairing; maybe, they will reason, you have to try for cross-cultural representativeness for things like game theory, but surely not for things further along the biological end of the biocultural spectrum.  And yet we know from our course readings that this is not true either: we have seen that what seem like very biological processes, from so-called African “precocity” (Gottlieb) to “normal” menstruation patterns (Strassmann), are very different for most of the world than for the Westerners who have long been presumed to be typical.

The always incisive neuroanthropology blog has done a great job of giving an overview of the review article, as well as pointing out some of the problems inherent in the neologism WEIRD (Western, Educated, Industrialized, Rich, and Democratic), despite its catchiness.

CFP for a great conference in Germany

Check out this great-looking conference in Mainz, starring medical anthropology superstars Joao Biehl, Thamar Klein and Hansjoerg Dilger.  It’s a good indication of the field’s continued struggles to define itself, and to articulate its relationship to political engagement and activism.

Subject: CFP Situating medical anthropology: between the “ivory tower of science,” activist engagement, and ethical responsibility

*GAA Biannual Conference 2013*

*Locations: anthropology in the academy, the workplace, and the public sphere*

*2. – 5. October at Mainz University, Germany*

*Keynote: João Biehl (unconfirmed)*

Workshop conveners: Thamar Klein and Hansjoerg Dilger (Work Group Medical Anthropology)

The situated knowledge of “science” has in the last 30 years taken center stage in anthropology, with ethnographic and anthropological ways of knowing and doing research having been described as being inseparably linked to sociopolitical forces and practices. This idea went hand in hand with the development of “perspectival science” – the awareness that there is no “view from nowhere” – but that research is conditioned by the particular “cultural baggage” of the re-searcher and his/her subjectivity.

That knowledge and social life forms are inter-dependent is also a well-established fact in critical medical anthropology, which has long been concerned with the production of knowledge in settings infused by power and authority. Furthermore, as medical anthropology deals with existential questions of suffering, health and the human body, the field has a strong tradition of applied approaches and activism. Yet, despite these insights the opposition of academia toward activist-scholars persists and those anthropologists en-gaged in applied practice are often disregarded.

We welcome proposals for papers that address aspects of the relationship of activism, attempts to do “situated research,” and academic medical anthropology, including questions about the researcher’s subjectivity and the moral and ethical challenges that medical anthropologists face in positioning themselves within and beyond the field. Furthermore, we are interested in what the ethical and applied responsibilities of medical anthropologists are in shifting landscapes of health and suffering that have become increasingly marked by dynamics of exclusion/social stratification – as well as by new opportunities for the funding of “societally meaningful” research.

Abstracts should be submitted both as a long version (200 words max.) and a short version (30 words max.). These should be e-mailed (including short biographical information) directly to the workshop conveners.

*Deadline:**15. February 2013*

klein@dr-thamar-klein.com <mailto:klein@dr-thamar-klein.com>

hansjoerg.dilger@berlin.de <mailto:hansjoerg.dilger@berlin.de>