once upon the time (and by that i mean "in the 80s") the world's poorest countries were call the Third World. canada was a First World country, and like all of the other popular countries it loved going to the mall, chewing bubble gum, and feeling sorry for the Third World - especially when those foster parents plan commercials interrupted The Fresh Prince of Belair - but mostly we just really liked our nikes. this phrase, however, went out of vogue when someone came along and said, "uh, 'First World?' doesn't that imply that you richie mcrichipants think you're better than everyone else?" to which the wealthy nations said "well, of cour--- i mean no! no, not at all. slip of the tongue. Two-Thirds World, we meant to say. because 66% of the planet is poor... get it?? go team poverty!" this expression was clumsy and, let's be honest, no one likes fractions. so, it didn't last long. in the optimism of the 90s we started to call the poor nations "developing." it seemed hopeful, full of promise, whole countries budding tiny breasts! the wealthy countries were called "developED." we're done growing, thank you very much and frankly if north american boobs get any bigger they will be visible from space. that same guy from the 80s was like "yeah but isn't it a little arrogant to suggest that you're all grown up? sounds like you don't think you have anything left to learn?" and the powerful nations states said "uh huh," and blinked. and the guy suggested that they think of something better at least until they could understand his remark. they had a big meeting and someone suggested "the expendable nations" but no one could spell that and besides, it didn't work well with Tears for Fears lyrics. "hobos" was stricken from the list - it was copyrighted by the Littlest. the group was stymied. it was important to label the poor countries properly; everyone remembered the whole 'Indians' debacle and didn't want to be caught with their maps down again. "what is the real difference between Us and Them?" the chair of the meeting inquired. i suspect it goes without saying that none of Them were invited to the meeting, after all, and since none of Us knew much of anything about Them, this question was a stumper. "wellllll..." someone offered. "they're poor. and we're not." ahhhh, the group sighed. too true, too true.
an acronym was born that day. LMIC. i know what you're thinking. it sounds like a good name for a rapper. but it stands for the new millennium catchphrase Low-to-Middle-Income-Country. (i believe it's known on the radio as honkytonk but never mind). alternately there are High-Income-Countries, which are paradoxically abbreviated as HIC's.
but no one really wants to be a HIC cuz that's honkytonk for sure. and it's too easy to generate the typo HIV, and THAT was gonna cause some serious confusion!
and so a geographical term has emerged for this decade. the North refers to the wealthy, developed nations (sorry australia) and the South refers to... everyone else (sorry everyone else). it seemed more polite not to put so fine a point on the whole "haves and havenots" business (awkwarrrrd) and most people feel like it's a little more egalitarian. directions on a compass aren't right or wrong, they're just relative. just like a family (insert hearts and happy faces)
and so here i study, the north versus the south in a kind of ethicotheoretical civil war. and i will write about these topics using the whole gamut of terminology. i like Two-Thirds World actually for the visual reminder of inequity that it offers. LMIC is almost as to-the-point as it gets. and north & south encapsulate the binariness of it all. but mostly i will use simpler words. rich and poor, perhaps. is that so wrong?
... probably.
hwb
Friday, May 27, 2011
Thursday, May 26, 2011
men can be mothers too ...?
it was a heckuva visual. the first (okay, only) time that i saw a man breastfeed a baby.
don't worry, i'm not going anywhere; you can re-read that sentence if you need to.
i was at a talk (i love how this verb gets turned into an "event" when a PhD is leading the conversation) a few weeks ago about birth practices and other such wizardry, when a woman at the back stood to ask a question. i turned to see who spoke.
one row ahead, there he was - shirt wide open and chest exposed, tenderly cradling an infant. "skin-to-skin contact" i thought, "awwwww..." i added mentally. "funny," my brain said, "he's holding the baby as if he's nurs---" it is not often that even my mind is at a loss for words. he was nursing. a tiny feed tube ran along his chest, aligned with his nipple and disappeared, avec said nipple, into the slurping mouth of the babe. i thought several things in sequence:
1. oh. my. crap.
2. oops knee-jerk reaction. think rationally heather. rational.
3. but oh my crap!
