Elizabeth Nolan Brown // Blog

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Archive for the ‘Health & Science’ Category

If Free Birth Control Lowers Costs, Why Haven’t Insurers Made Birth Control Free Already?

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That’s a question I’ve seen a few places, and which Conor Friedersdorf posed to me last week in  a bloggingheads dialogue. At the time I didn’t have an answer. I knew that birch control coverage could save money and I had some facts and figures about it. But if it drove down costs, why didn’t insurers already subsidize contraception?

One commenter at bloggingheads described my position as “let’s subsidize everything less dumb than the dumbest thing we subsidize,” which I liked. The fact that contraceptive services benefit more individuals or could drive down costs more (in terms of pregnancies prevented) than some of the other preventative services that are free under the new healthcare mandate was my rationale for including birth control (I’m a realist; my view is generally if this mandate exists—and it does—then what makes the most sense under it?) But dumb isn’t really the criteria, I don’t think. More like, “Let’s subsidize everything that genuinely is a preventative service and also benefits a large swath of the American public if we’re going to subsidize other less commonly-utilized stuff. I could be convinced to take dumb stuff off the preventative services list. I’m not sure I support the preventative services mandate to begin with. But since that’s happening: Hell, yes, contraceptive services should be part of it.

Much is made of why totally free versus must-be-covered by insurers, but with a copay. The argument is why should middle- or upper-class women have birth control totally subsidized? The assumption being, of course, that ‘birth control’ means the pill, which generally costs between $4 and $30 a month for a copay, with standard employer-based health insurance.

But the free preventative ‘contraceptive services’ could also include more expensive, longer-form birth control options. The IUD lasts between 5-12 years, and is a great option for young women who don’t want kids for some time or women who’ve already had kids but are pre-menopausal. Insurers have been slow to start covering it, and it’s expensive without coverage (between $500 and $1,000, for the IUD and insertion). That’s actually quite cost-effective in the long-run: At $1,000, spread over 5 years, it would only amount to about $16 a month—right around the average monthly oral contraceptive copay. But $1,000 is a lot of upfront cost, and that’s a big reason why women don’t choose this very effective birth control option.

Another very effective birth control option? Sterilization. It costs quite a lot up front if not covered by insurance. Which means it also costs quite a bit up front for the insurance company who’d have to subsidize it. But a woman who has her tubes tied or a man who has a vasectomy can cost less over a lifespan, because they’re not using birth control monthly and they wont’ get pregnant and need pre-natal and maternity care or an abortion. [And these are just the health care costs saved; less unwanted pregnancies brings less poverty, less unwanted societal costs, etc.]

So if this is all such a great deal for insurers, why haven’t they done it already?

Here’s my stab at a theory. The reason insurers haven’t already started offering free contraceptive services, if this drive down costs, is because with employer-based healthcare and folks jumping jobs so much these days, most people only have the same insurance company or plan for a few years. Subsidizing contraceptive services might drive down costs for you (relative to pregnancy or abortion), and in doing so drive down overall health care expenses in this country. It could drive down social costs. But it’s unlikely to substantially improve the bottom line of any particular health insurance company.

Of course, with the way the insurance market works, wouldn’t any given plan be just as likely to have people currently using free contraceptive services, thus driving up costs, and people who’d already benefited from contraceptive services, thus driving down costs? I don’t know. I’m not terribly well-versed in the economics of insurance policies and risk pooling. Maybe any particular insurance company is likely to have a net draw in costs expended and saved by offering free birth control services.

There may be a simpler reason why insurance companies don’t subsidize birth control: Because it’s the way they’ve always done things. The upfront cost—even just in terms of the time of the people involved in doing it—of changing their policy probably wouldn’t outweigh the savings for a while. Or maybe they just figure that women who use birth control will do so regardless, and they might as well make that $12 co-pay each month from each of them. (The latter theory is maybe true now, but maybe less true once everyone must be insured? And also maybe not as relevant when you, again, consider that birth control doesn’t just mean the pill).

Another component of this I’ve written about recently and Conor and I talked about is the conscience mandate. In any discussion of whether religious employers should have to cover contraceptive services, I feel it’s important to note: People use the pill for things other than pregnancy prevention (thanks, Erin, for reminding me of this). A Guttmacher Institute study found 14% of all birth control users rely on the pill solely for non-contraceptive reasons, such as reducing menstrual pain, treating acne or trying to tame irregular periods.

Churches are already exempt from the contraception mandate, but religious employers—like hospitals and universities—want to be able to (and can, now) opt out of covering contraception. And everyone’s framing it like a matter of choice—well, you choose to go to a religious school, or you choose to work for a religiously-affiliated employer. If covered/free contraption was so important to you, you could choose to go to school or work elsewhere (nevermind for now that just going to work elsewhere sometimes really isn’t that simple).

But I think framing it in terms of individual choice is a bad idea; it’s about whether a broad-spectrum of individual employers should be able to opt out of insurance coverage mandates they don’t like. I don’t think they should. Right now, we’re talking contraception, but it opens the door for any employer to opt out any insurance coverage requirements they don’t like.

Please note that this post is less a polemic and more a sort of stream-of-consciousness grappling with thoughts surrounding this issue. It’s a complicated issue. Do share your thoughts with me, too.

Yes, yes, 1,000 times yes.

