Up@dawn 2.0

Tuesday, March 20, 2018

Final solo reports

(Midterm reporters: unless I've indicated otherwise to you, claim 20 runs for your report in your logs and on the scorecard. Those who prepared report slideshows, please post them if you can... via Slideshare.net, perhaps.)
Final solo reports consist of a presentation (with quiz & discussion questions, beginning on April 10-see below*) and two blog post installments. 1st installment due no later than April 24, though you may find it useful for your presentation to post earlier. 2d installment due May 1. (Think of it as parts one and two of a single report, with part two including your reaction to any constructive feedback you received to part one.)

Choose any relevant topic. You may continue to explore your midterm report topic, if you wish.

Everyone should comment on at least two classmates' 1st report installments, and document that you have done so: include links to the reports you've commented on, in your own report.

Top 3 run-scorers are exempt from a 2d installment, but may still post for extra credit.
*T 10 - Final report presentations begin: Vincent, Kimberly, Kyle, Jonathan, Logan.

Th 12 - Chelsea Able, Shay Linell, Kayla Bean, Ana Aponte-Berrios, Ilija Zecevic

T 17 - Iman Abdel Khalek, Selwa Kanakrieh, Yazan Musleh, Alex Knight, Kimberly Warren

Th 19 - Zach Nix, Brittney Davis, Tariq McGruder, Clorissa Campbell, Cameron Oldham

T 24 - Joseph Churchill, Katelyne Tatum, Andrew Bunch. Last class, Exam 3, Final solo report post installment 1 due, turn in personal logs, top three run-scorers identified

T 1 - 2d final solo report blog post due from all but three top run-scorers

Monday, March 19, 2018

Brave New World related to medicalization and pharmaceuticalization

Medicalization: Current Concept and Future Directions in a Bionic Society

Antonio Maturo, Ph.D. in Sociology*


The manipulation and transformation of human nature by biomedical technology is increasing. As Foucault (1976[]) stated in the 1970's the sovereign-power of death (of giving death to people) has been replaced by the power of the State to give and improve life: biopower (and the welfare State is the main example of this). According to the Foucauldian scholar Nikolas Rose, molecular manipulation is the main trait of our society:
The “style of thought” of contemporary biomedicine considers life at the molecular level as a group of intelligible vital mechanisms which can be identified, isolated, manipulated, mobilized and recombined in intervention practices which are not constrained by the apparent normativity of a natural vital order (Rose, 2006, p.9[]).
Therefore, it can be said that we are living in a society which is becoming increasingly bionic. That is, biology and genetics are seen as the main forces which affect human life, with social factors playing a minor role. Medicalization, and its developments, is the main component of the bionic society of today.
Medicalization can be defined as the process by which some aspects of human life come to be considered as medical problems, whereas before they were not considered pathological. In sociology, medicalization is not a “new” concept. Forty years ago Ivan Illich (1973[]) made an accurate analysis of the iatrogenesis of many illnesses. The word iatrogenesis comes from the ancient Greek and means “originating from a physician/treatment”. According to Illich, social iatrogenesis is the proliferation of diseases caused by the extension of medical categories on everyday life. One practical example of social iatrogenesis given by Illich is the lowering of levels of tolerance for psychological discomfort or sadness, which brought about a steady increase of the diagnosis of depression (Horwitz and Wakefield, 2009[]). In the same period, Foucault (1976[]), considered the process of indefinite medicalization to be one of the main features of society. He stressed the role of doctors in deciding what was normal and what was pathological. In the words of Zola:
From sex to food, from aspirins to clothes, from driving your car to riding the surf, it seems that under certain conditions or in combination with certain other substances or activities or if done too much or too little, virtually anything can lead to medical problems (Zola, 1982, p. 49[]).
In more recent times, Peter Conrad (Conrad, 2007[]) has proposed to consider medicalization in three respects:
  • Conceptual medicalization: When medical lexicon is used to define non-medical entities (for example, the natural drooping of breasts after pregnancy diagnosed as “mammary ptosis”);
  • Institutional medicalization: When physicians have the power to steer non-medical personnel – what Eliot Freidson called “professional dominance” (Freidson, 1970[]; for example, physicians being managers of hospitals without having any academic title in management or business administration);
  • Interactional medicalization: When the physician, in interaction with the patient, redefines a social problem into a medical one (for example, homosexuality was listed as a pathology in the DSM until 1983).
Yet, according to Conrad, there are also other “engines of medicalization”. These engines are consumers, biotechnology and managed care.

Engines of Medicalization


Consumers are a factor of medicalization because health is increasingly becoming, and has become, a commodity (Turner, 2004[]). People are increasingly using medical terminology in order to analyse their own health influenced from watching TV and browsing the internet (Barker, 2008[]). Also, advertisements encourage people to consider health needs that otherwise they would not have thought about. New social representations of health and illness are emerging, for instance, the representations of idealized beauty and the parallel “treatments” of cosmetic surgery. The body is increasingly considered as a “text” through which people may transmit signals and information (Turner, 2004[]).


Technology is a driving factor of medicalization for many reasons. First, new diagnostic tools mean more chances to discover illnesses. Yet, often the risk factors are considered as pathological and therefore treated. Sometimes, the “discovery” of new diseases is done by pharmaceutical firms which also have the “right” treatment (‘disease mongering’).

