Medical Humanities Blog

On the Declaration of Helsinki

These days, Stuart Rennie seems to be doing a terrific job of voicing many of my own perspectives on global ethical issues.  So why not continue to link to his posts?

His latest effort assesses the FDA's decision to abandon the ethical dictates of the Declaration of Helsinki, moving instead to the weaker protections of the Good Clinical Practices of the International Conference on Harmonization.  Notwithstanding my own skepticism about the utility of ethical codes, Rennie provides good reason for thinking the decision is quite important, if not substantively, at the very least as a signal as to current priorities in global research:

The Declaration of Helsinki has its own problems, not the least of which are problems of ambiguity in its language and limited enforceability. But even its most uncharitable critic can see that the document has an ethical backbone. What impact the FDA's decision will have on clinical trials around the world remains to be seen, but the decision would seem to encourage pharmaceutical companies to cut ethical corners when working abroad.

Indeed.  Merrill Goozner comments here.

On the Moral Imagination

An evocative phrase within the medical humanities lexicon (I know, I know, I'm way behind in this series . . . ) is the "moral imagination," which we've briefly discussed.  The idea, roughly, is that a healer's ability to imagine what it might be like to experience the illness phenomena the patient narrates is itself of moral significance.  The healer who has a better developed imaginative faculty, IMO, is that much more likely to heal the patient, as opposed to merely treat the disease.  David Henderson Slater has an excellent post underscoring the importance of the moral imagination for the physician over at the Literature, Arts, and Medicine Blog.

Excerpts:

When we see a patient in clinic, or in the operating theatre, or on the ward, we see only a tiny part of their lives. We tend to see what they want to present to us. The clinic and the ward are not real life, or only a tiny part of it. If I really want to know what life is like for my patient I have to spend hours at it - perhaps also visiting them at home (something I often do) or in the Nursing Home. That way I get a feel for the things that get forgotten in clinic- such as the long hours of inactivity, or the financial poverty of the family, and an appreciation of what is important to them - for example the religious artefacts on the walls, the family pets, the old cars littering their garden, the half finished Do-it-Yourself projects.

While narrative studies are not my area of focus within the medical humanities (I gravitate to ethics, policy, and the history of medicine & public health), there is no doubt in my mind that narrative is important academically because it is so important phenomenologically.  What I mean by that is, in Slater's articulation, the idea is that the visits between doctor and patient are merely one tiny slice of the larger stream of narratives that comprise the patient's life.  To actually understand what it might be like to experience the illness(es) that the patient is living and/or dying with, attention simply has to be given to the larger context in which the patient is living out his or her life.  As Slater notes,

But sometimes we can’t access the patient in this direct way, and sometimes we don’t notice things. Our minds and our eyes need to be trained to spot things; so does our imagination. As trainee doctors we get extensive training in physical examination. I believe we also need to train our imagination, to learn to think what life is like for others, to experience things vicariously.

Indeed.  The suggestion here is not that the healer must go out and examine how the patient lives his or her life -- although that is probably a very good idea, and seems to me to characterize some of what medical anthropologists "do" and why it might be important -- but rather that the imagination is a faculty, and can be honed and refined like any other.  And the more developed this faculty is, the more effective, IMO, the healer is likely to be.

In any case, go read the whole post, which includes some perspectives from an Oxford medical student on disability and film.

Book Notice: Shrader-Frechette on Environmental and Public Health

Having read three of her previous books, Risk and Rationality: Philosophical  Foundations for Populist Reforms (Berkeley, CA: University of California Press, 1991), Environmental Justice: Creating Equality, Reclaiming Democracy (New York: Oxford University Press, 2002), and Ethics of Scientific Research (Lanham, MD: Rowman & Littlefield, 1994), I'm pleased to learn from Notre Dame Philosophical Reviews (NDPR) of a fairly new title from Kristin Shrader-Frechette: Taking Action, Saving Lives: Our Duties to Protect Environmental  and Public Health (New York: Oxford University Press, 2007). From the review by Madison Powers:

At the outset, it should be noted that environmental ethics is a comparatively small sub-set within practical ethics. Shrader-Frechette occupies a particularly small niche within that already small area of expertise.

One area of overlap between the concerns of a minority camp within bioethics and those of many who do environmental ethics is the question of whether humans have any moral duties to non-human animals. For the most part, however, environmental ethics focuses on a set of questions that occupies the attention of very few bioethicists. Does the natural world possess any intrinsic moral value independent of its instrumental value for sentient beings? Is biodiversity itself a morally significant matter?