Of course access to affordable birth control is primarily a woman’s problem, but how many men have not had babies they didn’t want because the women they were sleeping with were on birth control? Contraception is something that benefits both women and men. Phoebe’s totally right that most men don’t have any idea about how birth control works, and it’s just … sad, and stupid. But I am happy to report that I had a lovely discussion about the benefits of IUDs and the drawbacks of the pill with three women and one man at the bar last night. Anyway, I’ll leave you with Phoebe:

Precisely because contraception is oh-so-private, misconceptions arise – especially, needless to say, among men – about what this “birth control” thing is all about. They easily forget that the very need for contraception comes from women having sex with men. Sparing these men – I might add – 18 years of child-support payments, not to mention the serious possibility of 18 years of continued communications with every woman they’ve ever slept with. It becomes a discussion about women choosing to have sex, when the sex in question by definition involves men. Not such an issue for women who have sex with women.


Written by ENB

March 6, 2012 at 7:08 pm

Kansas Lawmakers Think It’s Fine For Doctors To Lie To Patients To Prevent Abortions

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By far the scariest of the anti-abortion bills pending before scores of state legislatures in the U.S. right now is a bill budding in Kansas that would let doctors withhold critical medical info from patients with no consequences. Among the bill’s many provisions is one exempting doctors from malpractice suits if they withhold information—such as potential birth defects or anything else that poses a health risk for the mother or child—in order to prevent an abortion. A suit can only be brought if the mother dies.

The bill assumes a doctor’s right not to potentially contribute to someone getting an abortion trumps both his duty to do his job and and a patient’s right to receive full and accurate information from their doctor. It’s also filled with some of the greatest hits of other states’ anti-abortion efforts: A requirement that a pregnant woman listen to a fetal heartbeat before abortion; doing away with tax credits for abortion providers; and stopping tax deductions for health savings accounts that include abortion coverage. It would also require doctors to tell pregnant women that abortion will increase their risk of breast cancer—a theory that’s generally disputed by doctors, scientists and health groups, including the World Health Organization and the National Cancer Institute. And:

With language stating that anesthesia is administered to fetuses during surgery and indicating that an unborn child feels pain, the Kansas bills calls for making 20 weeks the latest time for having an abortion, a decline from the 21-week point adopted last year. (Rep. Barbara Bollier, a moderate Republican) said she has professional objections to this requirement, saying that medical reports show that a fetus does not feel pain until 25 to 30 weeks and that the anesthesia is administered to prevent a rapid fetal heartbeat, which she said arises as a reflex to external stimulation.

Republican Gov. Sam Brownback said last week that he’s likely to sign the bill if it comes before him:

Brownback, speaking to The Huffington Post Monday following the National Governors Association meeting, said that while he has not read the 69-page bill, he is likely to sign the proposal since he opposes abortion rights. Brownback, a former U.S. senator, has signed several anti-abortion bills since he took office last year.

“I am pro-life,” Brownback said. “When I campaigned I said that if a pro-life bill got to my desk, I will sign it. I am not backing away from that.”

The bill, however, has yet to pass out of committee—it’s got a ways to go before getting to Brownback’s desk. Both Kansas’ Senate and House of Representatives are controlled by Republicans, but the more conservative House is expected to approve it, while a more moderate Senate could vote it down. But what a crazy point we’ve come to in all this conscience business when it seems reasonable to anyone that doctors should be allowed to coerce women into giving birth by withholding medical information and only be held accountable for any health problems this leads to if the patient ends up dying.

Image: Statemaster.com.

Written by ENB

March 3, 2012 at 1:14 pm

NEDA: Eating Disorder Lit, Lifetime Movies, the DSM-V, ‘Holy Anorexia’ and Tumblr v. Pro-Ana Blogs (@ Blisstree)

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I didn’t know what image to use for this post, so here is a picture of me and an old friend not having eating disorders, eating free ice cream from Friendly’s on a summer day.

Autumn Whitefield-Madrano at ‘the Beheld’ wrote some very nice things about our National Eating Disorder Awareness week coverage at Blisstree, the women’s health & wellness site where I write.

Elizabeth Nolan Brown examines the real fallout from eating disorder literature. I’m thrilled to see someone taking a sharp view on this—my own experience with ED lit mirrors Elizabeth’s, varying between using such books as dirty little guides to tips and tricks, and using them as actual support. In fact, I once pitched a piece about this to a teen mag and it was flatly shot down with, “There is no way in hell we can run a piece like that.” But Blisstree can! Yay Internet! (Actually, Blisstree overall seems to be offering smart content for NEDA week, sharing the real story behind sensationalist recovery tales and featuring an interview with Carrie Arnold, one of the best ED writers around.)

Yay Internet!, indeed. I’ve actually been very happy this week with the way we’ve been covering eating disorders. ED stories so often fall into sensationalism, melodrama or triteness. And I think we’ve done pretty well at avoiding that. In addition to the stories Autumn mentioned, we’ve posted:

• A non-sensationalist defense of pro-ana communities.

• A gallery of the best/most absurd Lifetime movies about eating disorders.

• A guide to proposed eating disorder changes in the DSM-V.

• A history of eating disorders, including “holy anorexia, fasting girls (like Mollie Fancher, the ‘Brooklyn Enigma’) and wasting diseases blamed on wandering uteruses.”

• A long, lovely and honest Q&A with Angela Liddon, of Oh She Glows.

• And a piece about how Tumblr plans to start restricting pro-ana and other ‘self harm’ blogs.

Written by ENB

March 2, 2012 at 2:53 pm

Catalogued: Delivered from Distraction

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A quote plucked from my current reading material.

