Medical Humanities Blog

On Fatness & Health

Perhaps because I read Gary Schwitzer's blog and quality assessment project so avidly, I am somewhat down on the quality of much health journalism, in the West, at least.  But every now and then, I read a terrific article that renews my faith.  One such article, authored by Margaret Wente, appeared in the Globe and Mail, a Toronto-based publication.  The article takes an unusually (for media, I think) critical look at the epistemology of the fatness-health connections.  It is quite well-written, and while I do not endorse the entire article, I absolutely appreciate the critical tone of the writing and the arguments adduced therein.  The article models, in many ways, some of the best and most persuasive academic writings in the critical obesity scholarship.

Some excerpts:

Thin was always in. But now, the social and public-health message is that fat is not simply a sign of sloth. It kills. The obesity epidemic is the greatest health crisis of the age. According to various health statistics (which are never consistent), between 17 per cent and 25 per cent of Canadian adults are obese. Thirty-six per cent of the adult population is overweight, or maybe two-thirds. Whatever. It's a catastrophe.

But is it? A new study based on Statistics Canada population data reaches an exceedingly awkward conclusion: People who are overweight live longer than people who are classified as “normal” weight. Not only that, people who are classified as significantly overweight also live longer.

(For the record, thin was most assuredly not always "in."  Quite the contrary, in fact.  But it has been so for much of the 20th century, at least in the U.S.)

[ . . . ]

“Overweight may not be the problem we thought it was,” said David Feeny, a senior investigator at Kaiser Permanente Center for Health Research in Oregon, almost apologetically. “Overweight was protective.” He added that agencies such as Health Canada might want to rethink the way they classify people's weight.

It is remarkable to see an academic investigator working on obesity research publicly allow as such.  Perhaps there is hope.  Indeed, as Wente notes,

Is this study just a fluke? On the contrary. It confirms the findings of dozens of other large population studies that rarely get publicity. They all conclude that being overweight is not a problem, except at the extreme. In fact, a little extra padding is good for you.

Many of these studies are documented in Gard and Wright's fine book on the subject.  Last excerpt:

In 2005, another researcher, Katherine Flegel, of the U.S. Centers for Disease Control and Prevention, published another large study with similar findings. Prominent health experts were outraged, calling the research flawed. “There's not a lot of money in trying to debunk obesity, but a huge amount in making sure it stays a big problem,” Patrick Basham, a professor of health-care policy at Johns Hopkins University, told The Associated Press.

Indeed.  

Go read the whole thing.  Thoughts?

(h/t SDOH Listserv) 

Call for Applications: Communicative Barriers between Biomedical Research and Everyday Health Care in a Museum Context

Medical Museion, University of Copenhagen, invites applications for a 3-year PhD/2-year postdoc position in the project ‘Communicative barriers between biomedical research and everyday health care in a museum context.'

The increasingly important role of biomedical knowledge and advanced medical technologies in Western health systems is a challenge to the public communication of and engagement with medicine, especially in science, technology and medical museums. This project aims to develop the understanding of the means through which esoteric biomedical and medico-technological knowledge and practices can be communicated to lay people in a museum exhibition context, with special emphasis on the use of material and visual cultural practices. The project is expected to help construct new physical and web-based exhibition and display practices for science, technology and medical museums.

Medical Museion is an integrated research and museum institution that focuses on the public engagement with the contemporary biomedical sciences. We are especially interested in the interface between biomedicine, material and visual studies, museum studies and studies of the participatory web. See www.corporeality.net/museion.

The salary level for a PhD-candidate in Denmark is 295,000 DKK (approx. € 39,600/ £ 34,000) p.a.

The salary levels for a postdoc is 370,000 DKK (approx. € 50,000 / £
42,000) p.a. upwards (depending on earlier experience).

The position is part of a larger cross-faculty research program ‘Dissemination and Innovation: Health in Everyday Life’, which in turn is part of a newly established Center for Healthy Aging at the University of Copenhagen (see http://healthyaging.ku.dk).