Such questions often proceed to resolution under cover of an overarching question. Does our ethical focus on human welfare, especially human health, represent an unacceptably anthropocentric way of framing questions about the place of humans in nature? These specific questions are not Shrader-Frechette's questions, and the overarching issues they presuppose are not ones that animate her work. Instead, she works on a parallel track. Her concern lies with the relation between risks to human health and attempts to control, manipulate, and remake the natural environment.

In-depth scholarship within environmental ethics that has human health as a central concern is therefore relatively rare.

Public health ethics is perhaps the field having the closest intellectual kinship with Shrader-Frechette's work, but there too there is a considerable difference in emphasis. The bulk of the public health ethics literature concentrates either on the ethics of interference with individual liberty through various public health interventions, or on the distributive justice issues that arise out of public policy priority setting with respect to the promotion and protection of population health. Contributions to human health deficits by way of environmental risk factors are more widely discussed than acted upon within public health practitioner circles, but within the literature of public health ethics, these issues generate little more than footnotes.

There are, nonetheless, very significant overlaps between public health ethics and environmental ethics as Shrader-Frechette approaches the subject. Her sub-title, Our Duties to Protect Environmental and Public Health, reflects her synthetic ambitions for bridging this gap. Public health ethics, like the central practice paradigm of public health itself, is traditionally concerned with disease prevention and control, and of course, more recently with behavioral risk factors that can be addressed through health education or marketplace regulation. But with more than 80,000 chemical compounds in the workplace, the home, and the broader environment, remarkably little in any great detail has been written on these arguably more substantial risk factors, or on the enormous range of ethical issues that are raised by our largely unreflective but ubiquitous alterations of the natural world.

Readers not familiar with the literatures of the various sub-disciplines of practical ethics may marvel that such a gap would exist. How, they might ask, could scholars in this area have failed to map the obvious connections?

There are, of course, many factors that account for what academics choose to study and what they overlook, but the sheer range of expertise and mix of disciplinary competences necessary to map the terrain goes a long way toward explaining why Shrader-Frechette has a unique voice in the field, and why this, and other books by her, are of such great (and I think, overlooked) intellectual importance.

This book offers an accessible primer for anyone who wants to know the kinds of things one needs to know in order to reflect on questions of environmental ethics from a perspective that elevates human health risks to the foreground.

It's interesting to consider this book in light of Onora O'Neill's suggestion that the "two principal domains of bioethics are medical ethics (broadly interpreted to include the ethics of bio-medical research) and environmental ethics."

Professor Shrader-Frechette taught in the Philosophy Dept. (and the Dept. of Environmental Studies) of my alma mater, UC Santa Barbara, back in the 1980s and I've always wondered how or why they let her get away.

Patrick S. O'Donnell

Health Wonk Review

Welcome to this edition of the Health Wonk Review.  For those of you new to the blog, and wondering what the heck the medical humanities are, and what their relation is to health policy, I'll quote from our previous opportunity to host:

As I see it, the key role for a medical humanist – if they wish to be consistent with an ethos of medieval and Renaissance humanists – is to focus on the translation of theory into practice.  Humanists eschewed the logic and abstractions that Scholastics privileged, reasoning that they did little to move those outside the cloisters and universities to live virtuously.

This ideal is perhaps most easily exemplified by Erasmus, who, in the humanist tradition, prioritized the study of rhetoric because, as Petrarch put it in citing Cicero and Quintillian, rhetoric was what moved people’s hearts.

Erasmus saw the handwriting on the wall, and devoted much of his life to a kind of moral epistolary practice, exchanging letters with Luther in the hope of averting bloodshed.  Erasmus deemed the prospect of war obvious given Luther and the ‘schismatics’ belief system.

A contemporary of Martin Luther’s and a devoted Catholic,

What could be more virtuous than using scholarship and language in the hopes of preventing violence and horror?

Not even his best efforts could prevent the coming storm, but his ideal remains one worth emulating, in my view.  Such is the need to translate scholarship into practice, and this is a quintessentially humanist precept.

As such, health policy remains a particular province of interest for me, and one in which I submit the medical humanist may have something to offer.  With this said, let us see what rhetoric our interlocutors have prepared for us, and what voices they speak in.