4. simmer down. don't be a prude. how is this any different than a woman nursing?
5. ps: crap crappity crap crap?
6. a nipple is a nipple is a nipple right?
7. really? you nurse anyone else's baby li'l miss interchanganip?
8. he is clearly a very devoted father
9. does devoted parenthood usually cause you to stare with your mouth hanging open at a perfect stranger in a crowded room? do you even know what dr. odent is talking about now?
10. ah crap.
that startling image stayed with me well after the talk concluded. while i confess it left me with an unmistakable "no" feeling, i couldn't really justify it to myself. what if the man had lost his wife during childbirth; if he and his husband had adopted an infant - either way there was a very compelling argument to be made about the connectivity of gaining nourishment via skin-to-skin contact. given those circumstances should not a baby have access to that kind of tenderness? i suspect that two groups of infants, both raised on breast milk, but one fed by bottle and other by flesh, would show a difference - my instinct is that the breast fed babies would fair better. i have no data to back me up on that, but hey this is a blog - who needs data when you can have opinion?
nevertheless, i felt unnerved. what will that child say, 13 years from now, to reminiscences of chest feedings from daddy? is this father self-sacrificing, bearing the inevitable brunt of crap from people like me, in order to provide loving nourishment to his child because it's in Baby's best interest? or is he selfish, seeking attention at the expense of the child's future confusion? in related news "is heather in any position to draw any conclusion or to validate/invalidate this man's experience in the first place?" right. <ahem>
keeping my conclusions to myself, how would i respond if keith had asked to chest feed our children? if he expressed a deep longing to connect and provide in that way... what would i say? if my brother had taken up the practice, would i try to persuade him otherwise, or defend his choice to others in an effort to protect him from the crap that is out there (and by out there i mean in here)?
what about you? should breastfeeding be ladies first, or ladies only?
hwb
don't worry, i'm not going anywhere; you can re-read that sentence if you need to.
i was at a talk (i love how this verb gets turned into an "event" when a PhD is leading the conversation) a few weeks ago about birth practices and other such wizardry, when a woman at the back stood to ask a question. i turned to see who spoke.
one row ahead, there he was - shirt wide open and chest exposed, tenderly cradling an infant. "skin-to-skin contact" i thought, "awwwww..." i added mentally. "funny," my brain said, "he's holding the baby as if he's nurs---" it is not often that even my mind is at a loss for words. he was nursing. a tiny feed tube ran along his chest, aligned with his nipple and disappeared, avec said nipple, into the slurping mouth of the babe. i thought several things in sequence:
1. oh. my. crap.
2. oops knee-jerk reaction. think rationally heather. rational.
3. but oh my crap!
4. simmer down. don't be a prude. how is this any different than a woman nursing?
5. ps: crap crappity crap crap?
6. a nipple is a nipple is a nipple right?
7. really? you nurse anyone else's baby li'l miss interchanganip?
8. he is clearly a very devoted father
9. does devoted parenthood usually cause you to stare with your mouth hanging open at a perfect stranger in a crowded room? do you even know what dr. odent is talking about now?
10. ah crap.
that startling image stayed with me well after the talk concluded. while i confess it left me with an unmistakable "no" feeling, i couldn't really justify it to myself. what if the man had lost his wife during childbirth; if he and his husband had adopted an infant - either way there was a very compelling argument to be made about the connectivity of gaining nourishment via skin-to-skin contact. given those circumstances should not a baby have access to that kind of tenderness? i suspect that two groups of infants, both raised on breast milk, but one fed by bottle and other by flesh, would show a difference - my instinct is that the breast fed babies would fair better. i have no data to back me up on that, but hey this is a blog - who needs data when you can have opinion?
nevertheless, i felt unnerved. what will that child say, 13 years from now, to reminiscences of chest feedings from daddy? is this father self-sacrificing, bearing the inevitable brunt of crap from people like me, in order to provide loving nourishment to his child because it's in Baby's best interest? or is he selfish, seeking attention at the expense of the child's future confusion? in related news "is heather in any position to draw any conclusion or to validate/invalidate this man's experience in the first place?" right. <ahem>
keeping my conclusions to myself, how would i respond if keith had asked to chest feed our children? if he expressed a deep longing to connect and provide in that way... what would i say? if my brother had taken up the practice, would i try to persuade him otherwise, or defend his choice to others in an effort to protect him from the crap that is out there (and by out there i mean in here)?