Applications for the postdoc level shall include CV and publication list; short description of background and motivation for choosing this research project; project description (max. 5 pages); and copies of degrees.

Application for the PhD level shall include a CV; short project proposal (max. 2 pages); academic transcripts; and copies of degrees.

Deadline is 1 September, 2009 at 14.00. Applications must be submitted electronically and in print (4 copies) to:

Assoc. prof. Lene Otto, Section of Ethnology, the SAXO Institute Faculty of Humanities, Njalsgade 80 DK-2300 Copenhagen, Denmark lotto@hum.ku.dk,

Further information can be obtained from Professor Thomas Söderqvist, ths@sund.ku.dk, or +45 2875 3801.

For the full text of the announcement in context, see http://healthyaging.ku.dk/vacancies.

(h/t H-SCI-MED-TECH)

On Fatness & Disability

An intriguing new article is available for full-text download on SSRN.  The article is written by Jane Byeff Korn (Univ. Arizone - Law), and is entited Too Fat.

Here is the Abstract:

No one wants to be fat but many Americans are obese. Although people who are obese are often discriminated against, they have had little or no protection under the Americans with Disabilities Act (“ADA”). The recently enacted Americans with Disabilities Act Amendments Act (“ADAAA”) promises to make recourse more readily available to people with disabilities who feel they have been discriminated against. Despite the intention of the ADAAA to provide a broad scope of protection, it will provide no more relief to people who are obese than the prior version of the Act. Although we do not know the cause of obesity, we blame the person for being obese and refuse to see this as a disabling condition.

A quick skim through the article suggests it is eminently worth reading, although I would have liked to have seen much more attention paid to the notion that "we do not know the cause of obesity," especially since, as it turns out, we know much less about the consequences of non-morbid obesity than is often reflected in both lay and professional discourse.  Still, the article spends quite a bit of time discussing stigma, as it should.

Finally, I do not necessary agree that "no one wants to be fat."  Of course, we are socialized at a profound level to believe this, but part of the point in subjecting discourse and attitudes about fatness to critical reflection is to, if you will pardon the pomo term, destabilize that position.  Thus, some, in fact, are quite happy being fat.

Thoughts?

On Renaissance Networks

Ann Moyer (History -- Univ. of Pennsylvania) has a wonderful review up on H-Net of Paul McLean's recent book, The Art of the Network: Strategic Interaction and Patronage in Renaissance Florence.  Many aspects of this review should be of interest to a medical humanities audience.

Moyer notes:

To get things done, then, required knowing whom to ask; it also required that the petitioner have something to offer, whether now or later, tangible or intangible, to repay the favor. And of course these urban citizens lived their lives embedded in a number of relationships of different sorts: family, profession, neighborhood, political party, and so on, to a very long list of social groupings and obligations, any or all of whose members might hope to make claims on one another over the course of a career or a lifetime.

These matters are exactly what the studia humanitatis were targeted towards: a practical engagement with the world.  But not simply any practical engagement will suffice; virtuous engagement is needed, and the studia humanitatis was intended to facilitate.  This is in part why the apparent belief that the humanities are impractical vexes me no end.  If this belief is actually accurate -- if the humanities as currently practiced are in fact disengaged and impractical, then those of us responsible for such practices are abandoning the hopes, lessons, and programs of our forefathers.

Thus, Moyer notes that

McLean’s specific focus on Florentine letters of recommendation and request then leads him to look at the role of the humanist educators who set a high standard for quality of writing and dispensed rules about the specifics. These men helped establish formal norms for such letters, and the literary skills they imparted aided Florentines in both composing and reading such letters strategically.

It is no accident that so many humanists and humanistically-educated personages were active participants in social and political life as diplomats, jurists, couriers, advisors, officials, attorneys, professors, etc.