Valley Courier Office, Reading, Ohio

I have been drawn to literary people my entire life. My heroes during my adolescence were Dostoyevsky and Shakespeare. I was an English major in college. I have always liked to write, and many of my closest friends are writers, editors, publishers, agents, columnists, or other kinds of workers in the word business. I have always been intrigued by a commonality I have noted in literary people. They tend to be highly creative, witty, ironic, a tad cynical, and a tad depressed. They tend to drink a lot of alcohol, or be in recovery from having done so. They tend to harbor great dreams, but over the years lose faith in their ability to fulfill those dreams. And yet they also tend to be tenacious, working hard even as they lose hope that their work will pay off.

[…] As a psychiatrist, I have come to think of the literary type in genetic terms. I believe they inherit the genes that predispose toward [reward deficiency syndrome], as well as the genes that predispose toward verbal dexterity, keen powers of observation, a highly developed sense of irony, and a touch of depression. Due to the RDS, they can’t find sufficient pleasure in ordinary life. So they resort to extraordinary means. For example, they write. They submit to that unforgiving discipline to try to improve upon life by creating order, even beauty, out of chaos. That is an extraordinary effort to find ordinary pleasure.

Edward M. Hallowell, Delivered from Distraction


Yes, I’m taking this idea directly from Conor F., because I like it so much. I never get around to “reviewing” books as a whole on here, though I always mean to. But I can handle posting quotes … We will go with “in my backpack,” rather than “on my bookshelf,” however, as a) I don’t have a bookshelf right now, and b) while Conor’s are quotes “plucked from [his] accumulated tomes,” the quotes I post will be from whatever book or magazine I am reading at the moment. And, yes, I carry a backpack with me to and from the office. Screw grown-up bags.

TTB issues statement on kombucha

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I guess it’s non-stop kombucha-blogging here this week. Apologies, but I’ve been trying to research the issue this week and things keep changing so quickly. This morning, I spoke with a man at the Alcohol Tobacco Tax & Trade Bureau (TTB), whom I’d heard was heading up the federal kombucha investigation. He said he wasn’t really at liberty to speak about the issue yet, but that it was something the department was looking into, and there would be some sort of statement from the TTB within a few days. Then he called me back this afternoon to let me know that the statement had just been posted on the TTB’s website.

It’s certainly intended as a warning for kombucha producers to get their acts together:

TTB has been advised that a major chain of grocery stores has removed a number of kombucha products from its shelves because of concerns about elevated alcohol content levels.  The distribution of an alcohol beverage product that is not labeled as such misleads consumers and could cause potentially serious consequences for consumers, especially pregnant women, children, and individuals who should avoid alcohol for medical reasons.  Accordingly, TTB encourages producers and distributors of kombucha products that are alcohol beverages to take immediate steps to ensure that their products comply with applicable Federal, State, and local laws regarding alcohol beverages.

As a result of the inquiries received on this issue, TTB is coordinating with the Food and Drug Administration (FDA) to ensure that kombucha products that are currently on the market comply with Federal laws.  Right now, our primary concern is to ensure that consumers are not  misled about the nature of alcohol beverage products that might be marketed as non-alcohol beverages.  At this point in time, we do not know how extensive the problem is.

TTB plans to take samples of kombucha products from the marketplace and test their alcohol content in order to determine if the products are labeled in compliance with Federal law.  If TTB finds alcohol beverages that are not labeled in accordance with Federal law, we will take appropriate steps to bring them into compliance.  TTB will consult with FDA to ensure that the affected products comply with applicable Federal laws.  If the testing results from this labeling initiative indicate potential violations of the IRC, they will be referred to the appropriate office within TTB for further investigation, as necessary.

I’ll reserve comment for now.

Written by ENB

June 23, 2010 at 4:16 am

Posted in Health & Science, News

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A different sort of story on kombucha & alcohol

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Lindsay Lohan says her alcohol monitoring bracelet was set off not by a break from teetotalling but from drinking kombucha tea.

Written by ENB

June 21, 2010 at 3:02 pm

Posted in Health & Science, News

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Whole Foods pulls kombucha tea

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So it begins? Whole Foods—the world’s leading retailer of natural and organic foods—has pulled all kombucha from its shelves.

Kombucha—for those neither crunchy, Asian, nor in close enough proximity to Brooklyn to have tried it—is a fermented tea. It grows from a giant spore called a “mother,” is slightly alcoholic, tastes a bit like vinegar, and is thought by many to have health benefits that range from increased energy to help with cancer recovery. Personally, I’ve found it delicious, and kind of addicting. The fizz, the yeast, the unusual taste—somehow, against all odds, it turns out to be incredibly refreshing.

Maybe it’s funny that I should call the drink addicting—some think kombucha could be part of the recovery process for alcoholics. By most accounts, the tea usually has an alcohol content of less than 0.5 percent (the limit for beverages not carrying a government warning). But content varies from batch to batch, and the amount of any particular element (lactic acid, gluconic acid, ethyl alcohol, B-vitamins, etc. ) that will end up in a finished batch can be unpredictable.

Last I heard, the FDA and the Alcohol, Tobacco, Tax and Trade Bureau were “looking into” the alcohol content of commercially available kombucha, spurred by state tests showing some brands had more than 2 percent alcohol content. Does Whole Foods know something we don’t?

And, at the risk of sounding like a 1940s reporter signing off: Will the kombucha battles kill the beverage before it even has a chance to become the next Vita Coco? Stay tuned…

Written by ENB

June 20, 2010 at 10:26 pm

Posted in Health & Science, News

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Adderall Nation

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The symptoms of adult attention-deficit hyperactivity disorder seem to describe half the people in New York City: restlessness, impatience, impulsivity, procrastination, chronic lateness, and difficulty getting organized, focusing and finishing tasks.