Over at Health Disparities Blog, David Porter links to a current debate within Australia over universal care.  But not quite the debate you might imagine.  He notes: "Here in the U.S. the debate is focused on whether or not universal health care should exist. In Australia the issue is how young a person should be when they get their own private universal health care account."

Speaking of Australia, health care systems around the world is the topic of Jason Shafrin's collection of posts over at Healthcare Economist.

Back on our shores, Roy Poses challenges CMS's inclusion of delirium as a non-reimbursable event within hospitals.

As to hospitals, Henry Stern wonders aloud whether the movement of health care out of hospitals and into specialty clinics may actually be advantageous.  Perhaps, though there is good reason to bemoan the increasing specialization of acute care in the U.S., as such care is a significant driver of health care costs, and diverts resources from primary care.

Something I've learned both in studying health policy and in practicing insurance law: insurance is complicated.  David Hamilton breaks it all down for you, courtesy of a WellPoint conference call, so you can see exactly where the incentives are aligned.

Seeing as how the health insurance industry might need some good publicity, Richard Eskow over at The Sentinel Effect notes the strange bedfellows who have rallied behind attempts to limit the sale of alcopops.  Yes, alcopops.

Eric Turkewitz, a general must-read on tort law and medicine, cites evidence that less than 2% of matriculating medical students from New York leave New York due to malpractice concerns.

Sticking with malpractice, the Canadian Medicine Blog details the development of apology laws -- which we've touched on here from a U.S. perspective -- in Ontario.

From lawyers to laws: At Drug Channels, Adam Fein lauds the introduction of H.R. 5839, which would preempt state standards regarding the pharmacy supply chain.

The likely passage of the Genetic Information Nondiscrimination Act made news this past week, and Louise over at Colorado Health Insurance Insider analyzes the ramifications for -- you guessed it -- Colorado health insurance.

Following a long and distinguished line of critics pointing out the inadequacies of much of the Bush Administrations' science and health policies, Mark Schauss notes that the White House could hardly look siller in denying the evidence-based link between smog and premature death.

Tackling a particularly troubling quality of care problem, Emily Cleath outlines the myriad problems plaguing the veterans health care 'system.'

Over at GoozNews, Merrill Goozner notes, as did many others, the long-awaited release of the AAMC's report on conflicts of interest in medical education.

You didn't think we'd get through an entire HWR without mentioning coverage, did you? Brian Klepper delivers the goods in his analysis of a new study documenting the general coverage erosion as to employer-sponsored health insurance.  And see Anthony Wright's excellent discussion of John McCain's health care plan, if it can be called as such.

You didn't think we'd get through an entire HWR without mentioning health care technology, did you? Fellow Cardinal David Williams eases your suffering with this discussion of Aimee, a web-based tool that helps providers understand typical radiation exposures associated with certain scans.

Sometimes, technology actually improves quality, as Tom Emswiler notes.  Huzzah!

Over at e-CareManagement, Vince Kuraitis wonders if the medical establishment is actually the best caretaker for your medical records.  Reminds me of a particularly humorous Seinfeld episode . . .

Speaking of humorous Seinfeld episodes, Jaan Sidorov has a thoughtful analysis of the recent fat-vs-fit study, sounding a pleasant note of skepticism, always welcome here at MH Blog in thinking about fatness and obesity.

Last, but obviously not least: Over at the Blogfather of the HWR, Jon Koppelman reasons that Tier 4 pricing for certain pharmaceuticals is unquestionably rationing.

On Gene "Therapy," and the Therapeutic Misconception

Here at MH Blog, I've posted several times on the woeful state of both public and academic discourse about genetics, and the high prevalence of reductionistic views of genetic causation.  Some particularly visible critics, like Richard Lewontin, whose work on the matter should be required reading for anyone venturing to write anything at all about the ELSI of genetic science, have charged that such reductionism proliferates even among scientists.

In this context, I wanted to note the news that

For the first time, researchers have shown that gene therapy can be used to improve vision for blind children and young adults. Two new studies document the treatment of six young people who underwent the potentially groundbreaking surgery at the Children's Hospital of Philadelphia and the University of Pennsylvania and at Moorsfields Eye Hospital in London.

The BBC news article on the story notes:

His doctors were shocked at the improvement.

Professor Robin Ali, of the Institute for Ophthalmology, who led the trial, said: "To get this indication after only three patients is hugely exciting.

"I find it difficult to remember being as excited as I am today about our science and what it might achieve."