Managed care

Managed care is also a force of medicalization. For instance, considering depression as a condition caused by a chemical imbalance legitimates a treatment based on pills rather than on expensive psychotherapy (Barker, 2008[]). On these bases, social problems are transformed into medical ones. In the US, according to Conrad:
It seems likely that physicians prescribe pharmaceutical treatment for psychiatric disorders knowing that these are the types of medical interventions covered under managed care plans, accelerating psychotropic treatments for human problems (Conrad, 2007, p. 141[]).
In the US, in 1997, laws regulating pharmaceutical advertisement became less restrictive which resulted in the expenditure for prescription drugs ads to increase four times between 1998 and 2007 (Murray, 2009[]). The increase in advertising has also strongly stimulated disease mongering, which is the “invention of illnesses” (Moynihan e Cassels, 2005[]). A commonly used strategy in the advertisement for drugs is the overstatement of the risks of certain situations which mislead consumers. People are increasingly encouraged to discover some diseases through a self-diagnosis based on a check-list (Jutel, 2009[]).

From Medicalization to Pharmaceuticalization?

The use of pharmaceuticals and medicalization are not the same thing. Some aspects of medicalization are not directly connected to the use of drugs: conceptual and interactional medicalization, for instance (Conrad, 2009[]). Moreover, there are situations of medicalization which do not include the consumption of pharmaceuticals as their main feature, even if pharmaceuticals have been used in those situations. This is the case of the medicalization of death, the medicalization of pregnancy and the medicalization of beauty. There are even pathological conditions in which the treatment is neither a pharmacological one nor a medical one strictly speaking, but require the patient to comply with a specific regimen or way of life. A typical example of this is coeliac disease, which is caused by a reaction to gliadin, a prolamin (gluten protein) found in wheat. At present, the only effective treatment is a life-long gluten-free diet.
According to Abraham (2010[]), the socio-cultural aspects of pharmaceutical consumption have peculiar features which cannot be properly analysed by the medicalization framework; therefore, he proposes the concept of pharmaceuticalization. Pharmaceuticalization can be defined as “the process by which social, behavioral, or bodily conditions are treated, or deemed to be in need of treatment/intervention, with pharmaceuticals by doctors, patients or both” (Abraham, 2010, p. 290[]). Main examples include: the treatment of mood by anxiolytics or antidepressants, treatment of ADHD with Methylphenidate (e.g., Ritalin®) and treatment of erectile dysfunction with Sildenafil citrate (e.g., Viagra®). In addition, even the treatment of heart-disease risk factors with cholesterol-lowering drugs, such as statins, may be considered an example of pharmaceuticalization. It should be noted that all the conditions mentioned above could also be treated in non-pharmaceutical ways – as they were in the past. The treatments could be medical, such as a psychotherapy, or non-medical, such as a change in lifestyle.
Among the factors that have fostered pharmaceuticalization, Abraham proposes to consider three main causes: the political economy of the pharmaceutical industry, the deregulatory state ideology, and consumerism. While the concept of consumerism has already been described, the other two factors deserve particular attention.
Abraham (2010, p. 299-301[]) describes “deregulatory state ideology” as the pharmaceutical legislation in the EU, North America, Australasia that requires manufacturers to demonstrate the quality, safety and efficacy of their products (but not their therapeutic advance) in order to have a new drug approved by regulatory agencies. Therefore, there can be pharmaceutical innovation without therapeutic advance. As stated by Donald Light:
When pharmaceutical companies say a drug is “effective” or “more” “effective,” they usually mean more effective than a placebo, not more effective than existing drugs. (Light, 2010, p.7[]).
Pharmaceutical companies are increasingly investing in advertising and marketing and decreasing their financial efforts devoted to research for new therapies (Angell, 2004[]). As said, an important component of marketing campaigns is advertising: “direct-to-consumer advertising does not simply attempt to sell particular products but strives to reshape consumers’ understanding of their problems into conditions that should be treated by medications” (Horwitz, 2010, p.110-111[]).
It is not only the loosening of advertising restrictions, marketing campaigns and consumerism that foster pharmaceuticalization and medicalization. Science also plays a great role in legitimising this tendency. For example, as it is shown in the next section, the Diagnostic and Statistical Manual of Mental Disorders, by giving the description of many mental disorders in terms of symptoms, strongly suggests pharmaceutical treatments.