A significant proportion of youngish people I know (in many cities)  have either been diagnosed/treated for ADHD, or suspect they should/could be.

Tyler Cowen points out that this WSJ article, “ADHD: Why More Adults Are Being Diagnosed,” is one of few that suggests that “some adults with ADHD are highly intelligent, energetic, charismatic and creative, and are able to focus intently on a narrow range of topics that interest them.” It’s also one of few I’ve ever seen that suggests a lot more adults could have ADHD and benefit from treatment:

About 4.4% of U.S. adults—some 10 million people—also have ADHD and less than one-quarter of them are aware of it.

That’s because while ADHD always starts in childhood, according to official diagnostic criteria, many adults with the disorder went unnoticed when they were young. And it’s only been since the 1980s that therapists even recognized the disorder could persist in adults.

Even now, getting an accurate diagnosis is tricky. Some experts think that too many adults—and children—are being put on medications for ADHD, often by doctors with little experience with the disorder. Others think that many more people could benefit from ADHD drugs and behavioral therapy.

I can’t decide if I’d like to see more or less of my friends running around popping adderall, which is the very-scientific method I’ve devised for solving this debate …

Written by ENB

April 6, 2010 at 10:55 am

“Orchid Children”

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One of the most fascinating articles I have read in a long time:

Most of us have genes that make us as hardy as dandelions: able to take root and survive almost anywhere. A few of us, however, are more like the orchid: fragile and fickle, but capable of blooming spectacularly if given greenhouse care. So holds a provocative new theory of genetics, which asserts that the very genes that give us the most trouble as a species, causing behaviors that are self-destructive and antisocial, also underlie humankind’s phenomenal adaptability and evolutionary success. With a bad environment and poor parenting, orchid children can end up depressed, drug-addicted, or in jail—but with the right environment and good parenting, they can grow up to be society’s most creative, successful, and happy people.

And while we’re on genetics, check out Kay Hymowitz’s City Journal article, “Femina Sapiens in the Nursery,” too.

Evolutionary psychologists are sometimes accused of not giving proper due to the flexibility of the human brain. In her recent book Mothers and Others, for instance, Hrdy argues that just as animal males don’t tend to their infants, so human fathers can’t be expected to hang around for the long run. But at their best, scientists are apt to describe the brain as chemically and neurologically predisposed to certain behaviors—nurturing babies in the case of women, for instance—while capable of adapting these behaviors to enormously varied environments. Sometimes those environments even change the brain’s chemistry, a process that the writer Matt Ridley calls “nature via nurture.” When Hrdy presumes the fecklessness of men, she underestimates the environmental pressure of social norms. The human record suggests that social norms, especially the universal one of marriage, can reinforce fathers’ ties to their children, which in turn might even become part of the male neural architecture. Recently, neuroscientists have even discovered evidence that married men’s testosterone levels fall at the birth of their baby.

I concede no opinions about ev-pscyh yet, but Dr. Science approves:

That is quite possibly the best account of the topic I have ever read! She pretty much gets everything right. The science doesn’t prescribe social policy, but rather informs it. How do we come to grips with all of the evolutionary inertia/path dependency that has built up over millions of years, reconcile it with our visions of what “the good life” ought to be, and set ourselves on a course to a better society?

That is the debate we ought to be having, but step one is accepting where we are at the moment with regard to our understanding of the world (science). And yes yes yes, our decisions about the kind of society we choose to create and live in will, over eons, create new selection pressures and reshape our evolutionary trajectory. And as Kay so eloquently points out, technology has already done a lot to change the selection pressures. Maybe a million years from now, our descendants will bemoan how much nature predisposes us to an asymmetrical paternal investment into offspring and they will create new technologies and social policies to swing nature back in the other direction once again.

Written by ENB

December 11, 2009 at 2:18 pm

Posted in Health & Science

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Sleep as Social Process; The Sadness of Science Journalism

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I have a friend whose job is, basically, all about communicating science ideas to the public for a major science organization. In grad school, he was the only non-communication-major in my group of friends (I think he studied environmental biology or chemistry, though I can never remember which), and we used to like—on boring, late-night, slightly-drunken metro rides—to play the game, “Ask Dr. Science!,” where we came up with inane, vaguely scientific questions and demanded answers from him. These days, I often send him science-y articles that catch my interest, and he tends to write me back lengthy responses about why this article is crap, or that finding is not as great as it’s being touted to be, etc. Which got me thinking: I think my blog needs an Ask Dr. Science! feature, obviously.

Because my friend wishes to remain anonymous, we shall heretofore refer to him only by the utterly ridiculous “Dr. Science,” or, if you’re into diminutions, the Doc. The subject of our our very first Ask Dr. Science! column is this New York Times article on a gene mutation tied to needing less sleep.

Researchers have found a genetic mutation in two people who need far less sleep than average, a discovery that might open the door to understanding human sleep patterns and lead to treatments for insomnia and other sleep disorders.

[…] Although the mutation has been identified in only two people, the power of the research stems from the fact that the shortened sleep effect was replicated in mouse and fruit-fly studies. As a result, the research now gives scientists a clearer sense of where to look for genetic traits linked to sleep patterns.

The lead researcher says her “fantasy” is that this might lead to a drug that can help people get by on less sleep without negative health consequences.