A few comments:

First, it is wonderful that the use of these techniques improved, or at least halted the degeneration, of several people's eyesight.  The amelioration of human suffering should always be recognized, validated, and lauded.  That these successes hold promise for future efforts at healing and easing human suffering and illness is obviously significant, as well.

Second, however, note the lede to the ABC News article: "for the first time."  Yes, indeed.  One of the most obvious datum for the prevalence of the therapeutic misconception is the continued usage of the term "gene therapy" in place of the more accurate (PDF) "gene transfer research."  Gene transfer research has, thus far, been long on promise and short on therapeutic results.

In and of itself, of course, there is nothing wrong with this.  Most worthwhile scientific endeavors feature a very great deal of failure before any kind of success.  Yet to term gene transfer research "gene therapy" is to beg the question of its therapeutic nature.  The entire question, for anyone who wishes to practice any kind of evidence-based healing, is whether there is good evidence for believing a given intervention will be therapeutic. 

As such, I continue to have difficulty understanding why both lay and professionals alike continue to refer to this kind of research as "gene therapy."  This datum suggests just how deep and widespread is the therapeutic misconception, especially when we have some reason to believe that gene transfer research poses no insignificant amount of risk to the human participants.

The March/April 2008 issue of the Hastings Center Report features an article written by Paul Gelsinger (Jesse's father) and Adil Shamoo, querying whether there is good reason to believe that human participants research is any safer 8 years after Jesse Gelsinger died (PDF).  They generally answer this question in the negative (as would I), and it is worth noting that some of Paul Gelsinger's public comments after Jesse died suggest that both he and Jesse were laboring under the therapeutic misconception.  (To be more precise, Paul's comments indicate that he was misled into believing the intervention would be likely to produce individual benefit for Jesse).

My point is simply this: while it is wonderful that an application of gene transfer research has demonstrated therapeutic efficacy, there are other important lessons lurking in the background of the story that should not go unnoticed.

Finally, speaking of the University of Pennsylvania, Anita Allen has an apt article up on SSRN entitled

The Poetry of Genetics: The Pitfalls of Popularizing Science.

Hypatia: A Journal of Feminist Philosophy (forthcoming).

Abstract:

The role genetic inheritance plays in the way human beings look and behave is a question about the biology of human sexual reproduction, one that scientists connected with the Human Genome Project dashed to answer before the close of the 20th century. This is also a question about politics, and, it turns out poetry, because, as the example of Lucretius shows, poetry is an ancient tool for the popularization of science. "Popularization" is a good word for successful efforts to communicate elite science to non-scientists in non-technical languages and media. According to prominent sociobiologist E.O. Wilson, "sexual dominance is a human universal." He meant, of course that men dominate women. Like sociobiology, gene science is freighted with politics, including gender politics. Scientists have gender perspectives that may color what they "see" in nature. As the late Susan Okin Miller suggested in an unpublished paper tracing the detrimental impact of Aristotle's teleology on western thought, scientists accustomed to thinking that men naturally dominate women, might interpret genetic discoveries accordingly. Biologists have good, scientific reasons to fight the effects of bias. One must be critical of how scientists and popularizers of science, like Genome author Matt Ridley, frame truth and theory. Ridley's "battle of the sexes" metaphor and others have a doubtful place in serious explanations of science.

Recommended!

Conflicts-of-Interest-O-Sphere

The American Association of Medical Colleges has released its Report on Industry Funding of Medical Education (PDF), the result of over 2 years of work.

There is lots of good discussion on this: Howard Brody, Daniel Carlat, Merrill Goozner, and, in detail, Roy Poses from Health Care Renewal.

Also, please be sure to check out the horrifying details related by Clin Psyc on the newest Paxil study.  While it may be too much of a generalization to suggest that professionals in general do a poor job of self-regulation, the modern history of the medical profession (since 1847) should not inspire confidence.  As someone sympathetic to virtue ethics, I believe quite strongly that the building of professional and virtuous character should be a paramount pedagogical goal for medical education.  Yet, given the legacy of lax self-regulation, which, as CP notes, continues to this very day, it is becoming increasingly untenable to suggest that such self-regulation is sufficient to resolve the worst problems of scientific misconduct and conflicts of interest.

Thoughts?

