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Is a 15-week limit on abortion an acceptable compromise?
A recent opinion piece by George F. Will, “Ambivalent about abortion, the American middle begins to find its voice” in the Washington Post made the startling claim that the overturning of Roe v. Wade (Dobbs v. Jackson Women’s Health Organization, 2022) has resulted in “a partial healing of the nation’s civic culture.” One might think exactly the reverse. The Dobbs decision energized voters, especially women and young people, resulting in numerous Republican electoral defeats across the country. However, Will argues that the return of abortion policy to the states gives voters the opportunity of choosing moderate restrictions on abortion. Since most Americans support early abortion while opposing late-gestation abortion, Will thinks that a 15-week ban on abortion would be an acceptable compromise.
Why 15 weeks? Two reasons can be given. Almost all abortions in the US—93%—occur within the first 15 weeks of pregnancy. For this reason, making abortion illegal after 15 weeks would not, it would seem, impose serious burdens on most people seeking abortions.
Another reason is that several European countries limit abortion on request to the first trimester, leading some US lawmakers to suggest that a 15-week ban would bring our abortion law in line with theirs. This is disingenuous, to say the least. While elective abortion is limited in some European countries, it is not banned afterwards, but is allowed on other grounds, including economic or social reasons, or a threat to the woman’s physical or mental health. Moreover, in most European countries, patients do not have to pay for abortion; it is covered under universal health coverage. The fact is that the trend in Europe has not been to limit abortion, but to expand access to it. Countries in Europe “… have removed bans, increased abortion’s legality and taken steps to ensure laws and policies on abortion are guided by public health evidence and clinical best practices.”
Were states to guarantee access to abortion prior to 15 weeks, a 15-week ban might be acceptable. However, even before Dobbs, many women in the US lacked access to abortion, due to a dearth of providers, especially in rural areas. They often had to travel many miles to find an abortion clinic, which meant that they had to arrange childcare if they have other children or take time off work. Delay is also caused by the need to raise money for an abortion, which is not paid for by Medicaid in most states, except in cases of rape, incest, or a life-threatening condition. To be sure, even if there were none of these roadblocks, some women would still not be able to have early abortions because they do not know that they are pregnant, due to youth, being menopausal, chronic obesity, or a lack of pregnancy symptoms. Any time limits will pose hardships for some people. But if access to early abortions were guaranteed, a compromise on a 15-week limit might be worth it.
I suspect that time-limit advocates are not particularly interested in making sure that women who have abortions get them early in pregnancy. They want to place roadblocks in the way of getting abortions, full stop. That these roadblocks increase the numbers of late abortions is of little concern to them, however much they wring their hands over late abortions. Abortion can be reduced by reducing the number of unwanted pregnancies, something that has been shown to be achieved by access to contraceptives and science-based sex education in the schools. Remember when pro-lifers emphasized those methods? Me neither.
“Some US lawmakers suggest that a 15-week ban would bring our abortion law in line with European countries. This is disingenuous, to say the least.”
My second concern is with abortions sought after 15 weeks. The reason for a late abortion may be that the woman has a medical condition that has not developed, or has not been detected, until later in pregnancy. In such cases, the pregnancy is almost always a wanted pregnancy, and the decision to terminate imposes a tragic choice.
It may be responded that all states allow abortions to be performed when this is necessary to save the pregnant woman’s life, and many allow for abortions to protect her from a serious health risk. The problem is that these exceptions conflict with standard medical care, especially in the case of miscarriage. Once the woman has begun to miscarry, the failure to remove the fetus is likely to cause her sepsis, which can be life-threatening. However, in states with restrictive abortion laws, doctors cannot perform an immediate abortion, which is the standard of care in such situations. They have to wait until her death is imminent and, in some states, they cannot remove the fetus until its heart stops.
Ireland’s restrictive abortion law was repealed after a woman who was denied an abortion during a miscarriage died from septicemia. To the best of my knowledge, no woman in the US has died as a result of restrictive abortion laws, but some have come close. An OB-GYN in San Antonio had to wait until the fetal heartbeat stopped to treat a miscarrying patient who developed a dangerous womb infection. The delay caused complications which required her to have surgery, lose multiple liters of blood, and be put on a breathing machine. Texas law essentially requires doctors to commit malpractice.
Conservatives often portray those in the pro-choice camp as advocating abortion until the day of delivery, for trivial reasons. This is deeply unfair. If they want us to compromise on time limits, they should be willing to guarantee access to abortion before 15 weeks. They should be willing to compromise on pregnancy prevention through contraception and sex education. And they should agree to drop all restrictions on late-term abortions that make legislators, rather than doctors, in charge of deciding what is appropriate medical care for their patients.
Featured image: Gayatri Malhotra via Unsplash (public domain)
Increasingly, scholars across the life and social sciences recognize the necessity of multi-method, interdisciplinary research for its ability to adequately understand the world’s complex problems.[1] However, the process of designing and executing these projects can be challenging. Interdisciplinary endeavors often risk privileging one discipline/methodological paradigm with others incorporated in a more consultative manner (i.e. quantitative versus qualitative), or, they run in-parallel without integrating epistemologies and methodologies (Lewis 2021). Examples of symmetric and integrative projects which unsettle disciplinary boundaries to afford new kinds of knowledge remain few and far between.
In the following piece, we (ZB and CB), as members and ethnographers of interdisciplinary teams, reflect on several “Mexican Exposures” (MEXPOS) projects which bring together researchers in anthropology, epidemiology, biostatistics, engineering, and health economics to make better knowledge and “better numbers” about health and inequality in Mexico (Roberts 2021). MEXPOS projects collaborate with long-standing epidemiological birth-cohort studies (ELEMENT and PROGRESS) which are based within Mexico’s National Institute of Public Health (INSP). Through performing and observing the laborious process of integrating the often-disparate methodologies, epistemologies, and analytical aims that each expert brings to the team, we have identified that some team members act as mediators, performing a critical role in making these interdisciplinary collaborations work. Our contribution to understanding how interdisciplinary knowledge is made (Lin et al. 2007) is a focus on the interpersonal aspects of knowledge production through exploring how these teams make better data by destabilizing disciplinary boundaries. By doing so, we hope to elucidate the challenges and opportunities of this kind of collaboration by exploring what is made possible when doing this work together.
ZB has a bachelor’s degree in Anthropology and has spent a year managing MEXPOS projects as she prepares to begin a joint MD-PhD Anthropology training program; as an undergraduate, she also spent three semesters working in the MEXPOS ethnographic coding lab. CB has a background in physiotherapy and medical anthropology, and works with MEXPOS as part of her doctoral research and the Biosocial Birth Cohort Network, which included shadowing the MEXPOS team for ten days in April 2023 and meeting field workers in Mexico City. We developed this essay from our shared experience and observations of interdisciplinary knowledge practices within MEXPOS team meetings.
MEXPOS projects perform bioethnographic work. Bioethnography is a research method which combines methodologies from the social and biological sciences to understand environment-body interactions as relational and situated processes (Roberts and Sanz 2018). The premise of bioethnographic teams is to generate new knowledge by transcending disciplinary boundaries to tackle the complexity of the topics of study. Bioethnographic methods differ from other examples of collaboration between the life and social sciences that break down because of the lack of a shared intent or question (Lewis 2021) and encourages critical implosions between “nature/culture” (Roberts 2021). This methodology calls for the unsettling of traditional epistemological boundaries between the disciplines involved to critically engage with the questions and objects of research at hand in new and innovative ways.
This interdisciplinary research model hopes to create knowledge that truly apprehends pressing problems and questions. In practice, however, we have found that this process can feel awkward, clunky, and falter as members navigate the integration and destabilization it requires, working through the tensions of epistemic purity and interdisciplinary compromise while creating new modes and subject positions towards these blended methods. In our experience, the element which often relieves these tensions and moves teams toward achieving their collaborative aims has been the presence of mediators and the labor they perform.