As someone who needs a full 8-hours or more of sleep per night (or copious amounts of caffeine) to feel decent, I have always regarded jealously those kind of people (in which category, unfortunately enough, all my boyfriends have always seemed to fall) who can get by on 5 or 6 hours of sleep per night. I seethe with envy at insomniacs. I pine for a safe upper stronger than coffee or red bull. I see my sleepiness as some sort of personal failure. And so: I am always interested in things that promise a possible end to this shameful shortcoming. Ah!, to cut my sleeping time in half! A girl can dream …

I sent the article to Dr. Science eagerly. He was not impressed.

First off, from a technical standpoint, how full of shit are the researchers here? And to what degree is this just hyping up a single study to justify continued funding for research? Nevermind the fact that the length of sleep people require is tied to far more than a single gene, the article states, “Although the mutation has been identified in only two people, the power of the research stems from the fact that the shortened sleep effect was replicated in mouse and fruit-fly studies.” Which begs the question,”How appropriate are fruit-flies and mice as models for studying the nature of sleep in humans?”

The article also has a quote from Dr. Fu,“When they wake up in morning, they feel they have slept enough,” Dr. Fu said. “They want to get up and do things. They arrange all their major tasks in their morning.” I hope the two women were subjected to more rigorous psychological testing than a couple of questions about their subjective state of feeling. How strong is their ability to consolidate memories after 6 hours of sleep? What about alertness, ability to concentrate, and willingness to exercise?

Anyway, I think it says something that at the end of the article that Dr. Fu chose the word “fantasy” to describe her hopes for the long-term outcome of this study.Namely, risk-free treatments for people who want to sleep less. I would like the article to have described exactly how the discovery will contribute to the development of such a technology. Skepticism about the actual significance of the discovery aside, the article glosses over the much more interesting question of “how much sleep do we actually need?” There was a related article about this in the same issue of Science. But it was (understandably so) restricted to a purely physiological discussion of the subject without any acknowledgment of how culture defines and influences what we consider to be the “appropriate” amount of sleep.

I admit, I glossed over his technical objections. But “how a culture defines and influences what we consider to be the appropriate amount of sleep?” How fascinating. I suppose I’ve never thought much about it before. What does Dr. Science know about different standards of sleep in different cultures, I wondered?

When I originally wrote that statement about cultural norms influencing sleep length I was in part thinking about how the adoption of certain technologies (in this case, artificial light, alarm clocks, and stimulants/sedatives) is itself a cultural practice. I did skim over a Wikipedia article that mentioned the “anthropology of sleep” before I wrote it just to make sure I wasn’t completely pulling something out of my ass, but it does appear that there is a small field of scholarship on this subject. Maybe its helpful to distinguish between an appropriate amount of sleep from a biological perspective from that of cultural expectation. So for instance, I think a neuroscientist would argue that the “appropriate amount of sleep” is the amount such that it doesn’t affect any of your cognitive faculties, alertness, attention span, and ability to engage in physical activity. But defining the optimum capacity for cognition, alertness, attention span, and ability to engage in physical activity is itself a social process. Although I would be willing to wager that most people feel more is better in each of those cases. So the questions becomes, at what point is enough enough? Where is the line between treating somebody with a disability and enhancing somebody who is already functioning at “normal” capacity? The baseline is dynamic and historically and culturally defined, so notions of treatment vs. enhancement are continuously being renegotiated by society.

I had to pause here and tell the doc about a play a friend of mine is writing, about a near-future society in which a test-batch of people begins on The Regimen, essentially a drug that only requires humans to get about an hour of sleep per day, or one full-night of sleep per week. He’s focusing on what this would do to not only work expectations, but how it would affect the relationship between a couple where one person is on the Regimen and the other isn’t. I love this kind of hypothetical stuff, and it also reminds me of the very-non-hypothetical debate over cognitive enhancement drugs.

But this is neither here nor there. Back to the Doc. He’s skeptical that Dr. Fu’s “fantasy” would be very good for society:

Let’s imagine for a moment that Dr. Fu was able to develop a risk-free treatment that allows people to comfortably rely on 6 hours of sleep a night without the use of an alarm clock to wake up and then function normally for the rest of the day. Why should we assume that would mean people would stop using stimulants and alarm clocks to further reduce the amount of sleep they need? So instead of going from an average of 8-8.5 hrs/night to 6 hrs, then let’s say people go from 6 to 3.5-4 hrs/night. How might that affect our culture? What would people do with all that time? Would businesses use it as an excuse to extend the work day by a couple more hours? How might it redefine what we refer to as “nightlife”?

And where in this chain of events in the development and deployment of such a sleep-reducing technology would people be given a choice about whether or not this is the type of society we want to live in? Or would we just sleep-walk (ok, maybe pun-intended) our way into this new world until it has become so entrenched that we can only attempt to create to a few modest regulations after the treatment has already become well established in the market and culture. How well has that approach worked for industrial agriculture and the way we eat food?

Anyway, it raises so many broad questions and I would just like to see science journalists raise a few of the issues rather than just congratulate the researchers. It looks like the author of the article only solicited one second opinion on the paper and it was from another physician doing sleep research. Why not ask a social scientist, an ethicist, or a historian about their thoughts on the subject? It’s a bit too important to simply leave it up to physical scientists to opine on the value of this research. So yeah, I’m not saying that a society where people only sleep 3.5-4 hrs/night would necessarily be a bad one to live in, but it warrants a broader debate than it will probably ever receive.