Normality and pathology in mental health

Mental health is likely the most medicalized aspect of human life. Emotions like sadness and shyness, if framed through a pathologizing gaze, can easily be turned into illnesses (Maturo, 2010a[]). It is hard to believe that 6% of the population in Great Britain meet the criteria for major depressive disorder at any time (Scott and Dikey, 2003[]) and even harder to believe that more that 5% of Americans suffer from bipolar disorder: “Awareness among general practitioners and psychiatrics that the broad clinical spectrum of bipolar disorders probably affects 5% of the population – rather than the often quoted figure of 1% – is regrettably low” (Smith, Ghaemi and Craddock, 2008, p. 398[]).
The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the commonly used basis for any mental disorder diagnosis. While the first two editions of the DSM were characterized by a strong theoretical view, mainly based on psychoanalysis, DSM-III and, even more, DSM-IV, try to be atheoretical and symptom-based. Thus, in the two last versions of the DSM, the psychiatric nosography became more and more descriptive and standardized, although not value-free (Fulford, 2010[]). To define an illness, the emphasis was put on symptoms, while causes were neglected. [Of course one may say causes were not neglected; they are simply not known, since ‘etiology unknown’ is still the hall-mark of psychiatry.] The focus of DSM-III and DSM-IV therefore shifted from illnesses to disorders and syndromes – the latter being multiple symptoms. The key-assumption of this “diagnostic psychiatry” is that “overt symptoms indicate discrete underlying diseases. Whenever enough symptoms are present to meet the criteria for a diagnosis, a particular mental disorder exists” (Horwitz, 2002, p. 106[]). Therefore the main consequences of the latest version of the DSM are reductionism and the proliferation of disorders (by shifting from illnesses to syndromes, the complexity of mental illness is reduced, because it coincides with its symptoms and virtually almost everything may be considered pathological), and the likeliness of pharmaceutical treatment (if disorders become more easily identifiable and cognisable it becomes easier to associate them with a specific therapy, and if the task of psychiatry is to relieve symptoms, then medicines are the best way to do so). This trajectory puts psychiatry together with all the other medical specialties, aligning mental illness with any other kind of biological disease.
It is not possible to demonstrate that corporations are involved in the designing of the DSM, but, in describing the onset of the medicalization of mood, Horwitz and Wakefield present a good point:
There is no evidence that pharmaceutical companies had a role in developing DSM-III diagnostic criteria. Yet, serendipitously, the new diagnostic model was ideally suited to promoting the pharmaceutical treatment of the conditions it delineated (Horwitz and Wakefield, 2007, p.182[]).

Risk in the Theoretical Discourse

Presently, the concept of risk seems to be very important in contemporary society. According to many scholars we have passed from a society dominated by dangers to a society dominated by risks.
According to Douglas (1992[]), risks are the outcome of human actions, while dangers have to do with the unpredictability of nature. If damages can be seen as a consequence of a decision of ours then we can speak about risk; if damages are caused by something overcoming our will, something “external”, then we can speak about danger. To use an extreme example: while in the past, falling ill with cancer was a danger, nowadays, thanks to the screening technology, falling ill with cancer has become a risk of a missed prevention. To view it in a different way, Luhmann (1993[]) wrote that when man discovered the umbrella, rain was not a danger anymore but a risk. Another important feature of risk is calculability: the word “risk” has its origin in the field of insurance, and therefore one of its main connotations is the likeliness of an event to occur.

Risk and health

In the discourse on health, risk may be connected to the individualization of social problems, biological reductionism, and the shifting borders between normal and pathological. As it will be shown in the next pages, it can be easier for political institutions to embrace a clinical and biological definition of a disease instead of addressing the social causes underlying these pathological conditions. Considering illness as an external risk, the responsibility to avoid it is shifted from social policy to the individual, despite pathology being strongly connected to social and economic conditions. Nowadays, health is increasingly considered an individual responsibility. People should avoid smoking, becoming overweight, and they are also encouraged to push back the ageing process as much as possible. Therefore, prevention is socially constructed as an individual duty. Moreover, huge investments in diagnostics and genetics have led to neglect of social causes of diseases, and to consider them only in biological terms (Clarke and Shim, 2011[]). Although many researchers have demonstrated that in rich countries social determinants are more influential in health status than an increase in health expenditure, social and economic conditions are seldom mentioned in biomedical discourse on health (Link and Phelan, 2010[]). It is cheaper, and simpler, to label an unruly child as someone suffering from a chemical imbalance instead of taking other factors into account: the possible unemployment of parents, poverty of the neighborhood, or other issues in the family. If we consider depression as the effect of the lack of serotonin in the brain, instead of the natural and normal answer to a condition of deprivation and stress, we implicitly reject the role of social policy. As Barker puts it:
It is far more politically expeditous to make claims on the welfare state (even the miserly US welfare state) to address discrete medical needs of homeless patients, than it is to fulfil the rights of homeless citizens to housing and employment. Again in the US context, it is more politically palatable to expand State Children's Health Insurance Program (SCHIP) than it is to address what sociological research consistently demonstrates to be the single best predictor of children's current and future health status; namely, social class (Barker, 2009, p. 101[])
Doing so, an individualistic and neoliberal view of society is legitimised, in which the State has increasingly less responsibilities for citizens’ welfare. Moreover, the emphasis on a healthy lifestyle may be misplaced. There is evidence that the “cause of causes” of illness is the socio-economic status (Link and Phelan, 2010[]). The connection between lifestyle and health, on which the risk-factor model is based, is only one side of the etiological link between health and society. The risk-factor model's explanation for health inequalities proceeds according to a seemingly persuasive logic: “social conditions are related to health because of their influence on a host of risk factors that lie between social conditions and disease in a chain of causality” (Link and Phelan, 2010, p. 3[]). What is lacking in the risk-factor model is that social and economic conditions powerfully shape the capacity to modify or eliminate identified risk factors. They put people “at risk of risk”. It is difficult to eat expensive organic food if you are unemployed. Perhaps people are not inclined to jog if they live in an urban sprawl close to the junction. And it is easier to quit smoking if you are a member of Harvard soccer team than a member of a gang in a Brazilian slum.
There are two more features of the idea of risk that should be mentioned. The first one is connected to the threshold. One of the most effective ways to widen the pathological sphere is to alter the threshold level. It is by lowering the threshold at which someone is considered “pre-sick” that prevention has been medicalized. The main examples of the medicalization of prevention is hypertension. Blood pressure rises with age and is one of the several factors that can increase the risk of stroke:
But because blood pressure is amenable to drugs, a world of marketing and guidelines developed around it. What constitute “high” blood pressure is open to opinion, and the US guidelines set by expert panels have periodically lowered the criteria so that millions of more people are labelled as ‘having hypertension’, or now ‘prehypertension’, and being ‘at risk’ of heart disease (Light, 2010, p. 22[]).
The second feature is a distorted idea of causality. An example of this distortion is the concept of genetization: the tendency to consider genes as the main factor responsible for any kind of condition. In this kind of reductionism: “a complex understanding of the causes of human development is displaced by one in which genes are perceived as the ‘true cause’ of difference” (Shostak and Frese, 2010, p. 419[]). Research has demonstrated that genes are “our destiny” only in a few cases (Maturo, 2009b[]).