what about you? should breastfeeding be ladies first, or ladies only?
hwb
who do you think you are?
researchers can be catty.
whole articles are dedicated to poo-poo-ing someone else's theory or ideal, or simply pouting about the language with which it was conveyed. the worst of these kinds of papers succeed only in pointing out another's philosophical shortcomings, proposing no alternatives or real suggestions aside from the academic version of "get a life."
that said, there can be illuminating critique, offering close-but-no-cigar something to actually put in its pipe and smoke.
dr. terese lysaught wrote a very compelling article about the political nature (and think germain greer here, the personal is the political etc etc) of medical research. there is a lot of talk about resources, economics, power imbalances and culture gaps in transnational research - north american researchers are often called "mosquitos" ... they fly in, collect blood, and fly away again leaving everyone a little more itchy than they had been. but at the end of the day, medicine (research or clinical) comes down to the experiences of individual bodies, trying to be alive.
applauding some thinkers and dismissing others, lysaught referred to a colleague, dr. rita rhodes who proposed that, like military service in some countries and jury duty in most, participation in medical research should be obligatory for all citizens. we all stand to benefit from its discoveries, so why should we not equally contribute to its efforts?
most of the world's medical discoveries take place on north american soil. most north american people are over the age of 30 and are middle class. but most research is largely performed on university students or upon vulnerable populations -- institutionalized, incarcerated or impoverished people who need the system as much as it needs them. perhaps by virtue of proximity we should discern whether university students are in fact a vulnerable population as well...?
while lysaught crouched to lay a steamer on rhodes' theories (which are extremely... extreme) i wondered if rita wasn't onto something.
what is so special about middle aged, middle class bodies that exempts them from biomedical research? all of this effort and energy is spent belaboring the question of "how can high income countries conduct research with low income countries with SANS exploitation?" but maybe the better question is to really examine "why are the high incomes there in the first place?" viagra, the world's top-selling drug was tested in the "Third World." really? is erectile dysfunction really the issue in Uganda?
there are very good, passionate physicians who want nothing more than to create opportunities to heal, say, the HIV pandemic in africa, and they conduct their research where the disease lives. but alongside, Big Pharma has built its barn in the developing world to cut overhead, circumvent ethical guidelines that govern research in north america, and most of all to gain access to an almost limitless source of bodies to test. if the bodies under scrutiny were middle aged middle class (and, imagine, maybe even UPPER class!) north americans, with their compliment of self-assigned entitlements, biomedical ethics would be lightyears ahead of where it is now. with the vast VAST majority of experimentation having been conducted on vulnerable persons, it is only the voice of advocates - first informed, then compelled and finally resourced sufficiently to speak out about mistreatment of patients/participants alike - that have driven the momentum behind bioethical change. imagine how much faster that would have transpired if the research subjects were CEOs and CMAs and even MDs in the first place!
whole articles are dedicated to poo-poo-ing someone else's theory or ideal, or simply pouting about the language with which it was conveyed. the worst of these kinds of papers succeed only in pointing out another's philosophical shortcomings, proposing no alternatives or real suggestions aside from the academic version of "get a life."
that said, there can be illuminating critique, offering close-but-no-cigar something to actually put in its pipe and smoke.
dr. terese lysaught wrote a very compelling article about the political nature (and think germain greer here, the personal is the political etc etc) of medical research. there is a lot of talk about resources, economics, power imbalances and culture gaps in transnational research - north american researchers are often called "mosquitos" ... they fly in, collect blood, and fly away again leaving everyone a little more itchy than they had been. but at the end of the day, medicine (research or clinical) comes down to the experiences of individual bodies, trying to be alive.