The sociology of science journalism! I hadn’t yet thought about that either. Sure, I publish “health discoveries” everyday on the Bulletin Web site, and wonder, vaguely and instinctively, what the point of reporting on these sort of things is, if it really creates any value, since findings seem to contradict each other and wind back and forth and get all twisty and bold and retracted every day or week or month. Oh, and I’ve read The Sociology of News, and I’ve thought about the way we cover press conferences and politics; I’ve wrote my graduate thesis on how we cover celebrities; I’ve pondered many times The Meaning of style-section articles … but I have never thought about the way we cover science. Or, if I have, it’s been with a vague assumption that science and health discovery reporting had to be kind of nebulous and shallow. Do you think the science journalism in the mainstream press in general is in a sorry state?, I asked Dr. Science.

Yeah, science journalism is definitely in trouble. Clearly not all journalists write these “gee-whiz, scientists discover X!” stories, but its pretty prevalent. Andrew Revkin at the NYTimes does a lot of good coverage of science. He has an interesting article on the phenomenon we’re talking about here with regard to slowly evolving research and contradictory results–what he refers to as the “whiplash effect.”

In it, Revkin writes:

When science is testing new ideas, the result is often a two-papers-forward-one-paper-back intellectual tussle among competing research teams.

When the work touches on issues that worry the public, affect the economy or polarize politics, the news media and advocates of all stripes dive in. Under nonstop scrutiny, conflicting findings can make news coverage veer from one extreme to another, resulting in a kind of journalistic whiplash for the public.

But with the current state of newspapers and journalism, can we really expect anything better?

Written by ENB

August 19, 2009 at 11:21 am

Obama, Contraception & the Stimulus Package

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I find I’m disagreeing a lot today with my favorite feminist bloggers, but here goes again … as much as I’m totally in support less bizarre-regulation of federal funding for family planning, I do not think the proper place for this is in the economic stimulus package.

Jill Filipovic disapprovingly quotes John Boehner asking, “How can you spend hundreds of millions of dollars on contraceptives? How does that stimulate the economy?” Well … yeah. As Jill also points out, the contraceptive funding would be part of an overall initiative to help states fund Medicaid programs, and “Medicaid spending generally isn’t being attacked; it’s contraception spending.” Ann Friedman at TAPPED adds:

Not only will this expand health care services and take some burden off states, it will eliminate the need for states to go to the federal government and obtain a waiver.

But I think Rachel Larimore at The XX Factor and Matthew Yglesias have the right idea when the point out that, despite the maybe worthwhile nature of this provision, the economic stimulus bill is not the right place for it. Rachel writes

Despite Obama’s pledge that there would be no pork in the legislation, Las Vegas’ mayor has been trying to get stimulus bucks for a planned “Mob Museum” for his city, and conservatives are already having fun with such proposals as an extra $50 million for the National Endowment for the Arts. If family planning is so important, do we really want it to be reduced to comparisons to the Mob Museum? Can’t it stand on its own merits?

[…] Make funding for family planning its OWN legislation. Get the debate out into the open. Obama promised hope and change. Congress shouldn’t let him down with business as usual.

If reversing the Bush administration’s insistence that state Medicaid programs apply for contraception/family planning funding separate from overall funding is a worthwhile enough goal—and I think it is, for both the ideologically and the bureaucraticly offensive portions of this provision— than addressing it as an issue in its own right instead of trying to sneak it into the economic recovery bill just seems proper.

Written by ENB

January 27, 2009 at 11:31 pm

Narcisisstic Desire Disorder

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So this has been blogged about all over the place, and I’ve already posted about it on Ladyblog, but I’m still pretty intrigued by the New York Times Magazine article on women and sexual desire [seriously, read the whole thing if you haven’t yet].

Yes, the article has a few flaws—the “post-feminist” tag on the headline is sort of annoying, since several of the researchers within are quoted as considering themselves “feminists,” but that’s hardly the writer’s fault; and the ending— “women’s sexuality is an unknowable forest” and all that—is, in addition to being kind of a cop-out, just kind of cheesy. But I think, overall, the (male) writer does a really great job of handling the topic and the material, presenting it in a way that avoids falling into any particular ideological pigeonhole or falling back on the old “women—man!, aren’t they crazy and inexplicable” trap.

The part that most intrigued me was the research about women’s desire based on a feeling of being desired:

[One researcher] emphasized the role of being desired — and of narcissism — in women’s desiring.

The critical part played by being desired, Julia Heiman observed, is an emerging theme in the current study of female sexuality. Three or four decades ago, with the sense of sexual independence brought by the birth-control pill and the women’s liberation movement, she said, the predominant cultural and sexological assumption was that female lust was fueled from within, that it didn’t depend on another’s initiation.

Meana made clear, during our conversations in a casino bar and on the U.N.L.V. campus, that she was speaking in general terms, that, when it comes to desire, “the variability within genders may be greater than the differences between genders,” that lust is infinitely complex and idiosyncratic.

She pronounced, as well, “I consider myself a feminist.” Then she added, “But political correctness isn’t sexy at all.” For women, “being desired is the orgasm,” Meana said somewhat metaphorically — it is, in her vision, at once the thing craved and the spark of craving.
This whole narcissism business has, of course, sparked some complaints from a few feminist bloggers. Jill at Feministe writes:

Shocking, absolutely shocking, that when women are raised in a culture that equates the female body with sex itself, that positions the female body as an object of desire, and that emphasizes that being desired is the height of female achievement, women will see sex as a process primarily centered on male attraction to women, and will get off more on being wanted than on wanting.

Maybe so. I like my cultural constructs as much as the next person and all that. But regardless—whether it comes from some innate position or from acculturation (which, sure, is an interesting exploration in and of itself, though really, an impossible one)—it’s still a fascinating finding. Women get off on being desired. And yet, one researcher notes:

… in comparison with men, women’s erotic fantasies center less on giving pleasure and more on getting it.