Human Enhancement and Biomedicalization

In the debate on medicalization, a new topic has emerged in the last years: the opportunity of using biotechnology – mainly drugs – not to treat pathology, but to enhance normal conditions. Human enhancement can be defined as the use of biomedical technology to improve (physical, cognitive, emotional or social) performance on a human being who does not need any cure (Maturo, 2009a[]). Human enhancement is part of the concept of biomedicalization proposed by Clarke and Shim (2011[]). Biomedicalization differs from the concept of medicalization because it takes into consideration the aspect of human enhancement and also the role of pharmaceuticalization in contemporary society (Cipolla, 2010[]).
Indeed, the topic of human enhancement has everything to do with the shift of medicine, or a section of it, from the treatment of pathologies to the optimization and possibility of going beyond normality: better than well. Some examples of human enhancement are: prosthetic limbs, cosmetic surgery, and emotional and cognitive enhancement through pharmaceuticals. The line between the medicalization of pathologies and the enhancement of normality is blurred, as there are actions carried out at the borders that do not fall into either category. Moreover, it is likely that the enhanceable of today becomes the pathological of tomorrow, which brings about an ever-broader area in which biomedical interventions are required [Figure 1].
Figure 1
Flowchart of paper

Concluding Remarks: Are we Heading toward a Bionic Society?

The World Health Organization definition's of health as a “state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (WHO, 1946[]) has been often criticized because it proposes an extremely wide and ambitious concept of health. An edenic idea of health! Instead, it seems that today these three dimensions – body, psyche and society – are fully involved in the medicalization process. Moreover, health should be considered more as a “process”, than a state. A process in which “physical, mental and social well-being” is constructed, maintained and rebuilt. An asyntotic process without an end – as biocorporations and advertising know very well.
As already stated, the expansion of medical categories into social spheres, which were not previously “read” medically, may play a reassuring role. For example, if we think that boisterous children are sick and have neurological problems and chemical imbalances, we allow ourselves to avoid looking at social problems like unemployment, social cohesion in ghettos and integration of the immigrants. A pill which works on serotonin levels is easy to prescribe, and is cheaper and “cleaner” than any social policy. Another example of medical colonization can be seen in food. In supermarkets, shelves of health foods are constantly growing. Food is increasingly advertised, packed and branded in ways which connect it to medical contexts. We have probiotic yoghurt which reduces the risk of ictus, blueberry drinks which improve our vision, and mineral waters which “purify”.
To sum up, the bionic society can be described by at least three intertwining forces:
  • A strong emphasis on health as considered by its chemical, neurological and genetic dimensions;
  • The extension of medical ways of thinking (not only medical treatments) in areas which were not medicalized previously – or were only partially medicalized – like prevention, cosmetic, nutrition;
A growing pharmaceuticalization which questions the borders between normality, pathology and enhancement, and therefore also between nature and nurture (Maturo, 2010b[]).
In the near future, it seems that a bionic healthscape could lead to the transformation of social problems into medical problems of the single individual, therefore de-responsabilizing political and social institutions. On the other side, the emphasis on genetics and neurological dimensions might foster fatalism and passivity, leading to the deresponsabilization of the individuals for their health choices. All of this happening in a context where the lines between natural and artificial, normal and pathological, treatment and enhancement, are increasingly blurred.

Take home message

The transformation of human conditions into medical problems is increasing. In the past, medical profession was considered the main driver of this trend. Today other factors should also be taken into consideration: consumerism, managed care, marketing for pharmaceuticals and biotechnology.
The risk of medicalization is to neglect the role of social determinants in shaping human health. A new phenomenon which is emerging is human enhancement, that is, use of biomedical devices to optimise normality (and not to cure illness).[]

There is a total of  20 quiz questions for a possible 5 runs.
Quiz for 3/20/2018

1.     Define medicalization.
2.     What is social iatrogenesis?
3.     What is a practical example of social iatrogenesis?
4.     Peter Conrad has proposed to consider medicalization in what three respects?
5.     What are the engines of medicalization?
6.     (T/F) The use of pharmaceuticals and medicalization are the same thing.
7.     What aspects of medicalization are not directly connected to the use of drugs?
8.     (T/F)  There are situations of medicalization which do not include the consumption of pharmaceuticals as their main feature.
9.     What situations of medicalization do not include the consumption of pharmaceuticals as their main feature?
10.  Define pharmaceuticalization.
11.  Give an example of pharmaceuticalization.
12.  What three main causes are proposed to have fostered pharmaceuticalization?
13.  (T/F) Causes of mental illness are often described as etiology unknown.
14.  What are the main consequences of the latest version of the DSM?
15.  Define risks.
16.  Define dangers.
17.  As related to health, risk may be connected to what?
18.  (T/F) It can be easier for political institutions to embrace a clinical and biological definition of a disease instead of addressing the social causes underlying these pathological conditions.
19.  What is lacking in the risk factor model?
20.  Define human enhancement.