More from Moyer:

[McLean] argues that good letter writers were able to give a shape in their letters to the ongoing relationship between author and recipient, such that the request and its granting would, it was hoped, ring true with the recipient and inspire him to undertake the desired action. The rhetorical tools of the humanists, along with their goals of shaping people’s understanding of their world and bringing them to appropriate action within it, thus had a major role to play in the lives of scholars and of middle-class Florentines. As McLean notes, in Florence these tools served not only social ends, but political ones as well; indeed, political and social goals often overlapped.

These considerations are why I continue to believe that those of us interested in the medical humanities should ground our work in an historically and philologically informed understanding of those who mediated antiquity into the educational program we continue to call the humanities.  There is, if not an essence to the humanities, at least a set of family resemblances that can shed a great deal of specific light on the nature and potential goals of the interdiscipline.  And those resemblances emerge in important part from examination of the humanists, the studia humanitatis, and the local social worlds in which these conversations took place.

Thoughts?

(H/T H-SCI-MED-TECH) 

On the Anatomy Lesson of Dr. Nicolaes Tulp

It has been far too long since I have posted anything in the Imaging the Medical Humanities series.  Having recently returned from Europe, including some time spent in the Netherlands, I thought this might be a nice opportunity to look at one of the countless masterpieces of Rembrandt van Rijn, this one focused on anatomy.

(image courtesy of Wikimedia)

In addition, I am currently making my way through Harold Cook's fascinating account of medicine, commerce and science during the Dutch Golden Age.  Chapter 5 of the book features an extended discussion of Dr. Tulp's life and career.  One of the themes of the book, one critical to the development of early modern science and medicine (and the medical humanities), is the interplay between commerce, natural investigations of the New World, and the rise of what A. Richard Turner refers to as the Eye/I, the linkage between the increasing focus on what the investigating Eye could see and the construction of the scientific self.

This relationship continues to have powerful reverberations; for an excellent analysis of this dynamic in context of the history of objectivity, Lorraine Daston and Peter Galison's recent book is superb.  Daston and Galison touch on many of the same themes as Cook, though in different ways, and it is hence no accident that both of them spend a great deal of time writing about botany.  Botany, as a critical part of materia medica and the Renaissance/early modern interest in Dioscorides, ties together commerce, medicine, science, the New World, and the Eye/I.

I was therefore intrigued but ultimately unsurprised to learn from Cook that Dr. Nicolaes Tulp did indeed take the professional surname "Tulp" from the flower for which Amsterdam is famous, and imprinted the image outside his home and business.

On Radiation Sickness & the Politics of Nuclear Energy

WORKSHOP, 'Radiation Sickness and the Politics of Nuclear Energy:
Cold-War Science, Technology and Medicine in Japan, USA and Britain'

14-15 August 2009

Needham Research Institute
8 Sylvester Road
Cambridge
CB3 9AF
United Kingdom

PROGRAMME

14 August
9.30-9.45
Registration

9.45-10.00
Welcome

10.00-11.30
Session 1

Chair: Gerald Kutcher

10.00-10.30 Keith Baverstock, Department of Environmental Science, University of Kuopio, Finland

A UK Historical Perspective on Radiation Induced Disease

10.30-11.00
Sue Rabbit Roff, Centre for Medical Education, Dundee Medical School, UK

De-constructing the Historiography of Denial of Government Liability for Health Effects of Participation in UK Atomic and Nuclear Weapons Tests

11.00-11.30: Discussion

11.30-13.30
Lunch

13.30-15.00
Session 2

Chair: Angela N. H. Creager

13.30-14.00
Yukuo Sasamoto, Independent scholar, Tokyo, Japan

Investigations of the Atomic Bomb under the Occupation

14.00-14.30
Emm Barnes, Royal Holloway, University of London, UK

Fears in Peacetime - American and British Responses to Japanese Studies on Children Exposed to Radiation, 1948-1969

14.30-15.00: Discussion

15.00-15.30
Coffee

15.30-17.00
Session 3

Chair: Masakatsu Yamazaki

15.30-16.00
Jeff Hughes, CHSTM, University of Manchester, UK

Medicalising Nuclear War: The National Health Service and the Bomb 1948-1960

16.00-16.30
Jacob Darwin Hamblin, Oregon State University, USA

Critical Pathways not Taken: Divergent Meanings of Radioactive Contamination in the Nuclear Era