Women are far more selfish and narcissistic in terms of sex—if not in practice, at least in fantasies—then men? Come on, this is good stuff! I don’t understand how this research can be construed as some sort of tool/effect of the patriarchy. And—I have to admit, though I have spent my formative years adamantly denying that gender differences exist at all—that, uh, based largely on anecdotal evidence, I’m beginning to come around to the idea that (while mental/emotional gender differences still be damned!) sexual desire/behavior may be an area of innate difference between the sexes. Not in the typical “men want it/women don’t” or “men can separate sex from love/women can’t” dichotomy that is often presented [one researcher thinks that women may be even less emotional/relational in their lust then men are], but in more subtle ways—which is what a lot of this research seems to be saying.

Written by ENB

January 27, 2009 at 10:52 pm

More on the HHS Conscience Rights Rule

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New LadyBlog post on the HHS ‘conscience rights’ rule change:

Amanda Marcotte suggests that the administration is trying to push this rule-change through this month — even though it will likely be overturned by Obama or the new Congress — as part of a strategy to draw even more attention to the issue when he/it does. I find this scenario extremely plausible—which is why I think its important to remember that it is the Bush administration that is creating the new rules. Medical practitioners already have the right to refuse to perform abortions, and have since the 1970s.


Written by ENB

December 9, 2008 at 3:42 pm

Posted in Health & Science

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Little Helpers 2.0

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Seriously, who is handing out all this Adderall and Provigil? Every few months it seems some publication or other is running an in-depth expose on the “new” recreational/professional use of prescription “smart drugs.” Our intrepid reporters gloss over how exactly they or their subjects get a hold of these drugs: Black market? Laissez-faire doctors? Mail order from Mexico? These are the things inquiring minds want to know!

The latest, “Can a Pill Make You Smarter?,” is from December’s Marie Claire.

Smart Drugs, or more precisely, cognitive enhancers, include a variety of controlled substances, available — if you insist on being legal about it — only by prescription. They include stimulants such as dextroamphetamine (sold as Dexedrine and Adderall) and methylphenidate (Ritalin, Concerta) for treating attention deficit hyperactivity disorder (ADHD). By mimicking the brain neurotransmitters norepinephrine and dopamine, stimulants leave you utterly consumed with the task at hand until mission accomplished. Then you’re fired up to tackle something else, anything else, from organizing your sock drawer to grooming your cat. Smart Drugs also include a class known as eugeroics, meaning “good arousal” … The eugeroics modafinil and armodafinil (sold as Provigil and Nuvigil) treat narcolepsy and “excessive sleepiness” (ES) due to shift work and sleep apnea. But prescribed off-label, they’ve also been found effective for ES due to overbearing superiors, perfectionist tendencies, and not enough hours in the day.

After hearing from a lawyer who takes Focalin to manage 14- to 20-hour workdays, reporter Joanne Chen decides to try some “smart drugs” for herself. And guess what? She gets a lot of shit done!

Now in my younger years, I conducted—as Audrey Hepburn might say—“a comprehensive study of depravity,” which included no small amount of Adderall use. And I concur wholeheartedly with Chen’s description of the effects—it makes it easy to get done even the most mundane tasks, the ones you’ve been putting on your to-do list for weeks. What she doesn’t bring up is how much easier it also makes certain social situations. I can be quite shy (if you know me and think ha!, let’s just say I hide it well), and I’m absolutely horrid at the social nicety known as “small talk” (seriously, when I watch people do the small talk thing with ease I’m filled with confusion, jealousy and wonderment), but on Adderall, everything anyone says to you is fascinating!, and not only that, but you have the perfect reply, too. Office Christmas party? You’re a hit! Socializing with strangers? Done and done!

I know I’m beginning to sound like the alcoholics or potheads who insist they need a drink, or a joint, to take the edge off, but the beauty of cognitive enhancers is that it’s possible without any of the messy/embarrassing side effects—you remain lucid, coordinated, unchanged personality-wise, and sharp, and also devoid of the jitteriness or other weirdness that other stimulants (even caffeine) can bring. You are just … focused, be it on answering emails or writing a paper or cleaning your house or mingling at the office Christmas soiree.

Focused, and awake. It’s not as if you never need to sleep, you just need to sleep less. For those ‘there aren’t enough hours’ types, voila!

Of course, as a friend said the other day, “I really do need more hours in the day. Of course, what would I do with more hours? Probably just read more blogs.”

It’s funny, but, oh-so-sadly, also probably true. Keeping up with blog reading (and writing) is actually something that minorly stresses out me and a lot of people I know. That might sound silly at first blush, but it’s really just symptomatic of some of the many problems the Internet and self-publishing and the oft-maligned “24-hour-news-cycle” and all of that have created, isn’t it? There is so much that can be known, and there is no longer any excuse for not knowing it—it is all right there! There is so much to keep up with around the world, and there is no longer any excuse for not keeping up with it—it is all right there! There is so much to read, and you had better read it now, because by next week (or 3 hours from now) it will be passé. Even with music—earlier today, in saying that I was really enjoying Okkervil River’s album, “The Stand Ins,” I caught myself qualifying it with “I know I’m a big late to the game, but.” The album came out in September.

In Chen’s article—and every other I’ve read like it—the people using cognitive enhancement drugs aren’t doing it to tune in, turn on and drop out; they aren’t doing it to expand their consciousness, baby, or to escape, or even to have really awesome sex. They are doing it so they can get more done. Chen quotes a neurologist who asks, “Is this a dysfunctional way of living?”