Brave New World

Since no quiz has yet been posted for Tuesday, maybe this is a good occasion  to crowd-source it? For starters: 1. Who wrote BNW, and when? 2. When was the "sequel" (BNW Revisited) published? 3. Who was the author's famous grandfather, and what was his nickname? 4. What substance was administered to the general population to keep them all blissfully "happy"? 5. The author says his subject is what? 6. Savage doesn't want comfort. What does he want?
(Add your quiz questions in "comments")... And some DQs: Has the prevalence of mood-altering drugs in our time born out that aspect of Huxley's dystopia? Has our society approximated BNW in other ways? Would you want to live there?
Far in the future, the World Controllers have created the ideal society. Through clever use of genetic engineering, brainwashing and recreational sex and drugs, all its members are happy consumers. Bernard Marx seems alone harbouring an ill-defined longing to break free. A visit to one of the few remaining Savage Reservations, where the old, imperfect life still continues, may be the cure for his distress... (goodreads, continues)
A SQUAT grey building of only thirty-four stories. Over the main entrance the words, CENTRAL LONDON HATCHERY AND CONDITIONING CENTRE, and, in a shield, the World State’s motto, COMMUNITY, IDENTITY, STABILITY. The enormous room on the ground floor faced towards the north. Cold for all the summer beyond the panes, for all the tropical heat of the room itself, a harsh thin light glared through the windows, hungrily seeking some draped lay figure, some pallid shape of academic goose-flesh, but finding only the glass and nickel and bleakly shining porcelain of a laboratory. Wintriness responded to wintriness. The overalls of the workers were white, their hands gloved with a pale corpse-coloured rubber. The light was frozen, dead, a ghost. Only from the yellow barrels of the microscopes did it borrow a certain rich and living substance, lying along the polished tubes like butter, streak after luscious streak in long recession down the work tables. “And this,” said the Director opening the door, “is the Fertilizing Room.” Bent over their instruments, three hundred Fertilizers were plunged, as the Director of Hatcheries and Conditioning entered the room, in the scarcely breathing silence, the absent-minded, soliloquizing hum or whistle, of absorbed concentration. A troop of newly arrived students, very young, pink and callow, followed nervously, rather abjectly, at the Director’s heels. Each of them carried a notebook, in which, whenever the great man spoke, he desperately scribbled. Straight from the horse’s mouth. It was a rare privilege. The D. H. C. for Central London always made a point of personally conducting his new students round the various departments. “Just to give you a general idea,” he would explain to them. For of course some sort of general idea they must have, if they were to do their work intelligentlythough as little of one, if they were to be good and happy members of society, as possible. For particulars, as every one knows, make for virture and happiness; generalities are intellectually necessary evils... (continues... BNW quotes)
Original 1956 radio dramatization, narrated by the author...
Brave New World Revisited
When the novel Brave New World first appeared in 1932, its shocking analysis of a scientific dictatorship seemed a projection into the remote future. Here, in one of the most important and fascinating books of his career, Aldous Huxley uses his tremendous knowledge of human relations to compare the modern-day world with his prophetic fantasy. He scrutinizes threats to humanity, such as overpopulation, propaganda, and chemical persuasion, and explains why we have found it virtually impossible to avoid them. Brave New World Revisited is a trenchant plea that humankind should educate itself for freedom before it is too late. Brave New World Revisted (first published in 1958) is not a reissue or revision of 0060850523 Brave New World. Brave New World is a novel, whereas Brave New World Revisted is a nonfiction exploration of the themes in Brave New World.
The soul of wit may become the very body of untruth. However elegant and memorable, brevity can never, in the nature of things, do justice to all the facts of a complex situation. On such a theme one can be brief only by omission and simplification. Omission and sim­plification help us to understand -- but help us, in many cases, to understand the wrong thing; for our compre­hension may be only of the abbreviator's neatly formu­lated notions, not of the vast, ramifying reality from which these notions have been so arbitrarily abstracted.

But life is short and information endless: nobody has time for everything. In practice we are generally forced to choose between an unduly brief exposition and no exposition at all. Abbreviation is a necessary evil and the abbreviator's business is to make the best of a job which, though intrinsically bad, is still better than nothing. He must learn to simplify, but not to the point of falsification. He must learn to concentrate upon the essentials of a situation, but without ignor­ing too many of reality's qualifying side issues. In this way he may be able to tell, not indeed the whole truth (for the whole truth about almost any important sub­ject is incompatible with brevity), but considerably more than the dangerous quarter-truths and half-truths which have always been the current coin of thought.

The subject of freedom and its enemies is enormous, and what I have written is certainly too short to do it full justice; but at least I have touched on many aspects of the problem. Each aspect may have been some­what over-simplified in the exposition; but these successive over-simplifications add up to a picture that, I hope, gives some hint of the vastness and complexity of the original.