Mediators are key for facilitating conversations between disciplines that bring underlying “taken-for-granted” assumptions to the surface, enabling these teams to progress past disciplinary limits. Most MEXPOS teams consist of a core of senior academics that are anchored within respective disciplines and act as knowledge-keepers alongside a variety of research assistants and management staff. Within MEXPOS, we have found that mediation is typically performed by the project manager and several graduate research assistants, including ZB. These are junior scholars with varying degrees of training in ethnographic methods as well as survey methodology, epidemiology, biology/life sciences, statistics, and other quantitative analyses. Through their training and background, mediators are well positioned to steer, generate, and develop bioethnographic questions while fostering a group dynamic that advances the team’s goals. The two examples we present here demonstrate mediation-in-action which allowed these teams to move forward amid, and possibly because of, disciplinary friction (Tsing 2011), which was harnessed by the mediators and transformed into something generative.
In the Spring of 2023, a team within MEXPOS worked on a collaborative paper based on the insights of the Household Chemical Assessment Project, a pilot study of two working-class households in Mexico City. This project, involving anthropologists, epidemiologists, exposure scientists, and metabolomics researchers, documented household and personal care products along with their use/meaning and generated a master list of chemical ingredients and insights about household exposure. During these meetings, the team debated how to situate this project and its outputs within an existing paradigm of exposure research, “the exposome” (Wild 2005). The team was stuck; the epidemiologists were aiming for epistemological clarity and a fixed structure to proceed, while the anthropologists were looping back and questioning the paradigm itself by posing alternative questions. The mediator registered that the two camps were talking past one another due to differences in their underlying notions of what “exposure” entailed on an ontological level, and pulled together readings that spanned both sets of disciplines to be discussed as a group at the next meeting. This effectively moved the team forward by 1) developing a new starting point with a shared knowledge base and vocabulary, and 2) opening a window into each discipline’s mode of inquiry in a way which allowed for more nuanced discussion about their respective stakes and assumptions. In this way, mediators can act as disciplinary polyglots thanks to their ability to understand the languages of the different disciplines, recognize and iron out misunderstandings, and summarize the conversations held by senior academics from different camps. This practice of mediation enabled the team to theorize beyond disciplinary limits and pioneer a new orientation towards exposure inquiry and intervention that enmeshes social and life scientists within a framework of shared understanding.
The second example involves another MEXPOS team, comprised of anthropologists, health economists, biostatisticians, and epidemiologists, that leveraged insights from a previous project (NESTSMX) about household water infrastructure. The team created a module of survey questions for the Mexican National Health and Nutrition Survey (ENSANUT) in order to investigate the impact of an intermittent water supply on health, gender, and household finances. One meeting about question revisions for the following year’s survey got stalled when differences in disciplinary aims and timelines surfaced. The anthropologists, who predominated, wanted to ameliorate their own apprehensions around survey methodology by tinkering with existing questions and discussing potential new ones to keep fidelity to the complex ethnographic insights. The biostaticians seemed frustrated by this, as they pointed out the looming due date and advocated for straightforward and generalizable questions to produce data that could be meaningfully compared to the previous year. The mediators suggested narrowing the discussion only to the ethnographic data that could be directly operationalized into the specific module questions that the biostaticians agreed would be worth modifying because they describe experience instead of measuring prevalence. As such, the mediators helped to reconcile qualitative richness and quantitative concreteness in translating ethnographic insights into questions that produce 0s and 1s, modulating between the sometimes-disparate aims and scales of ethnographic and statistical research processes that make integrating them so difficult.
Sketches from CB’s notebook while observing interdisciplinary knowledge practice, integrated and expanded by ZB.
Contemporary academic training calls for more interdisciplinary models, which could produce more mediators for multidisciplinary teams. These mediators do not always squash or quell conflict, but rather harness the productive role of the disciplinary unsettling that bioethnography facilitates among established academics, including the resulting misunderstandings and moments of uncertainty. These moments of generative friction offer critical points of reflection and surprise, and can reveal disciplinary assumptions and blind spots – which might be what is most valuable in bioethnography. This generative friction is a function of the unexpected: to borrow from studies of cognition, it is when a habit, in this case a disciplinary way of thinking, is contradicted and calls for a new way of understanding (Clark 2018), as well as epistemic humility. Here, these new ways of understanding are the interdisciplinary insights that are made possible through practices of bioethnographic integration. The mediators make friction productive by “paying attention to the diverse concerns of different disciplines and incorporating responsive negotiation of their collaborative possibilities and the tensions between them” (Mol and Hardon 2020). Here, mediators provide the crucial vector required to propel the group forward.
The making of truly interdisciplinary knowledge often requires overcoming epistemological paradigms through disciplinary destabilization. Mediators both manage interdisciplinary tensions and foster the generative friction that emerges, allowing for new kinds of knowledge to be produced together. Mediators can recognize, hold, and harness the discomfort of competing objectives and respond accordingly with the symmetry of the meta research process continually in mind. While disciplines will transform as opportunities for interdisciplinary training continue to increase, our experience with these bioethnographic collaborations underscores the importance of maintaining spaces for generative frictions that mediators can render into positive momentum.
[1] See https://www.ucl.ac.uk/soc-b-biosocial-doctoral-training/soc-b-centre-doctoral-training-biosocial-research; https://new.nsf.gov/funding/learn/research-types/learn-about-interdisciplinary-research
Clark, Andy. 2018. “A Nice Surprise? Predictive Processing and the Active Pursuit of Novelty.” Phenomenology and the Cognitive Sciences 17 (3): 521–34. https://doi.org/10.1007/s11097-017-9525-z.
Lewis, Ashley. 2021. “Questioning the Promise of Interdisciplinarity: An Ethnography of an Interdisciplinary Research Project.” University of Nottingham.
Lin, Wei, Rob Procter, Peter Halfpenny, Alex Voss, and Kenny Baird. 2007. “An Action-Oriented Ethnography of Interdisciplinary Social Scientific Work.”
Mol, Annemarie, and Anita Hardon. 2020. “What COVID-19 May Teach Us about Interdisciplinarity.” BMJ Global Health 5 (12): e004375. https://doi.org/10.1136/bmjgh-2020-004375.
Roberts, Elizabeth F. S., and Camilo Sanz. 2018. “Bioethnography: A How-To Guide for the Twenty-First Century.” In The Palgrave Handbook of Biology and Society, edited by Maurizio Meloni, John Cromby, Des Fitzgerald, and Stephanie Lloyd, 749–75. London: Palgrave Macmillan UK. https://doi.org/10.1057/978-1-137-52879-7_32.
Roberts, Elizabeth F.S. 2021. “Making Better Numbers through Bioethnographic Collaboration.” American Anthropologist 123 (2): 355–69. https://doi.org/10.1111/aman.13560.
Tsing, Anna Lowenhaupt. 2011. Friction: An Ethnography of Global Connection. Princeton University Press. https://doi.org/10.2307/j.ctt7s1xk.
Wild, Christopher Paul. 2005. “Complementing the Genome with an ‘Exposome’: The Outstanding Challenge of Environmental Exposure Measurement in Molecular Epidemiology.” Cancer Epidemiology, Biomarkers & Prevention 14 (8): 1847–50. https://doi.org/10.1158/1055-9965.EPI-05-0456.
The new documentary “No Way Back: The Reality of Gender-Affirming Care” criticizes transgender ideology from a self-described “liberal, west coast Democrat” perspective. Despite facing significant resistance from trans activists, it has been making an impact.
The film will be showing in select theaters across the country during a one-day AMC Theatres Special Event on Wednesday, June 21st at 4:30 and 7:30 pm. It will be available online and on DVD starting July 2nd.
