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Enlarge / A Wendy's old-fashion burger. Romaine lettuce on Wendy's burgers is thought to be the cause of the outbreak. (credit: Getty | Francis Dean)
We will never know for certain what caused a large, multistate outbreak of E. coli O157:H7 infections linked to Wendy's restaurants late last year, according to a new study led by investigators at the Centers for Disease Control and Prevention.
The study, highlighting weaknesses in our ability to respond to foodborne outbreaks, lands amid a separate report published by the CDC finding that, in general, we're also failing to prevent outbreaks. In fact, cases from some common foodborne pathogens have increased relative to pre-pandemic levels.
In the outbreak last year, which spanned from July to August, at least 109 people in six states fell ill, with 52 needing to be hospitalized. Eating at Wendy's was a clear link. But it wasn't enough to crack the case.
Enlarge / One of the medical clinics suspended by Mexican health authorities in Matamoros, Tamaulipas, Mexico, on May 19, 2023. (credit: Getty | AFP)
Three more people in the US have died from fungal meningitis in an outbreak linked to tainted surgeries in Mexico, bringing the total deaths to seven, the Centers for Disease Control and Prevention reported Thursday.
The total case count remains unchanged from an update earlier this month, with 34 cases in the US: nine confirmed, 10 probable, and 15 suspected. Health officials are investigating 161 others who may have been exposed.
The outbreak is linked to cosmetic surgeries involving epidural anesthesia at two clinics in Matamoros, Mexico, just across the border from Brownsville, Texas. Mexican and US officials suspect that a component of the anesthetic was contaminated, resulting in the pathogenic fungus Fusarium solani being injected directly into people's spinal cords. The tainted surgeries are thought to have occurred between January 1, 2023, to May 13, 2023, around when the clinics were shut down by local health officials.
Molecular model of Vitamin B12. Licensed under CCO 4.0, courtesy of Wikimedia Commons.
Three years ago, I biked into a curb and fell on my head. When I got up, I couldn’t remember where I was, so I called an ambulance, which drove me to the nearest hospital, which was apparently one block away. The emergency room doctors told me there was nothing they could do. My eye was swollen, but my face seemed otherwise normal, and they wouldn’t know if anything was wrong with my brain unless they ran a CAT scan, which would expose me to toxic radiation. I asked if there were any nontoxic tests they could run for free. They offered to run a blood panel, which would let me know if I had any STIs. I let them bind my forearm, which had nothing to do with my head.
The next day, the doctor sent a message through the hospital’s online portal. My tests all came back negative, but they had also run a nutrient panel, and I was deficient in B12. I started googling. “Fell off bike low B12?” Everything that came up was random; I might as well have strung together any other combination of five words. I wanted to google more, but the doctor had told me that the internet was bad for my concussion. So I forgot about my deficiency and tried hard to make my body do nothing, which was the only way for it to heal.
Things got better. I started to feel normal, and eventually I was allowed to google as much as I wanted. Years went by. And then one day at a café, I met a man—a comedian—who told me horror stories about his life as a former vegan. His hair had fallen out, he was exhausted, his mood was always sour, and it was all because of vitamins: he could never get enough of them. While he complained, I felt my hairline receding; I was a vegan, too. And when I thought about it, really thought about it, my personality was on the decline. I was always struggling to make my days have meaning, and I wore my meaninglessness like a divine premonition. (“I have a feeling,” I texted a friend, “that something bad, really bad, is going to happen.”) I remembered the emergency room doctor’s diagnosis and felt the empty place inside of me where all the B12 supplements should have been, leeching into my bloodstream.
I tried to make a doctor’s appointment, but I had moved to California, and my insurance only covered care in New York. My body was on the West Coast, but all the tools I had for reading it were on the East. I told my father I was coming home to visit him, and when I arrived, asked him to drop me off at urgent care.
“Sorry,” said the receptionist. “The only blood work we do is for STIs. Nutrition panels aren’t urgent.”