16.30-17.00: Discussion

15 August
9.30-11.00
Session 4

Chair: Emm Barnes

9.30-10.00
Gerald Kutcher, Department of History, Binghamton University, USA

Radiation Sickness in Cold War Cancer Therapy and Military Medicine

10.00-10.30
Angela N. H. Creager, Princeton University, USA

Radiation in Sickness and in Health

10.30-11.00: Discussion

11.00-11.30
Coffee

11.30-13.00
Session 5

Chair: Martin Dusinberre

11.30-12.00 Masakatsu Yamazaki, Graduate School of Decision Science and Technology, Tokyo Institute of Technology, Japan

The Impact of the Bikini Incident in 1954 on the Japanese Science Community and Nuclear Politics

12.00-12.30 Aya Homei, Needham Research Institute and Department of East Asian Studies, University of Cambridge, UK

Radiation Sickness and the US-Japan Medical Cooperation in the Lucky Dragon Incident

12.30-13.00: Discussion

13.00-14.30
Lunch

14.30-15.30
Session 6

Chair: Aya Homei

14.30-15.00
Martin Dusinberre, Newcastle University, UK

Hatoko Comes Home: Atomic Energy and Contentious Sites in post-war Japan

15.00-15.30: Discussion

15.30-16.00
Coffee

16.00-16.30
Final discussion and closing remarks

Attendance is free, but please contact Sue Bennett (Tel:
+44-(0)1223-311-545, E-mail: admin@nri.org.uk) or Aya Homei (Tel:
+44-(0)1223-311-545, ext. 237, E-mail: ah567@cam.ac.uk) in advance if
you wish to attend.

__________________________________________

(h/t H-SCI-MED-TECH)

On Minds, Brains, and Norms

At the UCL Law & Neuroscience Colloquium, I had the pleasure of meeting Mike Pardo, a law professor at the University of Alabama who apparently shares some of my skepticism at the reductionist tendency to equate brain with mind.  Pardo, along with one of preeminent American philosophers of law, Dennis Patterson, recently wrote an excellent rebuke to neuroreductionism that addresses and critiques many of the foundations of the conventional approaches to law & neuroscience.  We covered the article at MH Blog here, and you can find further discussion of it here, at Adam Kolber's fine Neuroethics & Law Blog.

Pardo informed me that he and Patterson had written another article extending their analysis, and that this article is forthcoming in Neuroethics.  Via the Professor, I learned that a draft of the article is available for (full-text) download from SSRN.  Anything written by Pardo & Patterson on this subject is a must-read, in my view.  Here is the Abstract:

Arguments for the importance of neuroscience reach across many disciplines. Advocates of neuroscience have made wide-ranging claims for neuroscience in the realms of ethics, value, and law. In law, for example, many scholars have argued for an increased role for neuroscientific evidence in the assessment of criminal responsibility. In this article, we take up claims for the explanatory role of neuroscience in matters of morals and law. Drawing on our previous work together, we assess the cogency of neuroscientific explanations of three issues that arise in these domains: rule following, interpretation, and knowledge. We critique these explanations and in general challenge claims as to the efficacy of the neuroscientific accounts. 

On Challenges to the Image of Humanity and Human Dignity by New Developments in Medical Technology

Blogging is slow because I am currently at the University of Bielefeld in Germany, as part of a Research Group in the Center for Interdisciplinary Studies.

The topic for the Research Group is the title of this post, and centers on the implications of novel technologies for the concept of human dignity and the image of humanity.

Generally, as readers of this blog know, I tend to think that ethicists spend too much time and energy thinking about high technology that (1) often has a tenuous (and sometimes even deleterious) connection with population health; and (2) is only relevant to developed countries.  But the opportunity to participate in a truly interdisciplinary group was important to me, and as there will be opportunities to discuss some of my work related to novel imaging techniques, and how the flaws of principlism reflect on the concept of human dignity,here in Bielefeld I sit.