On Moral Esperanto

Stuart Rennie, editor of the excellent Global Bioethics Blog, has an outstanding post on the dubiety of the search for universal consensus in bioethics (a subject both near and dear to my heart, and a position which I endorse whole-heartedly):

But it is -- and has always been -- precisely the lack of consensus that has driven many a moral philosopher or theologian to seek a kind of Ethical El Dorado, the one true set of ethical judgments that everyone (purely on the basis of being human) has to agree with. You can see the tendency at work in human rights documents, in international codes of research ethics, and in philosophical treatises. The desire for a universal morality (as opposed to the mores of some particular culture and tradition) seems to express a rage for order, and disgust with seemingly endless and messy ethical disagreement and conflict. Why can't we all get along?

The search for what Rennie terms the Ethical El Dorado, and what Walzer has termed "moral Esperanto," is quixotic, IMO.  It is, to borrow a Wittgensteinian metaphor, an attempt to open doors that are painted onto walls.  Ethics is an extremely messy business; we do not all speak the same moral language.  And given that languages are conceptual schemes in which we actively construct our world, that means we live our lives within divergent moral worlds (yes, yes, this is more Quine than Davidson, but there is no doubt both would agree on the notion of language as a conceptual scheme).  This is not to construct an atomistic notion of the moral life, because, again, as Wittgenstein showed, private languages do not exist.  To speak a language at all is to share some kind of weltanschauung.

We can understand each other; we can work to understand different worlds in context of the languages the inhabitants of those moral worlds speak. 

But we cannot all speak the same moral language.  Hence universal norms of morality are, IMO, chimerical.  But, the typical objection goes, what of justice? Who would disagree that justice is a crucial virtue? And if so, doesn't that show there are some kinds of universal norms? Rennie supplies one of my preferred responses to this line of argument:

The success rate [of the search], at least since Plato, has been abominable. What typically happens is that in order to become potentially universalizable, the set of judgments becomes so abstract as to become meaningless. It is almost as if one climbs a mountain top to transcend human disagreements and conflicts of value, only to find that -- while the panoramic view is great -- you have run right out of oxygen. But if more substantive content is added to the judgments, people start bickering about them again, and the reality of moral diversity comes flooding back.

It is perfectly fine to suppose that consensus could be obtained on an ethical norm at a high level of generality.  But as the tradition of virtue ethics reminds us -- in particular, see MacIntyre -- our moral lives are inherently localized and particular, because we practice our lives in these local, particular worlds.  As the Zen expression puts it, wherever you are, that's where you are.  Thus, the moral issues that arise from abstract commitments to justice only take on meaning in particular cases or contexts.  This is why Paul and Jane may agree perfectly well on the need for justice, but may understand what justice requires in any given case in diametrically opposed ways.

This is a blog post, not an essay, so I'll stop here, other than to note that these kinds of issues are at the core of the approach I plan to take in my dissertation (on pain).  Kudos to Rennie for raising the issue so thoughtfully and succintly.   

On Power, Abuse, and Disability

Kay Olson, proprietor of the outstanding disability blog, The Gimp Parade, has an absolutely phenomenal pathblogographical post up on power, abuse, and disability.  The setting is Kay's initial stint at a rehabilitation hospital following a month-long stay in an ICU.  The post details Kay's requests for help in order to avoid a pressure ulcer, made to a nurse's assistant Kay names "The Russian" (for the assistant's accent):

She understood I needed to be repositioned and she told me she needed to go get another person to help. It is commonly a two-person job in acute care settings and may even be required procedure, but when she didn't return and my butt began to ache badly from laying in one position too long, I rang the bell again.

The Russian returned alone to tell me she was trying to get help, then left again. I don't know exactly how much time passed, though it was easily 30 minutes since my first call for assistance, and it may have been as long as an hour. My butt was throbbing painfully now, sparks of nerve pain shooting down my leg. In desperation, I spent significant energy wrestling the pillow wedged behind my back away enough that I could shift slightly and ease the sharpest of pain to buy some time.

Shortly after, The Russian returned. Again alone. She saw the pillow had been moved and began berating me: "Why you bother me? You don't need help! You did this yourself after bothering me? If I catch you ever moving by yourself again don't expect me to do anything for you!"

Kay's situation was complicated by her limited ability to speak.  She concludes:

Abuse doesn't really need much space to thrive, and it needs even less to occur only once. Probably not everyone would consider this abuse. But it was a verbal threat to deny me assistance while lying helpless in a bed from someone charged to show up if, say, my ventilator quit giving me air. Like any sort of intimate violence (domestic violence, date rape, etc.), violence against disabled people is contextual and opportunistic and can happen to anyone.

The power of narrative is exemplified in this post.  As they say, go read the whole thing. 