Below, Joshua Pauling interviews producer Vera Lindner.
Joshua Pauling (JP): Thanks for taking the time to discuss your new documentary. It really is a powerful depiction of what is happening to people when transgender ideology takes over. I especially found the detransitioners’ stories compelling. The story you tell throughout is decidedly reasonable and anchored to reality. Kudos to you all for producing such a thorough and moving documentary on such an important and controversial topic. And much respect for being willing to say hard but true things in the documentary.
How has the response been to the film thus far?
Vera Lindner (VL): We’ve received tons of gratitude, tears, and donations. The most humbling has been the resonance the film created in suffering parents. I wept many times reading grateful, heartbreaking messages from parents. People are hungry, culturally speaking, and are embracing our film as truth and facts, and a “nuanced, compassionate, deeply researched” project.
JP: That is great to hear, and interesting that there has been an overwhelming response from parents. Parents are frequently the forgotten victims of this ideology.
How has the film been doing when it comes to numbers of views and reach?
VL: Since February 18th, the film has been viewed 40,000 times on Vimeo, after it was shut down in its first week and then reinstated due to publicity and pressure from concerned citizens. Many bootlegged copies have proliferated on Odysee, Rumble, and such, so probably 30,000 more views there as well. After we put it on Vimeo on Demand in mid-April, it’s getting purchased about 50 times a day. Our objective is the widest possible reach.
Since February 18th, the film has been viewed 40,000 times on Vimeo, after it was shut down in its first week and then reinstated due to publicity and pressure from concerned citizens.
JP: Sad to say, I’m not surprised that it was shut down within a few days. Can you explain more about how such a thing happens? In what ways has it been blocked or throttled?
VL: Vimeo blocked it on the third day due to activists’ doing a “blitz” pressure campaign on Vimeo. Then they reinstated it, after news articles and public pressure. Our private screening event in Austin was canceled due to “blitz” pressure on the venue (300 phone calls by activists in two days). These experiences help us refine our marketing strategy.
JP: I guess that shows the power of public pressure, from either side. You know you’ve touched a nerve when the response has been both so positive as to receive countless heartfelt letters from people, and so harsh that activists want it canceled.
What do you see as next steps in turning the tide on this topic as a society? What comes after raising awareness through a documentary like this?
VL: Our objective was to focus on the medical harm and regret of experimental treatments. All studies point to the fact that regret peaks around eight to eleven years later. Yet the message of the activists toward the detransitioners is, “It didn’t work for you, you freak, but other people are happy with their medicalization.”
Our expectation is that conversations about the long-term ramifications of this medical protocol will start. We need to talk not only about how individuals are affected, but the society as a whole. Wrong-sex hormone treatment and puberty blockers lead to serious health complications that could lead to lifelong disability, chronic pain, osteoporosis, cardiac events, worsening mental health. SRSs (sex-reassignment surgeries) cost hundreds of thousands of dollars. These are not just one individual’s personal issues.
The economics of our health insurance will be impacted. The ability of these people to be contributing members of society will be impacted profoundly. The Reuters investigation from November 2022 stated that there are 18,000 U.S. children currently on puberty blockers and 122,000 kids diagnosed with gender dysphoria (and this is only via public insurance data, so likely an undercount). These all are future patients with musculoskeletal, cardiovascular, and mental illnesses for a lifetime. A hysterectomy at twenty-one can lead to early dementia, early menopause, and collapse of the pelvic floor organs.
The economics of our health insurance will be impacted. The ability of these people to be contributing members of society will be impacted profoundly.
I don’t yet see conversations about the long-term health implications of “gender-affirming care,” particularly in relation to how insurance, the labor force, interpersonal relationships, and future offspring will be affected. Everyone wants to be affirmed now and medicalized now. But there are lifelong implications to experimental medicine: autoimmune illnesses, cancers, etc. Sexual dysfunction and anorgasmia have real implications on dating, romantic life, and partnering up. A few people are talking about this on NSFW posts on Reddit.
JP: It’s interesting how speaking out against trans ideology and gender-affirming care creates some unlikely alliances across the political and religious spectrum. What do you see as the potentials and pitfalls of such alliances?
VL: We align with people who are pro-reality, who respect core community values such as truth and honesty, and who see the human being as a whole: body and soul. There is no metaphysical “gendered soul” separate from the body. Teaching body dissociation to kids (“born in the wrong body”) has led to a tidal wave of self-hatred, body dysmorphia, depression, anxiety, and self-harm. We are our bodies, and we are part of the biosphere. We respect nature and the body’s own intricate biochemical mechanism for self-regulation, the endocrine system. We believe that humans cannot and should not try to “play God.” We are students of history and know that radical attempts to re-engineer human society according to someone’s outrageous vision (read Martine Rothblatt’s The Apartheid of Sex) have led to enormous human cataclysms (communism, Chinese cultural revolution).
We are our bodies, and we are part of the biosphere. We respect nature and the body’s own intricate biochemical mechanism for self-regulation, the endocrine system.
JP: Well, then count me a realist, too! Funny you use the term pro-reality. I’ve written similarly about the possibility of realist alliances. While this makes for some improbable pairings, there can be agreement on the importance of fact-based objective reality and the givenness of the human body.
Realists can agree that the world is an objective reality with inherent meaning, in which humans are situated as embodied, contingent beings. Such realists, whether conservative, moderate, or progressive, might have more in common with each other on understanding reality and humanity than some on their “own side” whom I call constructivists: those who see the world as a conglomeration of relative meanings, subjectively experienced by autonomous, self-determining beings, who construct their own truth and identity based on internal feelings.
But I do have a related question on this point—a bit of respectful pushback, if I may.
Your pro-reality position seems to have implications beyond just the transgender question. Can one consistently oppose the extremes of gender-affirming care while upholding the rest of the LGB revolution? If our male and female bodies matter, and their inherent design and ordering toward each other mean something, then doesn’t that raise some questions about the sexual revolution more broadly?
As we see the continued deleterious effects on human flourishing unfold as thousands of years of wisdom and common sense regarding sex and sexuality are jettisoned, there are both religious and non-religious thinkers raising this question, though some go farther than others. I think, for example, of Louise Perry’s The Case Against the Sexual Revolution, Christine Emba’s Rethinking Sex, Mary Harrington’s Feminism Against Progress, and Erika Bachiochi’s “Sex-Realist Feminism.” An enlightening panel discussion with many of these thinkers was co-hosted by Public Discourse earlier this year. When the real human body is considered, its holistic structure as male or female is clearly ordered and designed to unite with its complement.
If our male and female bodies matter, and their inherent design and ordering towards each other mean something, then doesn’t that raise some questions about the sexual revolution more broadly?
How does this reality relate to the rest of the sexual revolution? If one argues that individuals should be able to express themselves sexually and fulfill their desires with no external limits beyond human desire or will, how does one justify saying that transgenderism is off-limits?
VL: I will answer the question, but I need to say that this is my personal opinion. I’m fifty-five and have worked in entertainment for more than thirty years, and in Hollywood for twenty-five years. The entertainment industry attracts LGBT people, so I’ve hired, mentored, befriended, and promoted LGBT and gender-non-conforming people every day of my career. I believe that being gay or lesbian is how these people were born. Some were affected by their circumstances, as well, but in general I believe that homosexuality is innate, inborn, and has existed for millennia. There were a handful of “classic” transsexual women as well. I have three close friends who transitioned in their late forties.
But the explosion we are seeing now is different. A 4,000-percent increase of teenage girls identifying as trans? This is unprecedented. Mostly these are autistic, traumatized, mentally ill teens who seek to belong, who wish to escape their traumatized brains and bodies, who have been bullied relentlessly (“dyke,” “fag,” “freak”) and now seek a “mark of distinction” that will elevate their social status. Instead of being offered therapy, deep understanding, and compassion for their actual traumas, they are being ushered toward testosterone, mastectomies, and hysterectomies. This is not health care. The tidal wave of regret is coming, because these adolescents were never transsexual to begin with. Many of them are lesbians or gay boys who have internalized so much homophobia and bullying that they would rather escape all of it and become someone different than deal with it.