Over the course of the next year, I will update the activities and progress of the Research Group here at MH Blog.

Regular blogging resumes next week.

On Law & Neuroscience

I'm currently in London, contributing to and participating in the Fourteenth University College London Current Legal Issues Colloquium, this one on Law & Neuroscience.  I will be speaking on the power of the visible as it relates to neuroimaging and American legal culture.

Being at UCL is doubly nice, as it gives me excuse to check out the Wellcome Library and the Wellcome Centre, both of which I have been dying to see for some time.

The program for the Colloquium is available here (*PDF), and, as always, I am honored to meet any readers of MH Blog.

On Eugenics and History (II)

I have the privilege of corresponding, from time to time, with historian of eugenics Gie van den Berghe, a professor at the University of Ghent.  I reprint below his comments on my recent post on eugenics and history:

You call Oliver Wendell Holmes' line 'Three generations of imbeciles are enough' "infamous", but that is how we judge it here and now. In fact it was, seen in its time, a courageous and logical standpoint (and of course not only the decision of Holmes but of the almost unanimous Supreme Court). So his/their decision shouldn't, in my opinion, so much be admired ('Holmes was nevertheless ready, willing, and able to utter the infamous line') then understood.

"We have seen more than once that the public welfare may call upon the best citizens for their lives. It would be strange if it could not call upon those who already sap the strength of the State for these lesser sacrifices, often not felt to be such by those concer­ned, in order to prevent our being swamped with incompetence. It is better for all the world, if instead of waiting to execute degenerate offspring for crime, or to let them starve for their imbecility, society can prevent those who are mani­festly unfit from continuing their kind. The principle that sustains compulsory vaccination is broad enough to cover cutting the Fallopian tubes. Jacobson v. Massachusetts, 197 U.S. 11. Three generations of imbeciles are enough".

 Generally one cites only this part of 'The Supreme Court Opinion in Buck v. Bell' (or some extract of it), but the Opinion continues and ends by the following line:

 "But, it is said, however it might be if this reasoning were applied generally, it fails when it is confined to the small number who are in the institutions named and is not applied to the ultitudes outside. It is the usual last resort of constitutional arguments to point out shortcomings of this sort. But the answer is that the law does all that is needed when it does all that it can, indicates a policy, applies it to all within the lines, and seeks to bring within the lines all similarly situated so far and so fast as its means allow. Of course so far as the operations enable those who otherwise must be kept confined to be returned to the world, and thus open the asylum to others, the equality aimed at will be more nearly reached."

This kind of argumentation had been employed in the 1920s by several eminent American and European men, frequently with a reference to the many thousands young, vigorous men who had died or ho were mutilated during the devastating Great War. In 1920, in Weimar Germany, the reknowned jurist Karl Binding and doctor Alfred Hoch pleaded wit this and other arguments for the 'euthanasia' for so-called lifes unworthy of life (Die Freigabe der Vernichtung lebensunwerten Lebens), and Adolf Hitler did the same in 1924 in the first part of his Mein Kampf.

his is not to claim that Nazism was founded on Darwinism. There is no direct link, but indirectly one can trace a kind of reasoning about asocial, marginal 'elements' in one's community, a community that was seen as of much greater importance than the individual. The people (Volk), the nation, the body of the nation (Volkskörper in German) had to be saved of the contaminated, rotten cells/individuals it contained. This kind of thinking generated in Great-Britain, shortly before Darwin wrote his 'On the origin of species' (1859) - think for instance of Herbert Spencer. And after the publication of Darwins masterpiece, more and more thinkers, such as Francis Galton, adopted it. Now that the motor of evolution, natural selection, was discovered, one was afraid that the biological evolution, this progress of the human species, was countered or even stopped by Civilisation. A civilisation who not only kept in live marginals that Nature normally would have eleminated (poor laws, medicine, hospitals, asiles), but even made possible that these unfit breed and multiply themselves at a faster rate then the fittest specimens of the nation.