On BMI

The critiques over the use of BMI as a criterion for fatness/obesity are not new.  Eric Oliver's excellent book, Fat Politics, which demonstrates the arbitrariness of BMI over the decades, was published in 2005.  ("Arbitrary" is one possible description; "socially constructed" would be perhaps a more descriptive phrase).  Kate Harding has a nice slideshow at Shapely Prose entitled the BMI Project, intended to show just how flawed the measure is as an assessment of fatness and/or obesity.

While the problems with BMI, then, are hardly unknown, these difficulties have not generally translated into scholarship (aside from critical theory) or into media reporting.  In this context comes a strongly worded article in the newest Journal of Health Economics:

Beyond BMI: The value of more accurate measures of fatness and obesity in social science research

Richard V. Burkhauser, John Cawley

Abstract:

Virtually all social science research related to obesity studies a person's body mass index (BMI). Yet there is wide agreement in the medical literature that BMI is seriously flawed because it does not distinguish fat from fat-free mass such as muscle and bone.  This paper studies data that include multiple measures of fatness and finds that many important patterns, such as who is classified as obese, group rates of obesity, and correlations of obesity with social science outcomes, are all sensitive to the measure of fatness and obesity used.

We show that, relative to percent body fat, BMI misclassifies substantial fractions of individuals as obese or non-obese; in general, BMI is less accurate classifying men than women.  Furthermore, when percent body fat instead of BMI is used to define obesity, the gap in obesity between white and African American men increases substantially but the gap in obesity between African American and white women is cut in half.  Finally, total body fat is negatively correlated with employment for some groups and fat-free mass is not significantly correlated with employment for any group, a difference that was obscured in previous research that studied BMI.

In the long run, social science datasets should include more accurate measures of fatness.  In the short run, estimating more accurate measures of fatness using height and weight is not possible except by making unattractive assumptions, but there is also no reason to adhere uncritically to BMI as a measure of fatness.  Social science research on obesity would be enriched by greater consideration of alternate specifications of weight and height and more accurate measures of fatness.

____________________________

It is particularly interesting to note how the social construction of BMI affects prevalence and incidence of obesity among racial groups.  This in turn shows that prevalence and incidence are themselves irreducibly social concepts, and that our beliefs about who has what health status is irretrievably informed by all manner of social, political, and cultural factors.

Call for Papers: Victorian Disability

CALL FOR PAPERS

Special Issue: Victorian Disability

Fall 2009

Submission Date: 15 September 2008

The Victorian Review invites submissions for its forthcoming special issue devoted to Victorian Disability. From the development of new sign

systems for the blind and deaf, to the growth of eugenics, from Dickens’ one-legged man, Silas Wegg, to the disabled communities that populate the fiction of Charlotte Yonge, the Victorians were creating and consolidating ideas of ability, normalcy, difference, health, and illness. This special issue seeks to explore the constructions of ability and disability that circulated in Victorian Britain and abroad.

Recent critical work in Disability Studies has suggested disability as another mode of analysis alongside class, race, gender and sexuality in the understanding of culture. How can a focus on ableness complicate traditional readings of gender, class, race, and sexuality in the period? We particularly invite submissions that engage with the challenge that Disability Studies poses for the future of Victorian Studies. To what extent might Disability Studies pressure conventional disciplinary boundaries? How might we approach Victorian Disability Studies while recognizing that the term "disability" and the meanings we now grant to it as a general category did not exist in the Victorian period?

Possible topics may include (but are not limited to):

• The Representation of Disability in Victorian Literature
• Disability and Cultural Production (blind poets, deaf artists)
• Disability and the Practice of Reading Disability
• Communities and Cultures
• Medicine and Disability
• Social Darwinism and Eugenics
• Industrialization and Disability
• The Materiality of Disability (canes, wheelchairs, ear trumpets)
• The Languages of Disability (Braille, Sign)
• Celebrity and Disability
• The Spectacularisation of Disability
• Health, Disability and Invalidism
• The Institutionalization of Disability (educational, governmental and charitable)

Essays must be between 5000 and 8000 words and formatted according to MLA guidelines. Please submit electronic copies of essays to both of the issue’s guest editors by September 15, 2008:

Christopher Keep

Department of English

The University of Western Ontario

ckeep@uwo.ca 

Jennifer Esmail

Department of English

Queen’s University

3je@queensu.ca 

(h/t H-NET-DISABILITY)