This is what we want to address. Kids explore identities. This is a natural process of discovering who they are. Medicalizing this exploration cements this exploration they were doing when they were teens. Life is long, and one goes through many phases and many “identities.” To be “cemented” for a lifetime in the decision you made as a distressed sixteen-year-old to amputate healthy sex organs does not make sense.
JP: The rise in the rate of transgender identification is indeed stunning, as is the stark increase in the percentage of Gen-Zers who identify as LGBT. What those trends portend is a live question, as are the varied possible causes. And as you say, there is a tidal wave of regret building, from those who have been pushed toward gender transition. We will all need to make special effort to love and care for them.
You’ve been so gracious with your time. As we conclude, are there any other comments you’d like to share with our readers?
VL: Find a theater near you to attend the theatrical one-day premier on June 21st. Then the movie will become available online and via DVD on July 2nd. Watch the documentary and pass it on to all in your circles!
And ask commonsense humanistic questions:
– Can adults make decisions on behalf of kids that will forever change the path of the kids’ lives?
– Is it worth it to ruin one’s health in the name of a belief system?
– Is what you are reading in academic medical research based on evidence, or pseudo-science?
– If humans have been going through puberty for millennia, who are we to mess with that now?
– Is puberty a disease?
JP: Thank you for your work on this vital issue. I hope this documentary continues to make an impact. And realists unite!
The biology, as astonishing as it is, does not tell us what it will mean. -Stephan Helmreich, “Homo Microbis” (2014, 4)
Within microbiome research, the human body can be recast as a host of microbial ecologies, a “supraorganism” or “holobiont.” From this comes new ways of understanding and treating digestive diseases as well as illnesses associated with brain functioning, like depression and Alzheimer’s. This research reflects the increasing emphasis in the life sciences on “life as process” (Dupre and O’Malley 2007, Dupre 2020), and in the social sciences on the body as “biosocial” (Niehwöhner and Lock 2018). We take up these insights and examine one way that these ontologies of body and environment circulate in public ways by analyzing how the human body is depicted in relation to microbes and environments through public visualizations of the human microbiome.
Despite the fact that the human microbiome is made of up non-humans and should raise questions about human exceptionality, the human microbiome circulates in the media primarily in relation to human health. How to care for health through attending to the human microbiome has become a wellness topic circulating in popular news media, from science journalism to lifestyle and wellness magazines and websites. There are soaps, foods, and food preparation methods that are microbiome-friendly. There are direct-to-consumer tests that will offer personalized, if not precise, nutrition recommendations. There are magazine articles advising readers on how to care and optimize their various microbiomes, from stomach to skin to vagina. How are bodies, microbes, and environments portrayed as the relational entities that they are for public audiences?
We explore two prominent visual themes in the public visualizations of the microbiome. First, the representations of boundaries of the human body in relation to microbial bodies. This means paying attention to how the microbial worlds within, and the environment outside, the body are visually constituted. This is to visually contextualize the ubiquitous headline or textual hook about the human microbiome: that within the human body, microbial cells outnumber human cells. The scale of difference has oscillated as research accumulates and has ranged from estimates of a ratio of 100 microbial cells to 1 human cell, to 10:1 to 3:1, and most recently resting closer to a ratio of 1.3:1 (Saey 2016). Second, we consider how differences (racial, gendered, in physical ability/fitness) were represented. Our focus on public media follows Adele Clarke’s analysis of the role of the media in the assemblages of “healthscapes” (2010, 105-06) and shows how the microbiome becomes part of expansive processes of biomedicalization (Clarke et al 2010) that normalize directions of health care and individual responsibility. The media is not only central to the proliferation of concepts of health, but also generates and reproduces expectations of how the world should work in regard to health (Briggs and Hallin 2016).
We argue that the visualizations of the microbiome in the popular media depict it as a friendly frontier within the bounded human body. Through pictures and the news article headlines that accompany them, the human microbiome is presented as having silently cared for the body until its potential was recently discovered by scientists. This depiction suggests that the human body’s health is the purpose of the microbiome itself and of scientific research into its mechanisms. The human body, with the guidance of experts, becomes a site in which one can attune themselves to their microbiome’s unique composition through experiments in diet, skin care, nutritional supplements, and nutraceuticals. Ultimately, the microbiome becomes another part of the human body that can be known through biomedicine with the ends of optimizing human health. As such, we are critical of the science communication but also see it as embedded in social and political processes that exceed it, meaning that the future for more-than-human flourishing that some narratives of microbiome science hope for will take a great deal of work to realize in a world of the financialization of microbial life.
Our visual discourse analysis is based on publicly circulating images we compiled from online news articles about the human microbiome. In so doing, we aimed to capture a part of the microbiome’s place in the contemporary healthscape. Our database spans across all forms of online news, from traditional to specialist, reflecting the accessibility of media in the current age. We collected these articles by following Google Alerts set up to catch the keywords “microbiome” and “direct-to-consumer microbiome test.” We have focused our visual analysis on images featured in articles for a generalized audience—like a health news site detailing steps readers can take in their daily lives to improve their health—rather than those speaking to experts—like a health news site informing practitioners about new treatments and developments in the field. We compiled this data in the fall of 2019, from September 7th, 2019 to January 20th, 2020, unknowingly doing so just before the COVID-19 pandemic began and people the world over were compelled to be aware of a new microbe harmful to human health. Throughout this article, we focus in-depth on several images which reflect or contest the makeup of our larger collection of 152 images.
With few exceptions, the human bodies portrayed in these articles are all white, able-bodied, and fit (Figure 1). The link between fitness and the human microbiome is strongly emphasized in the media, visually and textually, echoing the portrayal of able-bodiedness and weight loss as ideals by direct-to-consumer microbiome tests, as Dryden has also found in gut microbiome therapies (2023). The majority of the photos featuring people show them alone. If not alone, then the images depict humans in a clinical setting of medical professionals or scientists alongside a patient. Very few images feature people together in non-medical settings.
Figure 1: A close up on a white person’s bare torso with hands cradling a slim stomach (Image taken from iStock, Peopleimages)
Figure 2: Illustration of microbes in the shape of two human bodies coded as female and male (Shuttershock, lanatoma)
There are important translations occurring in these images, notably that of scale, a particular challenge for visualizing the connection between humans and their microbiomes as the average human is well over a million times greater in size than a single microbe. Even the width of a single human hair is seventy-five times greater than an average microbe. The relationship between the two across this vast space is visually affirmed by truncating the human body and enlarging the microbes, portraying them as closer in scale. Related images show enlarged microbes that render the silhouette of a human body (Figure 2). Notably, even in this abstracted state, the microbes privilege sexual dimorphism and gender stereotypes: the microbes representing a woman are identifiable as such because they are positioned to imply the wearing of a skirt, much like the dualistic symbols used to denote gender on public washrooms stalls. In contrast to the solitude of the human body among microbes, microbes are always represented in plenty; there is no solitary microbe, only solitary humans.
Of all the images we analyzed, only two showed microbes engaged in activity, and they offer a striking contradiction. One image features two microbes fighting each other, equipped with anachronistic armour and weapons[1]; the other image features three microbes with stick arms and legs meditating harmoniously in a stomach.[2] These images represent differing public metaphors for understanding the microbiome. One is antagonistic, portraying the supposed need to attack and destroy to survive, while the other shows harmony as the desired state and solution. The microbiome is a potential site for human intervention and control in service to one’s health, but it is also a slippery research subject that requires large data sets and whose implications are emergent and nascent, despite what the landscape of wellness products would have consumers believe. The microbiome challenges contemporary health management practices but is still trying to be understood through these practices (Wolf-Meyer 2017).