I called my primary care physician’s office and told them that I had a need, a pressing need, for a B12 test. Everything I was feeling—daily bouts of idiocy, a persistent feeling of doom—was perfectly summarized by the deficiency symptoms I found online: headaches, psychological problems, palpitations, dementia. The receptionist told me that a nurse practitioner would be able to draw blood the next day—not soon enough. I requested a personal day from work and went to CVS, where I bought a bottle of supplements labeled “maximum strength.” Each pill contained 5,000 mcg of B12, which is 208,000 percent times the recommended daily value. They weren’t even vegan, but I took a double dose, hoping it would tide me over until my appointment, after which I was sure the doctor would put me on an emergency course of injections.
My brain was becoming an abacus. It was almost impossible to feel my feelings without translating them into the language of diagnosis, which was laughably general and yet strangely precise: symptoms claimed to contain the spectrum of human experience, but reduced that experience to a dozen ugly words. The vitamins themselves could counteract those ugly words because they contained good words of their own. Happiness, energy, valiance, relaxation: swallowing them daily felt like ingesting a little promise, saying a little prayer. How else could I communicate with my body besides putting speech inside it?
Anyway, my appointment came and went. No one called to give me my results, and when I checked the online portal, I noticed that my doctor, who hadn’t even seen me directly, who was in the habit of using the euphemisms “number one” and “number two,” had left me a message. “Hi mya—everything is looking great : ) No need for a follow-up at this time.” I checked the numbers. My B12 levels had surpassed the minimum threshold; they had even surpassed the desirable range. The pills had worked, and they had worked too well. The data, my data, had been contaminated: the language on the screen had nothing to do with what was happening in my body. And yet the doctor depended upon that language to approach my body, even though my body had been in front of her, trying to announce its problems.
I wanted the numbers to go down. Once they went down, I could prove to my doctor that they needed desperately to go back up. And so, I stopped taking the supplements, and the B12 slowly left me, detaching itself from my vocabulary until it became an abstract problem, a nonurgent problem, a random string of letters and numbers whose meaning was obscure to me, and which was no longer a metaphor for happiness.
Maya Binyam is a contributing editor of the Review. Her novel, Hangman, will be published by Farrar, Straus and Giroux in August.
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)
According to NPR, “Caffeine is the most widely consumed drug in the world. Here in the U.S., according to a 2022 survey, more than 93% of adults consume caffeine, and of those, 75% consume caffeine at least once a day.” Given the prevalence of coffee worldwide, it pays to ask a simple question: Is coffee good for you? Above, James Hoffmann, the author of The World Atlas of Coffee, provides an overview of research examining the relationship between coffee and various dimensions of health, including the gut/microbiome, sleep, cancer, cognition, mortality and more. If you want to explore this subject more deeply, Hoffmann has created a list of the research papers reviewed here.
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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.
When I joined a tech company after working for myself for 20 years, the corporate world had changed in many ways. One, in particular, struck me. My old jobs had existed in environments so laddish and rowdy that even I, as a man, had felt uncomfortable in them. So I’d gotten out.
For 20 years, I ran my own businesses. I prioritized impact over profit. I prized adherence to a set of beliefs over survival. If marketplace disruptions made pivoting to an ugly business model the only way to keep a company going, I shut that company down—even when I wasn’t sure what I would do next.
After shutting down enough of my companies to convince me that maybe “business” wasn’t my strength, what I did next, in 2019, was to join Automattic, Inc.—the people behind WordPress.com, Jetpack, WooCommerce, Simplenote, Tumblr, and other web-based empowerment tools.
It’s nothing like the places where I used to work.
We believe in Open Source. Follow a Creed. Instead of laddishness, we support and even celebrate difference. One way that support flows is through Employee Resource Groups, which we at Automattic call Automattician Resource Groups, or ARGs—so that’s the name I’ll use here.
ARGs are communities, formed around personal identity and situation, where colleagues connect with and support each other and work together toward common goals.