applauding some thinkers and dismissing others, lysaught referred to a colleague, dr. rita rhodes who proposed that, like military service in some countries and jury duty in most, participation in medical research should be obligatory for all citizens. we all stand to benefit from its discoveries, so why should we not equally contribute to its efforts?
most of the world's medical discoveries take place on north american soil. most north american people are over the age of 30 and are middle class. but most research is largely performed on university students or upon vulnerable populations -- institutionalized, incarcerated or impoverished people who need the system as much as it needs them. perhaps by virtue of proximity we should discern whether university students are in fact a vulnerable population as well...?
while lysaught crouched to lay a steamer on rhodes' theories (which are extremely... extreme) i wondered if rita wasn't onto something.
what is so special about middle aged, middle class bodies that exempts them from biomedical research? all of this effort and energy is spent belaboring the question of "how can high income countries conduct research with low income countries with SANS exploitation?" but maybe the better question is to really examine "why are the high incomes there in the first place?" viagra, the world's top-selling drug was tested in the "Third World." really? is erectile dysfunction really the issue in Uganda?
there are very good, passionate physicians who want nothing more than to create opportunities to heal, say, the HIV pandemic in africa, and they conduct their research where the disease lives. but alongside, Big Pharma has built its barn in the developing world to cut overhead, circumvent ethical guidelines that govern research in north america, and most of all to gain access to an almost limitless source of bodies to test. if the bodies under scrutiny were middle aged middle class (and, imagine, maybe even UPPER class!) north americans, with their compliment of self-assigned entitlements, biomedical ethics would be lightyears ahead of where it is now. with the vast VAST majority of experimentation having been conducted on vulnerable persons, it is only the voice of advocates - first informed, then compelled and finally resourced sufficiently to speak out about mistreatment of patients/participants alike - that have driven the momentum behind bioethical change. imagine how much faster that would have transpired if the research subjects were CEOs and CMAs and even MDs in the first place!
i haven't been a guinea pig for anything more complicated than a beep-test during psychology 101. kind of hard to justify becoming a medical professional if i'm not willing to be a lab rat for a day. just who do i think i am?
who does the biomedical community think that people in the poorest countries aren't?
if i were made queen for a day, i would want to implement a new layer of ethical requirement. researchers submit their proposals for ethics-board scrutiny, but they have never been asked to justify the locale of their learning. but shouldn't research for a given treatment/disorder be conducted upon its target population... tested upon the persons for whom it is designed?
there are no disposable bodies in the human family. until we can genuinely appreciate that and abandon the practice of farming vulnerable populations for inexpensive and compliant test materials there cannot BE ethical research in transnational practice.
there are no disposable bodies in the human family. until we can genuinely appreciate that and abandon the practice of farming vulnerable populations for inexpensive and compliant test materials there cannot BE ethical research in transnational practice.
hwb
Lysaught, MT (2009). Docile Bodies: Transnational Research Ethics as Biopolititcs. Journal of Medicine and Philosophy, 34:384-408
living ethics?
somewhere in the first layer of reading, the soil, shall we say, of my research was an article entitled "living ethics." it sounds so 90s, doesn't it? i imagine a tree with words in lieu of leaves - catch phrases like introspection, and attunement. (the latter of which i do not know how to spell. but neither does my spellchecker so we shall suffer together.)
the phrase came out of a paper written by 5 people - a masters student, a phd student, an untenured prof and a tenured one plus the dean of the faculty. they're a research team researching, well, themselves (long story, not important). the thing that is both hilarious and awesome about their paper was that they came up with this phrase, this raison d'etre-type slogan... and couldn't decide what it meant. "hello, philosophy department, how may i direct your call, or not direct it, paradox and whatnot..."
instead of anyone pulling rank or voting on the definition, all 5 definitions were included, and a very rich concept - better for the indecision - emerged.
i'm just not 100% sure what it is.
heh.
living ethics as an organic, alive and changing thing.
living ethics as a culture, as a way of doing life.
living ethics as in the collision of theory and action - putting your morality where your mouth is. something you have to tend, nurture, expose to daylight on a regular basis.
one of the 5 theorists didn't have a definition. she said "they came up with this term during a conference call and i wasn't there. i'm not sure i get it." it's actually written there in a peer-reviewed and published scholarly article! i think i love her.