The microbes in our database images are made friendly by their bright colouring. This makes them approachable, perhaps to counteract their daunting plenitude, association with germs that impede health, and integrality to scatological functions. Only one image of a microbe from our data set was not digitally rendered and colourized; all the others were turned into bright colours. Images of diverse microbiomes used an array of aesthetically pleasing colours to differentiate between the different microbes. This colourizing continues outside of our dataset. For instance, on the front page of APC Microbiome Ireland’s (a research centre at University College Cork) website for World Microbiome Day, microbes are caricatured into bright, grotesquely smiling little monsters reminiscent of the characters from Monsters Inc. or the pill-shaped yellow Minions (similar to Figure 3). This representation maintains the otherness of the microbe to the human—some have only one eye, others have horns, all are oddly shaped—while also bringing the microbe closer to the human—the mere fact that they have eyes, smiling mouths, waving arms, and bipedal legs. The translation between human and microbe is emphasizing commonality and aestheticizing difference in a familiar and palatable way. The microbes are not quite anthropomorphized, but recognized as distinct yet potentially friendly. Microbes—these infinitesimal organisms that have only the most basic similarities to humans—are being translated into human conceptions of what life looks like and how the human can optimize it through proper management and care regimes.
Figure 5: Banner from APC Irelands’ World Microbiome Day (Image taken from Shuttershock, curiosity)
These visual representations of microbes contribute to narratives that strongly associate the microbiome with actively managing human health. Microbiome science also challenges narratives of dangerous microbes as disease causing pathogens to be systematically eradicated. Because the microbe of the microbiome’s ecology challenges such narratives, it is rendered visually relatable and appealing through the methods of representation detailed above. While people are mostly pictured alone in these representations, they are also frequently pictured in clinical settings. The individualism of healthy practices is thus bridged through the figure of the expert, the scientist or doctor.
Penny Ironstone (2019) writes that the human microbiome is associated with a liberatory micropolitics because it potentially challenges biomedical models of health, providing “post-Pasteurian models” (Paxson 2008) or “post-antibiotic futures” (Sariola 2021). But while certain people, such as fermentation specialists (e.g. Hey in press; Widmer 2021), draw on human-microbial relations to critique biomedicine, even capitalism, in favor of new futures, the optimism of new relations between humans and microbes is conveyed slightly differently in biomedical and wellness narratives.
There is an almost unimaginably large amount of microbial life that humans move through in their daily lives, and that moves through humans. Although the microbiome’s promise in the health sciences, and to a lesser extent in the social sciences, circulates with much hope for new experiences of the body and new kinds of politics, the visual depictions to date rather replicate other aspects of biomedicalization: the microbiome is visualized as a scientized entity to be harnessed by the human host to optimize wellness. This is in the scaling translations of microbes to seem closer to human, as well as in the way that microbes are depicted in relation to the boundaries of the human body and not to microbes in surrounding environments, such as soils. This is also in the depiction of friendly microbes that resemble children’s cartoons. The visualizations of the microbes in the service of the human host render the “human microbiome” as something that can become “my microbiome.” This rendering lends itself well to precision wellness possibilities. The visualizations do not disrupt other common naturalizing categories associated with the body: the bodies in the healthscape of the microbiome centre whiteness, able bodies, and heteronormative gender binaries.
The microbiome sciences and the social scientists who engage with them (e.g. Benezra 2020, 2023) hold promise for reimagining the body and illness in ways that might decentre the human. While this work is crucially necessary for grappling with health and social issues of the broader late or post-industrial context, the images of the microbiome in the current biomedicalized healthscape only take us a short way there.
[1] https://www.eurekalert.org/news-releases/569226
[2] https://thevarsity.ca/2019/09/30/the-promise-of-the-human-microbiome-in-cancer-research/
Benezra, Amber. 2020. “Race in the Microbiome.” Science, Technology, & Human Values 45(5): 877–902. https://doi.org/10.1177/0162243920911998.
Benezra, Amber, 2023. Gut Anthro: An Experiment in Thinking with Microbes. Minneapolis: University of Minnesota Press.
Briggs, Charles L., and Daniel C. Hallin. 2016. Making Health Public: How News Coverage Is Remaking Media, Medicine, and Contemporary Life. London: Routledge.
Clarke, Adele. E. 2010. “From the Rise of Medicine to Biomedicalization: U.S. Healthscapes and Iconography, circa 1890–Present.” In Biomedicalization: Technoscience, Health, and Illness in the U.S., edited by Adele E. Clarke, Laura Mamo, Jennifer Ruth Fosket, Jennifer R. Fishman, and Janet K. Shim, 104–146. Durham: Duke University Press.
Clarke, Adele E., Laura Mamo, Jennifer Ruth Fosket, Jennifer R. Fishman, and Janet K. Shim, eds. 2010. Biomedicalization: Technoscience, Health, and Illness in the U.S. Durham: Duke University Press.
Dryden, Jane. 2023. “The Gut Microbiome and the Imperative of Normalcy.” International Journal of Feminist Approaches to Bioethics 16:1, 131-162
Dupré, John, and Maureen A. O’Malley. 2007. “Metagenomics and biological ontology.” Studies in History and Philosophy of Biological and Biomedical Science 38 (4):834–846.
Dupré, John. 2020. “Life as Process.” Epistemology and Philosophy of Science 57 (2):96–113. https://doi.org/10.5840/eps202057224.
Hey, Maya. (in press). “Communicating with the Microbial Other: How the Material Practices of Fermentation Connect Humans and Microbes in Polylogue.” Global Media Journal: Canada Edition.
Ironstone, Penny. 2019. “Me, my self, and the multitude: Microbiopolitics of the human microbiome.” European Journal of Social Theory 22 (3):325–341.
Niehwöhner, Jörg, and Margaret Lock. 2018. “Situating local biologies: Anthropological perspectives on environment/human entanglements.” BioSocieties 13:681–697. https://doi.org/10.1057/s41292-017-0089-5.
Paxson, Heather. 2008. “Post-Pasteurian Cultures: The Microbiopolitics of Raw-Milk Cheese in the United States.” Cultural Anthropology 23 (1):15–47.
Saey, Tina. 2016. “Body’s bacteria don’t outnumber human cells so much after all.” Science News. January 8, 2016. https://www.sciencenews.org/article/bodys-bacteria-dont-outnumber-human-cells-so-much-after-all.
Sariola, Salla. 2021. “Fermentation in Post-antibiotic Words: Tuning in to Sourdough Workshops in Finland.” Current Anthropology 62 (S24):S388–398.
Widmer, Alexandra. 2021. “Positioning Human Microbiome DTC Tests: On the Search for Health, Data and Alternatives Amid the Financialisation of Life.” Medicine, Anthropology, Theory 8(2): online. https://doi.org/10.17157/mat.8.2.5127.
Wolf-Meyer, Matthew J. 2017. “Normal, Regular, and Standard: Scaling the Body through Fecal Microbial Transplants: Normal, Regular, and Standard.” Medical Anthropology Quarterly 31 (3): 297–314. https://doi.org/10.1111/maq.12328.
Download the transcript of this interview.
For this episode of Platypod, I talked to Dr. Tanja Ahlin about her research, work, and academic trajectory. She’s currently a postdoctoral researcher at the University of Amsterdam in the Netherlands, and her work focuses on intersections of medical anthropology, social robots, and artificial intelligence. I told her of my perspective as a grad student, making plans and deciding what routes to take to be successful in my field. Dr. Ahlin was very generous in sharing her stories and experiences, which I’m sure are helpful to other grad students as well. Enjoy this episode, and contact us if you have questions, thoughts, or suggestions for other episodes.