At Automattic, we have several of these ARG communities. Eventually, as the lead of Automattic’s Employer Brand activity, I plan to join them all. Initially, I joined two: Neurodiverseomattic and Queeromattic. I saw myself as an ally. In joining these two ARGs, I hoped to become wiser and kinder; to increase my ability to support, live, and work with family, friends, and colleagues; to deepen my interpersonal skills; and to grow in compassion and understanding.
I accomplished those goals, but I also gained something I hadn’t expected.
It started with Neurodiverseomattic, a group that provides support and resources for neurodivergent Automatticians (including but not limited to autism, ADHD, dyslexia) and their allies.
As the dad of an autistic daughter (who also suffers from an alphabet soup of additional diagnoses), I have the joy of loving, living with, and learning from one of the most brilliant minds I’ve ever encountered. But I also have the challenge of supporting someone whose life, through no fault of her own, is often painfully difficult.
I must listen when she needs an ear. Advise when she seeks help—and occasionally when she doesn’t.
Autism, in my daughter’s case, simultaneously includes remarkable, magical, wondrous capabilities, along with painful, mostly social, disabilities.
Some Neurodiverseomattic members are neurodiverse themselves; some are neurotypical but support neurodiverse family members; many, maybe most, are neurodiverse themselves and also support neurodiverse family members.
Over months, the more I shared experiences with members of my ARG, the better I became at meeting the challenges of parenting an autistic, depressed, anxious, dyslexic, artistic, gifted, emotionally intense, profoundly insightful teenager. And the more I came to realize that other members of my family had also been on the spectrum. Like my late father. And maybe my late brother. And, in a different way, my late mom. And…
And the more Ava shared her past experiences of being bullied, misunderstood, abandoned, and confused, the more I realized that I myself had had many of the same feelings and experiences growing up that she was having.
Like Ava, I had gone through a period of crying every day at the thought of going to school. The terror of brutal bullying and the shame of not fighting back. The shock of trusted friends laughing at me, not with me, or pretending not to know me. Lubricating their rise in the social ranks by pretending to find me ridiculous. Or maybe not pretending.
Like Ava, I’d concocted strange fantasies to try to understand why these things happened to me. Had I committed some crime? Was I a mistake? Had my parents been bribing my school friends to pretend to like me, and then run out of money?
So much of what Ava experienced, I had experienced. And so, it seemed, had many of my neurodiverse colleagues who courageously shared their stories.
And, finally, reader, it sank in:
I’m not just the president of hair club for men, I’m also a customer.
I’m on the spectrum. Of course I am. And always have been. Of course. And just never, ever knew.
Once I saw it, I was amazed that I’d never realized or even wondered about it.
Once I saw it, I was grateful to work at a place where we’re afforded the kind of support that can not only help us improve our people skills, but can also introduce us, on a deeper level, to ourselves.
And meanwhile, as an ally, I also joined Queeromattic. Need I say more?
Okay, I will.
The world I grew up in was so homophobic, and the romantic films I grew up watching were so prescriptive, that I got in touch with my heterosexuality long before I reached puberty … and didn’t recognize my queer side for decades.
Not even when I made out with a boy. (Hey, I was drunk.) Or years later, when I made out with another boy. (Hey, I was drunk, and, anyway, he looked like a girl.)
My new self-knowledge is mostly academic. Divorce has freed me of certain illusions, a spiritual practice has brought a taste of inner peace, and aging has eased up on the hormonal gas pedal, so that I no longer confuse attraction for a plan, or feelings for fate. Parenting keeps me plenty busy and fulfilled, and singlehood may not be exciting, but I’ve had enough excitement for multiple lifetimes.
Romantic love is for those still willing to risk everything. I prefer to hold onto what I have left. Because I know it’s a hell of a lot.
Thanks to the wisdom, vulnerability, truthfulness, and compassion of the friends I’ve made through my company’s ARGs, I have come to better know myself. It gives me pride, no pun intended. It even grants me serenity. And for that, I am grateful.
Illustration by Ava Zeldman. This article also appears on Medium.
The post ARG for thee and me appeared first on Zeldman on Web and Interaction Design.
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.
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