Omitted from the picture (not as being unimportant, but merely for convenience and because I have dis­cussed them on earlier occasions) are the mechanical and military enemies of freedom -- the weapons and "hardware" which have so powerfully strengthened the hands of the world's rulers against their subjects, and the ever more ruinously costly preparations for ever more senseless and suicidal wars. The chapters that follow should be read against a background of thoughts about the Hungarian uprising and its re­pression, about H-bombs, about the cost of what every nation refers to as "defense," and about those endless columns of uniformed boys, white, black, brown, yel­low, marching obediently toward the common grave... (continues... BNWR quotes)

Quiz March 22

Eula Biss, On Immunity: An Innoculation, 3-39. 

1. The stories of Achilles and the dragon imply what about immunity?

2. "A valuable asset placed in the care of someone to whom it does not ultimately belong" is Biss's definition of what? OR, it captures her understanding of what?

3. Our vaccines are now sterile, so anti-vaccine activists' greatest fear is not of bacterial but ____ contamination.

4. What is Dracula about, besides vampires?

5. Who said love is known "by its fruits"?

6. Contributions to the "banking of immunity" give rise to the principle of ____ immunity.

7. What's the most common way that infants contract hep B?

8. What raises the probability that undervaccinated children will contract a disease?

9. Who or what were microbiologist Graham Rook's "old friends"?

10. "There is never enough evidence to prove that an event _____ happen? (can/can't)

  • "No mortal can ever be made invulnerable." True? What do you see as the important implications of this for the issue of vaccination as public health policy?
  • Why does Biss dislike consumer confidence? What's wrong with conceiving of the public as "consumers" of health care?
  • Do you find anything sexual or vampiric in vaccination?
  • "Faith is that which enables us to believe things we know to be untrue." Is that fair? How does it apply to the vaccination debate?
  • Do you agree that one must enact and embody one's beliefs? What if one's beliefs imperil public health and safety?
  • "We owe our health to our neighbors." 20 But how do we persuade them, or ourselves, of this?
  • Have you heard anyone make the argument that public health measures are not for "people like us"? Did you construe it as covert, coded racism?
  • "Enlisting a majority in protection of a minority" is often a hard-sell in America. Is this a social justice issue, like voting rights?
‘On Immunity,’ by Eula Biss
Lucretius said to handle them with caution; Berkeley, not to handle them at all. Aristotle said that too many confound; Locke, that even one can “mislead the judgment”; Hobbes, that their natural end was “contention and sedition, or contempt.” Sontag said simply, they kill.

Pity the poor metaphor, so maligned, so alluring. We’ve been warned repeatedly — and, inevitably, in metaphors — that metaphors can do terrible things. (According to Sontag, the grotesque metaphors attached to AIDS and cancer contributed to their stigma and prevented people from seeking treatment.) And yet, it’s impossible to go without. Supposedly, we use one metaphor a minute, about one metaphor for every 25 words; we seem scarcely able to string together two thoughts without them (there goes one), they cast such clarifying, necessary light (and another).

The essayist Eula Biss is something of a specialist at handling our twitchiest, most combustible metaphors. In her 2009 collection, “Notes From No Man’s Land,” she picked apart the metaphors we’ve used to construct and report on race in America. In her new book, the subtle, spellbinding “On Immunity,” she goes under the skin. She asks why vaccination triggers such anxiety — anxiety so intense it lives in the language: The British call it a “jab,” Americans, a “shot.”

...Biss reports from deep inside the panic. “My son’s birth brought with it an exaggerated sense of both my own power and my own powerlessness,” she writes. The world became suddenly forbidding: There is the lead paint in the wall to fear, the hexavalent chromium in the water. Even stagnant air, she was told, can kill her child. “It is both a luxury and a hazard to feel threatened by the invisible,” she says. “In Chicago, where 677 children were shot the year after my son was born, I still somehow manage to find myself more captivated by less tangible threats.” Weaning proved especially excruciating. “As long as a child takes only breast milk, I discovered, one can enjoy the illusion of a closed system, a body that is not yet in dialogue with the impurities of farm and factory,” she writes. “I remember feeling agony when my son drank water for the first time. ‘Unclean! Unclean!’ my mind screamed.”

We do love to pit the sacred against the profane, but breast milk, it turns out, contains traces of paint thinners, flame-­retardants, even rocket fuel. If it were sold in stores, some samples would exceed federal food-safety levels for pesticides. “We are all already polluted,” Biss learns. “We are crawling with bacteria and we are full of chemicals. We are, in other words, continuous with everything here on earth. Including, and especially, each other.”

Sontag said she wrote “Illness as Metaphor” to “calm the imagination, not to incite it,” and “On Immunity” also seeks to cool and console. But where Sontag was imperious, Biss is stealthy. She advances from all sides, like a chess player, drawing on science, myth, literature to herd us to the only logical end, to vaccinate. To refuse is to fall in love with our fears, to create a fantasy of our purity and vulnerability and forget all the ways we are dangerous. She writes of one mother resistant to vaccination to whom it had never occurred that her child might be strong enough to fight off a virus but might pass it on to someone more vulnerable — a baby, an elderly or sick person — who couldn’t. Vaccines were meant to enlist a “majority in the protection of a minority,” Biss writes. Today, “a privileged 1 percent are sheltered from risk while they draw resources from the other 99 percent.”