Dr. Tanja Ahlin, image from her personal website.
Dr. Tanja Ahlin is a medical anthropologist and STS scholar with a background in translation. She has translated books about technology and more. She has a master’s degree in medical anthropology, focusing on the topic of health and society in South Asia. Dr. Ahlin has been interested in e-health/telehealth for a long time, before the recent COVID-19 pandemic years, in which those words became part of our daily vocabulary. Her Ph.D., which she concluded at the University of Amsterdam, has focused on everyday digital technologies in elder care at a distance. Her Ph.D. research is being published as a book at Rutgers University Press. The book will be available for purchase starting on August 11, 2023.
Calling Family – Digital Technologies and the Making of Transnational Care Collectives | Rutgers University Press
In our conversation, we talked about Dr. Ahlin’s blog focusing on the Anthropology of Data and AI. This project—in which Dr. Ahlin writes about the intersection of tech and different fields such as robotics, policy, ethics, health, and ethnography—is a kind of translation work, since Dr. Ahlin is writing about complex topics to a broader audience who are not familiar with some STS and anthropological concepts and discussions. “The blog posts are not supposed to be very long. I aim for two to four minutes of reading … I realized that people often don’t have time to read more than that, right?” says Dr. Tanja Ahlin.
Dr. Ahlin’s book is based on ten years of ethnographic research with Indian transnational families. These are families where family members live all around the world. The reason for migration is mostly due to work opportunities abroad. In her research, Dr. Ahlin looked at how these families used all kinds of technologies like mobile phones and webcams, the Internet, and Whatsapp, not only to keep in touch with each other but also to provide care at a distance. Dr. Ahlin conducted interviews with nurses living all around the world, from the US to Canada to the UK, the Maldives, and Australia. This varied and diverse field gave origin to the concept of field events that Dr. Ahlin develops in her work. In her work, Dr. Ahlin also developed the notion of transnational care collective to show how care is reconceptualized when it has to be done at a distance.
In sum, this episode of Platypod highlights how anthropologists come from different backgrounds and gives an honest overview of how we get to research our topics and occupy the spaces we do. We do not have linear stories, and that does not determine our potential. We at Platypod are very thankful for Dr. Ahlin’s time and generosity.
By Rebecca Farrington, Louise Tomkow, Gabrielle Prager, and Kitty Worthing.
Healthcare professionals are increasingly expected to be hardy and ‘suck it up’ to survive in complex and demoralising workplaces. As NHS clinicians, we saw staffing shortages and limited resources firsthand during the COVID-19 pandemic. These experiences magnified our scepticism about the onus on us, as individuals, to be ‘resilient’ as a solution to both the workforce crisis and wider societal problems.
Our paper ‘In critique of moral resilience’ describes the responses of NHS staff faced with navigating COVID-19 and caring for one of the most disadvantaged groups in our society – people seeking asylum housed in contingency accommodation. The staff we interviewed provided a social commentary on the state-sponsored neglect of vulnerable migrants in the UK. We don’t overlook this, but we focus on healthcare professionals’ understanding, responses and negotiation of their roles in this ‘Hostile Environment’.
Resilience was clearly important to staff for self-preservation, but so was an ability to see the limits of a biomedical approach to social suffering. The concept of moral resilience helped to unpick this but was not enough to describe the ideological changes and challenges to systems made by staff using their new insights. They did put up with the difficult bits of their work, and we describe how they survived. However, these coping actions alone did nothing to change the status quo in the political and social systems causing the underlying health problems. Some staff we interviewed made positive changes in the lives of the people seeking asylum through activism to improve their health and wellbeing. We found that the concept of resilience failed to capture these important moral actions: advocating beyond the clinic, beyond just doing their best on the job.
The popular focus on resilience is here to stay in much of our work and home lives, but we encourage caution in using it as a broad-brush solution to complex problems. Healthcare providers who see and yet continue morally problematic care in the name of resilience might be thought of as complicit in social suffering. Does moral resilience just promote acceptance of the status quo, even when it feels unbearable? What cost does this fixation on resilience bring to both care providers and patients?
Reflecting on our work in clinical medicine, research, and medical advocacy, we recognise that some of our most effective improvements to social conditions have been through collective action and joint resistance. In times of increasing moral outrage, such as against the UK government’s illegal migration bill, this feels a more appropriate response than just sucking it up in the name of resilience in the hope that we will survive.
Authors: Louise Tomkow1, Gabrielle Prager1, Kitty Worthing2, Rebecca Farrington1
Affiliations:
The post Does our preoccupation with resilience mean we must tolerate the morally intolerable? appeared first on Journal of Medical Ethics blog.
Mollie Holmberg takes crip lessons from philosopher Val Plumwood's experience of being prey to a crocodile, pointing toward strategies for collective pandemic survival and resistance to environmental violence.
The post Pandemics, Predation, and Crip Worldings appeared first on Edge Effects.
Bly’s 1887 masterpiece Ten Days in a Mad-House reminds us that the ultimate test for public safety programs for the mentally ill is their impact on the most vulnerable.
My son’s language is made of a bundle of sounds that do not exist in the Spanish that we speak around the Río de la Plata. He repeats syllables he himself invented, he alternates them with onomatopoeias, guttural sounds, and high-pitched shouts. It is an expressive, singing language. I wrote this on Twitter at 6:30 in the morning on a Thursday because Galileo woke me up at 5:30. He does this, madruga (there is no word for “madrugar”, “waking up early in the morning” in English, I want to know why). As I look after him, I open a Word document in my computer. I write a little while I hear “aiuuuh shíii shíiii prrrrrr boio boio seeehhh” and then some whispers, all this accompanied with his rhythmic stimming of patting himself on the chest or drumming on the walls and tables around the house.
My life with Gali goes by like this, between scenes like this one and the passionate kisses and hugs he gives me. This morning everything else is quiet. He brings me an apple for me to cut it for him in four segments. He likes the skin and gnaws the rest, leaving pieces of apples with his bitemarks all around the house. He also brings me a box of rice cookies he doesn’t know how to open. Then he eats them jumping on my bed. He leaves a trace of crumbles. Galileo inhabits the world by leaving evidence of his existence, of his habits, of his way of being in the world.
When we started walking the uncertain road to diagnosis, someone next of kin who is a children’s psychologist with a sort of specialisation in autism informally assessed him. She ruled (diagnosed, prognosed) that he wasn’t autistic, that we shouldn’t ask for the official disability certificate (because “labels” are wrong, she held), and that he should go on Lacanian therapy and music therapy on Zoom —now I think this is a ready-made sentence she just gives in general to anyone.
The most violent intervention in Galileo’s subjectivity is denying his being-disabled in an ableist world and his being-autistic in an allistic world. We, as a culture, have internalised the terror of disability so deep in our minds that we hurry to deny it. We are not willing to accept that what causes us so much angst and dread actually exists, that it is not an imagined ghost. Denying like this, in this delusional way, is an instinct only humans have. It is so human (so stupid) that it is not a survival instinct. When we deny autistic affirmation, we prepare the ground for its annihilation, i.e., for the annihilation of everyone who is autistic. Being autistic isn’t being an imperfect allistic, a not-yet-allistic person. Being disabled isn’t the same as being a flawed abled person. The denial of disability doesn’t amount to affirming an alternative ability, it implies the ableist annihilation of all vulnerability. But when disability is negated, able people do not survive either. We are born and we die in disability. How did it happen that we dare to imagine we can supersede need? (Maybe by the same process by which it is believed that capitalist profits are meant to satisfy human needs).
The instinct of denying disability is not innate, though. It is an intelligent trap designed to break communities apart, to disorganise, to debilitate us: not to make us disabled but to make us unable, powerless. This is how ableism works, de-politicising vulnerability and unease, making disability, at most, an object of pity and compassion, a matter of bad luck, a fate to try to twist and avoid.