but i extra love the image within the phrase. that values - morality - are alive. earthy and squatting in the underbrush, playing hide and seek with constantly changing circumstances. pulling pranks on their arch nemesis "economics". (sometimes ethics and economics play well together... but they both have to get drunk first.)
living ethics means not just reading about them or thinking about them but dusting off some theory to Act.
we had a conference call on friday - i got to meet the rest of the team, hailing from halifax, ottawa, miami and grenada. it was unlike any other conf-call i've ever had. no one interrupted anyone else. sorry, i didn't say that properly. ACTUALLY NO ONE HONESTLY INTERRUPTED ANYONE ELSE NOT EVEN ONCE FOR SERIOUS. that's better. we were using Skype and one party had to type cuz her mic was down, and so when addressing her directly, the others typed too. communicating on her terms. at the office, the prof down the hall spilled soil from one of her plants (it's like a freakin botany dept over here) and asked housekeeping to come vacuum. she learned the woman's name, talked to her about her day, too, helped clean up together. everywhere i turn people are, even in these small ways, trying, quite simply, to Do Right by one another. my prof has spent much of her career working with aboriginal peoples, trying to unearth fairness and equity in the mire of their bad-boyfriend relationship with the state, but she brings the same ethic to emails with me. it's a little stepfordian, i'm not gonna lie. but mostly it's amazing. there is a kind of tranquility that comes out of conversations where no one speaks over anyone else. people complaaaaaain about politically correct language, but i think there are no finer manners in the world than genuinely taking care with how you say what you say in order to be as welcoming as possible.
i want to grow up to be living ethics. or at least someone who keeps trying to understand what it might mean, 5 definitions at a time, richer for the indecision. and i want to learn about this not-talking-over-other-people business. i feel like a universe of happiness might live inside that habit... if only i could master it.
hwb.
Wednesday, May 25, 2011
paging doctor blog?
bloggery.
i have mixed feelings writing this introductory blurb to my blab. next thing you know i'll be tweeting. and i generally try to avoid things that have "twit" right in the title. hardly need the help on that front :)
but i have this new job. and it is filling my skull beyond capacity and i need a release valve for the 8 ka-billion new thoughts it's making me think. i'm studying biomedical ethics as they are strained between high-income and low-to-middle-income countries in the context of transnational medical research, and my job is to read (all day) other people's thoughts on the matter. and they are such prolific thinkers! full of passion and insight for what is Right and Moral (and really, what is Right and Moral?). i spend half of my time trying to discipline my own tinker, stifling the 80-katrillion questions that this research provokes. politics, personalities, institutions and individuals colliding in the effort we all share - how to stay alive!
in short, i'm in mental heaven :)
i've also recently been accepted into medical school. all day i work professionally with the question: "what does it mean to practice medicine ethically? morally? what does it mean for a physician to be Good - not in terms of skill, but in terms of being?"
it naturally makes me wonder: can i be a Good doctor when i grow up?
tbd.
i have mixed feelings writing this introductory blurb to my blab. next thing you know i'll be tweeting. and i generally try to avoid things that have "twit" right in the title. hardly need the help on that front :)
but i have this new job. and it is filling my skull beyond capacity and i need a release valve for the 8 ka-billion new thoughts it's making me think. i'm studying biomedical ethics as they are strained between high-income and low-to-middle-income countries in the context of transnational medical research, and my job is to read (all day) other people's thoughts on the matter. and they are such prolific thinkers! full of passion and insight for what is Right and Moral (and really, what is Right and Moral?). i spend half of my time trying to discipline my own tinker, stifling the 80-katrillion questions that this research provokes. politics, personalities, institutions and individuals colliding in the effort we all share - how to stay alive!
in short, i'm in mental heaven :)
i've also recently been accepted into medical school. all day i work professionally with the question: "what does it mean to practice medicine ethically? morally? what does it mean for a physician to be Good - not in terms of skill, but in terms of being?"
it naturally makes me wonder: can i be a Good doctor when i grow up?
tbd.
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