“On Immunity” concludes by inviting us to relinquish illusions of the body’s independence and acknowledge our participation in a web of interdependency. This isn’t a treacly take on “community,” though. It’s the blunt reality of blood banks and organ donors. Biss reminds us that we owe each other our lives.

But her realization that “from birth onward, our bodies are a shared space” posits a question. Didn’t “Notes From No Man’s Land,” open with the words “We are all connected, all of us”? Did she feel compelled to create a narrator for “On Immunity” who is more naïve than we know her to be? I suspect it’s more complicated — not a restatement of a theme but a deepening. The idea that all bodies are continuous is greatly important to Biss; she even plays with it textually, with one book leaking into another and the delayed attribution of quotations challenging our notions about what is native to the book and what is foreign. What she seems to be suggesting is that knowledge isn’t an inoculation. It doesn’t happen just once. There are things that must be learned and learned again, seen first with the mind and felt later in the body.

Biss’s “natural” delivery went wrong. After the baby was born, her uterus inverted, and she was taken immediately into surgery. “Alarms were sounded for me, doctors rushed to me, bags of blood were rigged for me,” she writes. “During the birth, when the violence to my body was the greatest, I was most aware not of the ugliness of a body’s dependence on other bodies, but of the beauty of it.” When she wakes, shivering, tethered to IV bags of antibiotics, she’s told: “You’ve had a lot of people’s hands in you.” No metaphors necessary.
‘On Immunity: An Inoculation,’ Essays by Eula Biss

The summer of 2010 was a bummer for many reasons. Heat waves stewed the East Coast into submission. Harvey Pekar and Tony Judt died. WikiLeaks dumped so many anxiety-inducing classified Afghan war documents that this sprig of dialogue from “Gravity’s Rainbow” seemed freshly plucked: “Everything is some kind of plot, man.”

That summer’s most sinister happening, the troll under the bridge to sanity, was the Deepwater Horizon oil leak in the Gulf of Mexico. The writer Eula Biss was home with an infant son in the wake of that mean summer. When she learned that the plastic on her baby’s mattress was possibly toxic, it was one shred of paranoia too many.

“If our government can’t keep phthalates out of my baby’s bedroom and parabens out of his lotion,” Ms. Biss cried aloud to her husband, “and 210 million gallons of crude oil and 1.84 million gallons of dispersant out of the Gulf of Mexico, for the love of God, then what is it good for?”

Her husband took a deep breath. He said, “I hear you.” He added, “Let’s just get a new mattress for now. Let’s start there.”Continue reading the main story
The Panic Virus
In 1998 Andrew Wakefield, a British gastroenterologist with a history of self-promotion, published a paper with a shocking allegation: the measles-mumps-rubella vaccine might cause autism. The media seized hold of the story and, in the process, helped to launch one of the most devastating health scares ever. In the years to come Wakefield would be revealed as a profiteer in league with class-action lawyers, and he would eventually lose his medical license. Meanwhile one study after another failed to find any link between childhood vaccines and autism.
Yet the myth that vaccines somehow cause developmental disorders lives on. Despite the lack of corroborating evidence, it has been popularized by media personalities such as Oprah Winfrey and Jenny McCarthy and legitimized by journalists who claim that they are just being fair to “both sides” of an issue about which there is little debate. Meanwhile millions of dollars have been diverted from potential breakthroughs in autism research, families have spent their savings on ineffective “miracle cures,” and declining vaccination rates have led to outbreaks of deadly illnesses like Hib, measles, and whooping cough. Most tragic of all is the increasing number of children dying from vaccine-preventable diseases.
In The Panic Virus, Seth Mnookin draws on interviews with parents, public-health advocates, scientists, and anti-vaccine activists to tackle a fundamental question: How do we decide what the truth is? The fascinating answer helps explain everything from the persistence of conspiracy theories about 9/11 to the appeal of talk-show hosts who demand that President Obama “prove” he was born in America.
The Panic Virus is a riveting and sometimes heart-breaking medical detective story that explores the limits of rational thought. It is the ultimate cautionary tale for our time. (continues)
...he really hits his stride when he turns to the social history of autism advocacy; his section on the actress Jenny McCarthy is a tour de force. To promote her 2007 book describing the purported vaccine-induced autism of her young son and his subsequent cure, Ms. McCarthy staged a media blitz, a medical tent show writ large. Blond and charismatic, she waved away the science, energized the people who wanted to believe her message (the not inconsiderable “I feel, therefore it is” segment of our society, as Mr. Mnookin puts it) and managed to do quite nicely for herself as well, netting a deal with Oprah Winfrey’s production company.

“So, as you can see, health care is so complicated you may never get well.” New Yorker
Informed patient? Don't bet on it. Most patients don’t have any idea what they have agreed to let their doctors do to them.

Get Out of Here: Scientists Examine the Benefits of Forests, Birdsong and Running Water
In “The Nature Fix,” Florence Williams looks at new research on how spending time in nature makes people happier and more creative.
The Future of Humans? One Forecaster Calls for Obsolescence

A Brief History of Tomorrow
By Yuval Noah Harari
Illustrated. 449 pp. Harper/HarperCollins Publishers. $35.