***
Galileo’s spoken language has the musical texture of a genre he alone can perform. There was a (short) time when I thought that my role in his life was to be her translator, a mediation between him and the rest of the world. This is impossible for many reasons. The most important of them isn’t that I don’t get him (I don’t), it isn’t that I don’t speak his language (I don’t), or that no one (much less a mother) can or should mediate anyone. The main reason is that Galileo speaks as someone who plays in their instrument a piece that they have composed for themselves.
Sometimes language is comprehensible only insofar as one gets ready to listen to it as if they were in an empty church in front of a little bench where Rostropovich is about to play Bach’s suites with his Duport, and as if he were Bach himself. Then, and only then, we understand that we don’t understand, that we are at the gates of the incomprehensible. When is language more language than when it is spoken so incomprehensibly? The impossibility of interpreting oneself, myself, comes not only from the fact that no one controls or owns language. No one plays their own scores because no one creates their own language. No one, but Galileo and his equals. The autistic non-verbal language is that impossible thing that we try not to talk about when we talk, that we try to drown by talking too much, moving our hands, and writing for example this text. Autistic languages say what can’t be said in any articulated allistic “normal” language. Galileo speaks a language that complements other languages. This language of his is not the opposite of language: it perfects other languages, like music or silence do.
***
Does my son have a mother tongue? Do we speak to each other as mother and child? What do we tell each other when we chat? My son’s autism and his magic words lend me a whole new vocabulary for my own neurodiversity, a new and authentic view on my severe misophonia, hyperacusis, and hyperosmia, and on my life-long inability to grasp the majority of the rules of interpersonal relationships, among other things I thought were personal flaws that made me inferior. I won’t mask it anymore. I won’t keep it a secret anymore. Now I know how to talk about it, now I have names to name it. Maybe he will never speak his mother tongue or any other “normal” language, but he has taught me to speak a language in which I now can say what I couldn’t formulate in an allistic alien tongue. Stripping me of all the allistic and ableist expectations that have shaped the way I was meant to raise my children has liberated me from the suffering of trying to meet them myself. The truly difficult thing, besides raising an autistic child in an allistic world, besides being a non-verbal autistic child in an ableist world, is how to de-internalise all this life-long inferiorisation.
But I know he will tell me how.
Greg Hart has been named chief technology officer at Washington University in St. Louis. Most recently, he has been vice president of corporate engineering for Faith Technologies Inc. of Lenexa, Kansas. Prior to that, he served for four years as vice president of enterprise project management and performance improvement for Mosaic Life Care, a four-hospital health system in Kansas City.
Dr. Hart earned a bachelor’s degree in electrical engineering and technology from California University of Pennsylvania. He holds an MBA from Ashland University in Ohio and a Ph.D. in information technology management from Capella University.
Brenda Murrell is the new associate vice chancellor for research in the Office of Sponsored Programs at the University of Tennessee Health Science Center in Memphis. She has served in the role on an interim basis for the past year. She has been on the staff at the university for 17 years.
Murrell holds a bachelor’s degree in accounting from the University of Memphis and a bachelor’s degree in management from Lemoyne-Owen College in Memphis. She earned an MBA in finance from Christian Brothers University in Memphis.
Todd Misener was appointed assistant vice president in the Division of Student Affairs at Oklahoma State University. Since 2016, he has been the chief wellness officer at the university. Earlier, Dr. Misener was assistant director of wealth and fitness at Western Kentucky University.
Dr. Misener is a graduate of the University of Saskatchewan in Canada, where he majored in kinesiology. He holds a master of public health degree from Western Kentucky University and a Ph.D. in health promotion from the University of Louisville.
D’Andra Mull will be the next vice chancellor for student affairs at the University of Colorado Boulder, effective June 1. Dr. Mull most recently served as vice president for student life at the University of Florida. Prior to her position at the University of Florida, she held leadership positions at Ohio State University.
Dr. Mull is a graduate of Kent State University in Ohio. She holds a master’s degree in adult education and human resource management from Michigan State University and a Ph.D. in educational policy and leadership from Ohio State University.
Khala Granville is the new director of undergraduate admission and recruitment at Morgan State University in Baltimore. She is the former dean of admissions at the College of Charleston in South Carolina and a senior associate director of admissions, diversity recruitment, and outreach at Indiana University.
Granville holds a bachelor’s degree in communication from the University of Louisville. She earned a master of divinity degree from the Christian Theological Seminary in Indianapolis.
A new 3D-printed customized insole uses integrated sensors to measure the pressure on the sole of the foot directly in the shoe during various activities.
In elite sports, fractions of a second sometimes make the difference between victory and defeat. To optimize their performance, athletes use custom-made insoles. But people with musculoskeletal pain also turn to insoles to combat their discomfort.
Before specialists can accurately fit such insoles, they must first create a pressure profile of the feet. To this end, athletes or patients have to walk barefoot over pressure-sensitive mats, where they leave their individual footprints.
Based on this pressure profile, orthopedists then create customized insoles by hand. The problem with this approach is that optimizations and adjustments take time. Another disadvantage is that the pressure-sensitive mats allow measurements only in a confined space, but not during workouts or outdoor activities.
The new invention, described in the journal Scientific Reports, addresses these issues.
“You can tell from the pressure patterns detected whether someone is walking, running, climbing stairs, or even carrying a heavy load on their back—in which case the pressure shifts more to the heel,” explains co-project leader Gilberto Siqueira, senior assistant at Empa and at the ETH Zurich Complex Materials Laboratory. This makes tedious mat tests a thing of the past.
These insoles aren’t just easy to use, they’re also easy to make. They are produced in just one step—including the integrated sensors and conductors—using a single 3D printer, called an extruder.
For printing, the researchers use various inks developed specifically for this application. As the basis for the insole, the materials scientists use a mixture of silicone and cellulose nanoparticles.
Next, they print the conductors on this first layer using a conductive ink containing silver. They then print the sensors on the conductors in individual places using ink that contains carbon black. The sensors aren’t distributed at random: they are placed exactly where the foot sole pressure is greatest. To protect the sensors and conductors, the researchers coat them with another layer of silicone.
An initial difficulty was to achieve good adhesion between the different material layers. The researchers resolved this by treating the surface of the silicone layers with hot plasma.
As sensors for measuring normal and shear forces, they use piezo components, which convert mechanical pressure into electrical signals. In addition, the researchers have built an interface into the sole for reading out the generated data.
Tests showed the researchers that the additively manufactured insole works well.
“So with data analysis, we can actually identify different activities based on which sensors responded and how strong that response was,” Siqueira says.
At the moment, Siqueira and his colleagues still need a cable connection to read out the data; to this end, they have installed a contact on the side of the insole.
One of the next development steps, he says, will be to create a wireless connection. “However, reading out the data hasn’t been the main focus of our work so far.”
In the future, 3D-printed insoles with integrated sensors could be used by athletes or in physiotherapy, for example to measure training or therapy progress. Based on such measurement data, training plans can then be adjusted and permanent shoe insoles with different hard and soft zones can be produced using 3D printing.
Although Siqueira believes there is strong market potential for their product, especially in elite sports, his team hasn’t yet taken any steps towards commercialization.
Additional coauthors are from Lausanne University Hospital, the orthopedics company Numo, and ETH Zurich.
The ETH Domain’s Strategic Focus Areas program funded the project.
Source: ETH Zurich
The post 3D-printed insole measures foot pressure right in shoe appeared first on Futurity.
An interdisciplinary team led by philosopher Havi Carel (Bristol) has won a £2.6 million grant for its project, “Epistemic Injustice in Health Care” (EPIC).
The “Discovery Grant“, from the charitable science foundation Wellcome, will fund the project for six years, beginning this September.