Well, yes! Of course it is!

Now before you accuse me of having no historical perspective, I will state for the record that I realize people using productivity-enhancing drugs is not a new phenomenon. Benzedrine and mother’s little helpers and the cocaine 80s and all that. But I think there is something profoundly different about these cognitive enhancers, isn’t there? For one, they’re legal. And for another, they carry much less risk of addiction and side effects than their 1950s and 1960s counterparts. That’s not to say they’re harmless, but the risks are relatively minimal, and as Chen mentions in her article, a new class of cognitive enhancers already in the works contain even less downsides.

I’ve always been extremely ambivalent about the pathologizing and medicalizing of human nature. Phoebe sort of took up this question last week as it relates to Atzberger’s disease, and it was more or less a variation on the same discussion that has raged over ADD and depression for the past two decades or so, which is in itself just a variation on the age-old debate over how much variance we, as a society, allow in human behavior, temperament and relationships; how we decide on the outer-limits, beyond which it is not just unusual but unhealthy, sick, to be cured.

As it seems de rigueur to point out so as not to incur the wrath of those who take any discussion of the benefits of pharmaceutical cures as making light of this or that condition, I know there are many serious cases of serious conditions for which drugs are totally imperative, etc.

I also believe that in many, many cases the whole idea of medicating is silly; that it’s ill-advised that we’ve given up on human variance and ‘flaws’ so much. But if everyone else has given up on it, I don’t want to be left behind, the only poor sucker relying on my normal brain chemistry and energy levels and attention span.

So … I’d like to hear anyone’s thoughts on this. Do you think cognitive enhancing drugs will become more widely prescribed than they are now? Is there a not-too-distant future when we’re all going to be able to get this stuff as easily as aspirin? Or do you think there’s going to be a major governmental crackdown/backlash? Is more widespread use of these drugs something to be embraced, or feared? Are we getting too close to creating a weird society of super humans? And does anyone know a good doctor? 😉

Written by ENB

November 23, 2008 at 9:54 pm

The long and continuing saga of me learning not to eat like a hillbilly*

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I just read this Salon article on farmers seeking to bring truffles — the elusive, highly-coveted and correspondingly expensive wing of the fungi family — to America, physically and culturally.

A sliver of truffle can transform a simple serving of pasta into something mysterious and carnal — a meal for which, as chefs know, you might be willing to empty your wallet. As one woman told me, “If I had a piece of truffle in my mouth, I’d probably say yes to anything.” Or as the Roman scholar Pliny put it nearly 2,000 years ago, “Better to suffer a wheat famine than a shortage of truffles.” Such exuberance accounts for the odd fact that the mushroom in Michaels’ hand — at $800 a pound — was worth more than the watch on his wrist.

I tried something truffle-flavored for the first time this weekend. It was definitively one of the most disgusting things I have ever tasted.

I actually bought a processed cheese-ball from Giant last week, however, and ate it on triscuits. I probably can’t be trusted.

* Part one of many.

Written by ENB

February 19, 2008 at 9:22 pm

Anorexic teens ordered to turn Myspace writings over to the court

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There are many levels of weirdness to this New Jersey court case involving Horizon Blue Cross Blue Shield, a group of anorexic teenagers, and Myspace.

Here are the basics: In New Jersey, health insurance companies are required to cover mental illness only if it is biologically based. Horizon declined to pay for the treatment of three teenagers with eating disorders, and their families sued (in federal court). The families say the eating disorders are biologically based; Horizon says anorexia and bulimia are emotional disorders. The cases, filed separately, were consolidated for discovery.

Because the court has barred Horizon from taking depositions from the teens, Horizon requested access to the their diaries, emails, and any writing posted on Myspace or Facebook. The judge limited the scope of discovery to writings that were made public and “shared with others,” which means the emails and social networking pages are still up for grabs.

This presents the first level of weirdness. Can emails and postings on an (at least theoretically) closed-access social networking sites be classified as public, and up for grabs in discovery of this sort? Phillip Malone, director of the cyber law clinic at Harvard’s Berkman Cener for Interent and Technology, told Portfolio that the case law on discovery of materials posted on social networking sites is still just developing.

“Malone … says the generation that has grown up online have different privacy expectations, and believe they can put material on the Internet with the expectation that only a limited group will see it. “We should recognize that there is a continuum,” Malone says. A teenager on Facebook sharing with six friends “is a very small and limited group and courts should treat that differently than a blog available to the whole world.”

The bigger – and weirder – question, I think, is what exactly does Horizon hope to learn from these teens’ Myspace blogs? Philip Sellinger, Horizon’s lawyer, said these posts “go to the heart of” whether the girls’ eating disorders were biologically or emotionally based.

Really? A whole slew of mental health professionals can’t agree on this issue (the National Institute for Mental Health says eating disorders are biologically based, but others disagree), but by golly, teenage Myspace ramblings should get to the heart of it! Why, who even needs a psychiatry degree? I can’t wait to start diagnosing all my friends based on their facebook profiles. This is psychiatry 2.0, baby!

Says Rachel at Women’s Health News: “I wonder how BCBS plans to separate normal teenage angst from writings demonstrating a direct cause of their eating disorders? Somehow I doubt that’s even possible, because, let’s be frank – if someone dug up all of your teenage missives, would it seem like you were a mature, mentally stable person? Probably not.”

Newsweek take
Junkfood Science on the biology of starvation

Written by ENB

February 14, 2008 at 5:13 pm