“Organisms are algorithms,” Yuval Noah Harari asserts in his provocative new book, “Homo Deus.” “Every animal — including Homo sapiens — is an assemblage of organic algorithms shaped by natural selection over millions of years of evolution. . . . There is no reason to think that organic algorithms can do things that nonorganic algorithms will never be able to replicate or surpass.” In Harari’s telling, the human “algorithm” will soon be overrun and outpaced by other algorithms. It is not the specter of mass extinction that is hanging over us. It is the specter of mass obsolescence.

To understand how Harari arrives at this conclusion, we might turn to his earlier book. “Sapiens: A Brief History of Humankind” was an attempt to write a genetic, anthropological, cultural, social and epistemological history of humans over the last 100,000-odd years. Historians, scientists and academic pedants carped about its audacity of scope — but the book, modeled after Jared Diamond’s “Guns, Germs, and Steel” (a book that also received its share of carping and academic envy), presented a sweeping macrohistory, often marvelously. From the birth of a slight, sly, naked ape somewhere in the depths of Africa to the growth, spread and eventual dominance of that species over the world, “Sapiens” split the story of humankind into three broad “revolutions.” The first, the “cognitive revolution,” resulted in humans acquiring the capacity to think, learn and communicate information with a facility unprecedented in the animal kingdom. The second — the “agricultural revolution” — allowed humans to domesticate crops and animals, enabling us to form stable societies and intensifying the flow of information within them. The “scientific revolution” came last. Humans acquired the capacity to interrogate and manipulate the physical, chemical and biological worlds, resulting in even more potent technological advances that surround us today.

“Homo Deus” takes off where “Sapiens” left off; it is a “brief history of tomorrow.” What is the natural culmination of the scientific revolution, Harari asks. What will the future look like? “At the dawn of the third millennium,” he writes, “humanity wakes up, stretching its limbs and rubbing its eyes. Remnants of some awful nightmare are still drifting across its mind. ‘There was something with barbed wire, and huge mushroom clouds. Oh well, it was just a bad dream.’ Going to the bathroom, humanity washes its face, examines its wrinkles in the mirror, makes a cup of coffee and opens the diary, ‘Let’s see what’s on the agenda today.’ ”Continue reading the main story

Siddhartha Mukherjee is an assistant professor of medicine at Columbia University. His latest book is “The Gene: An Intimate History.” He won a Pulitzer Prize for his book “The Emperor of All Maladies: A Biography of Cancer.”
The Quest for Artificial Intelligence — and Where It’s Taking Us Next
By Luke Dormehl
275 pp. TarcherPerigee. Paper, $16.

Our Future in a World of Artificial Emotional Intelligence
By Richard Yonck
312 pp. Arcade Publishing. $25.99.

Books about science and especially computer science often suffer from one of two failure modes. Treatises by scientists sometimes fail to clearly communicate insights. Conversely, the work of journalists and other professional writers may exhibit a weak understanding of the science in the first place.

Luke Dormehl is the rare lay person — a journalist and filmmaker — who actually understands the science (and even the math) and is able to parse it in an edifying and exciting way. He is also a gifted storyteller who interweaves the personal stories with the broad history of artificial intelligence. I found myself turning the pages of “Thinking Machines” to find out what happens, even though I was there for much of it, and often in the very room...

Continue reading the main story 
The Anti-Vaccine Movement Gains a Friend in the White House
Vaccine opponents, often the subject of ridicule, have found fresh energy in the election of a president who has repeated discredited claims linking childhood immunizations to autism and who has apparently decided to pursue them. With President Trump’s support, this fringe movement could win official recognition, threatening lives and making it urgent that health officials, educators and others respond with a science-based defense of vaccines.
Vaccines have saved lives by protecting children and adults from diseases like measles, polio, smallpox, cervical cancer and whooping cough. And there is no evidence whatsoever that vaccines or a preservative used in flu shots cause autism. Scientists have also shown that parents who refuse to immunize their children are threatening to undo decades of public health gains.
Yet, activists like Robert Kennedy Jr. continue to push pseudoscience about immunizations. The terrifying thing is that they appear to have Mr. Trump's ear. After a meeting with the president last month, Mr. Kennedy said that the president would name him to head a new committee on vaccine safety; the government already has an advisory group that is meeting this week. And last week, during a news conference with Robert De Niro, Mr. Kennedy offered a $100,000 reward to anyone who could prove that vaccines are safe for children and pregnant women. (continues)

Wednesday, March 14, 2018

Medical Paternalism

March 15 Medical Paternalism Case Studies
Clorissa Campbell, Joseph Churchill, Cameron Oldham

1. What is “autonomy” drawn from vs. “paternalism” being drawn from the role of the father?

2. According to Childress what makes paternalism morally interesting?

3. In what cases should a physician override one person's autonomy?

4.What does Dworkin call liberty in contradiction to liberty as license?

5. what are the two factors of justification often given for paternalistic interventions?

6.What two matters does the duty to respect autonomy involve?

7. What could a policy that affirms “you should care for yourself” be interpreted as?

Discussion Questions
1. Do you agree with the 3 examples of when a physician can override a person's autonomy? What other conditions would you add if any?
2. Would you view Liberty as a license or as independence? Explain your reasoning.
3. Childress talks about having some procedures of moral reasoning and accountability. What procedures would you suggest?