In addition to Professor Carel, the core team is:
They will be bringing on six* postdoctoral researchers and a range of other researchers and collaborators from Swansea, City and Aston Universities, and the Universities of Bologna and Ferrara.
(l to r) Lisa Bortolotti, Matthew Broome, Havi Carel, Ian James Kidd, Sheelagh McGuinness
According to the team, the project
will offer a systematic investigation of epistemic injustice across a diverse range of case studies—including somatic and psychiatric illnesses, and neurodiverse persons, as well as children and those in later-life care. EPIC aims to identify the interpersonal, institutional, and cultural dimensions of epistemic injustices. The project will include a range of events, postdoctoral positions, and publications and aims to identify practical measures for the benefit of patients and healthcare practitioners alike.
Inquiries about the project should be sent to Professor Carel.
(* Note: the original post stated there would be eight postdocs. That was an error.)
By Joshua Parker and Ben Davies
Like many public services, the UK’s National Health Service (NHS) is under increasing resource pressure across the service. Acute services are under strain, with every stage between dialling 999 and getting into a hospital bed taking longer. Waiting times are also up for non-urgent care: 7 million people are on a waiting list in England, while General Practitioners (GPs, the UK’s primary care physicians) are exceeding safety limits and still not managing to meet demand. These measures are only proxies; the underlying concern is that failures in these metrics betray failures of quality and safety.
In part this is due to chronic under-investment made worse by a range of factors: greater demand generated by Covid and lockdowns; increasing complexity with an ageing patient population; more medical ability due to developments in medical technologies; and staff shortages that are in part a result of the UK’s departure from the European Union. However, some may argue that the pressure is also a sign that the NHS is trying to do too much in straitened times, and perhaps even that the scope of what a health system is responsible for has been expanded too far.
The idea that we should rein in the responsibilities of a particular public sector is not confined to health. It may be tempting to categorise problems as health needs because for many people there is a health ‘halo effect’: we tolerate less inequality in health than we do in other areas, and NHS spending is often protected (at least superficially) from political cuts. There are two ways a healthcare system might limit this to produce better equilibrium between supply and demand. Both use thresholds to contract healthcare’s scope and get a firmer grip on overstretched services. One threshold borrows from the philosophical idea of ‘sufficiency’: ensuring that resources are targeted at those who are badly off, or who have severe need. To simplify, a sufficiency threshold is an imaginary boundary: those whose health is below the boundary are entitled to certain services until they reach the desired health level. We could phrase this in terms of need: somebody is unwell, so they need healthcare until the need has been satisfied. The other threshold constrains the issues that are legitimate problems for a health service. This concerns the scope of healthcare. We might think of these two thresholds as a vertical and horizonal threshold. The vertical threshold is about “how much?” and the horizontal asks “what kind of problem?”.
Some examples may help. As each threshold is, to a certain degree, socially constructed the thresholds can be flexible, shifting in response to resources, demands, changes in social attitudes, and so on. Take the vertical threshold. One way of contracting a health service is to lower this threshold meaning that the numbers of people severe enough to merit certain treatments goes down. For example, GPs might find thresholds for having referrals accepted by specialists becoming stricter, and more referrals thus being rejected. It might be that to have a referral accepted, the patient’s symptoms must be especially severe, or the likely diagnosis especially concerning, or that ever-increasing treatments must have been trialled in primary care first. Other examples could be provided: patients’ thresholds for seeking medical attention may go up meaning they present sicker; doctors’ thresholds for initiating certain treatments or investigations may also go up. The underlying point is the same however that the sufficiency threshold is being shunted down, resulting in the threshold for which people can access certain medical treatments dialling up. In turn, this helps a healthcare system spread is limited resources – in terms of healthcare professionals time, diagnostics, ambulances, treatments etc – further.
The horizontal threshold seeks to constrain the scope of a healthcare service by differentiating between ‘genuine’ health needs, and needs which are better dealt with in other ways. Implicit in this version of the argument is the idea that the health service has been over-extended. For some this might be framed as medicalisation, the march of medicine into non-medical areas. Of course, this raises some difficult questions around the concepts of health, disease, illness, disability and so forth. Nevertheless, where there is a certain fuzziness around these concepts a healthcare system under strain can use this to narrow its scope. For instance, one GP writes that loneliness, infantile colic and premenstrual mood swings are all forms of medicalisation but more importantly, that these issues gum the system up preventing healthcare professionals dealing with the ‘real’ problems. One concerning consequence of this narrowing of scope is that aspects of care within healthcare are stripped away. Perhaps infantile colic is a normal part of early life, but part of what GPs provide is not just technical knowledge in how to manage this but care in providing reassurance.
Primarily, we are aiming to show that the more theoretical world of philosophical discussions about sufficiency and need can help describe these issues facing the health service. The further question is what to make of this phenomenon. To a certain extent, reshaping this sphere of concern for a health service along the vertical and horizontal axis is inevitable and to a degree, having some flexibility in the system may also be desirable. Nonetheless, there are certain risks worth noting.
Lowering the vertical threshold straightforwardly can make people worse off. Going back to the referrals example, if GPs’ gatekeeping role is more stringent and its harder to get patients into the system, some of these patients will be made worse off by this. Furthermore, there is a difference between taking sufficiency as our ultimate aim, and as an explicit target. For instance, one common objection to the idea of sufficiency in political philosophy is that it seems to arbitrarily abandon those who sit just above a sufficiency threshold. What this tells us is that even if we take a sufficiency-based view, that does not mean that we should only focus on those who are currently below whatever threshold we have decided on; we also need to pay attention to those who are at risk of falling below it.
Pulling in the horizontal threshold also, similarly, may leave individuals worse off by restricting the scope of help that healthcare offers. There are also obvious concerns about a healthcare system so highly pressured that professionals are not able to provide aspects of care and can secure only the technical aspects of diagnosis and treatment. Importantly, providing care provides other opportunities. Much of the valuable work that GPs do is, we might say, finding needles in haystacks. Shrink the haystack and needles will be easier to find; but some needles will be left out of the search altogether. That’s not to deny that resource shortages may demand a rollback of services. But if the health service is forced to limit care either vertically or horizontally, this should not be seen as trimming an over-extended service back to its proper function. Rather, it should be seen for what it is: a hard choice to prioritise the urgent over the important.
In a piece that stares down tragedy and refuses to give up, Jen Agg recounts the agonizing weeks following her husband’s stroke, which took place at the onset of the pandemic. This is a gripping essay about being strong for someone else, but it’s also a piece about the devils and angels in the medical system: those who think dashing your optimism is some sort of sadistic duty vs. those who understand their role is to offer not only medical help, but most importantly, kindness and hope.
I started describing a stroke as a twenty-car pile-up on the highway of your brain’s quickest route. Recovery is the next car getting off the highway just before the devastation and twisted-up metal of cars blocking the road, except it’s night time, and the power is out, and it’s a thunderstorm and actually, turns out there is no road. So one car slowly and timidly draws a new path where there never was one. Your brain is resourceful this way, but it’s slow going. After a while, all the cars start taking this newly formed exit and your brain learns a whole new way of communicating with your body.
At first it was the destabilizing uncertainty: would it be a bad day, or a rare good day? How could I keep both our moods afloat when I was working really hard on the basics of our survival while maintaining an unbreakable facade of hopefulness? Was there effort in that? I don’t remember. Roland was sad a lot at the beginning and I knew I couldn’t let that sadness drown us both. Many of life’s challenges force reaction and demand a change of perspective, but particularly with health issues, you have to really be committed or the ugliness of it can win. I absolutely refused to let it. This was not going to be the thing that unwound our love—a love born in a fireball of attraction, bonded over a shared enemy and nurtured over decades of simply never being bored of each other or running out of fascinating things to talk about while remaining enthralled with each others’ faces.
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