Tag Archives: health/medicine

    Apple’s Health App: Where’s the Power?

    In truth, I didn’t pay a tremendous amount of attention to iOS8 until a post scrolled by on my Tumblr feed, which disturbed me a good deal: The new iteration of Apple’s OS included “Health”, an app that – among many other things – contains a weight tracker and a calorie counter.

    And can’t be deleted.

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    Okay, so why is this a big deal? Pretty much all “health” apps include those features. I have one (third-party). A lot of people have one. They can be very useful. Apple sticking non-removable apps into its OS is annoying, but why would it be something worth getting up in arms over? This is where it becomes a bit difficult to explain, and where you’re likely to encounter two kinds of people (somewhat oversimplified, but go with me here). One group will react with mild bafflement. The other will immediately understand what’s at stake.

    The Health app is literally dangerous, specifically to people dealing with/in recovery from eating disorders and related obsessive-compulsive behaviors. Obsessive weight tracking and calorie counting are classic symptoms. These disorders literally kill people. A lot of people. Apple’s Health app is an enabler of this behavior, a temptation to fall back into self-destructive habits. The fact that it can’t be deleted makes it worse by orders of magnitude.

    So why can’t people just not use it? Why not just hide it? That’s not how obsessive-compulsive behavior works. One of the nastiest things about OCD symptoms – and one of the most difficult to understand for people who haven’t experienced them – is the fact that a brain with this kind of chemical imbalance can and will make you do things you don’t want to do. That’s what “compulsive” means. Things you know you shouldn’t do, that will hurt you. When it’s at its worst it’s almost impossible to fight, and it’s painful and frightening. I don’t deal with disordered eating, but my messed-up neurochemistry has forced me to do things I desperately didn’t want to do, things that damaged me. The very presence of this app on a device is a very real threat (from post linked above):

    Whilst of course the app cannot force you to use it, it cannot be deleted, so will be present within your apps and can be a source of feelings of temptation to record numbers and of guilt and judgement for not using the app.

    Apple doesn’t hate people with eating disorders. They probably weren’t thinking about people with eating disorders at all. That’s the problem.

    Then this weekend another post caught my attention: The Health app doesn’t include the ability to track menstrual cycles, something that’s actually kind of important for the health of people who menstruate. Again: so? Apple thinks a number of other forms of incredibly specific tracking were important enough to include:

    In case you’re wondering whether Health is only concerned with a few basics: Apple has predicted the need to input data about blood oxygen saturation, your daily molybdenum or pathogenic acid intake, cycling distance, number of times fallen and your electrodermal activity, but nothing to do with recording information about your menstrual cycle.

    Again: Apple almost certainly doesn’t actively hate cisgender women, or anyone else who menstruates. They didn’t consider including a cycle tracker and then went “PFFT SCREW WOMEN.” They probably weren’t thinking about women at all.

    During the design phase of this OS, half the world’s population was probably invisible. The specific needs of this half of the population were folded into an unspecified default. Which doesn’t – generally – menstruate.

    I should note that – of course – third-party menstrual cycle tracking apps exist. But people have problems with these (problems I share), and it would have been nice if Apple had provided an escape from them:

    There are already many apps designed for tracking periods, although many of my survey respondents mentioned that they’re too gendered (there were many complaints about colour schemes, needless ornamentation and twee language), difficult to use, too focused on conceiving, or not taking into account things that the respondents wanted to track.

    Both of these problems are part of a larger design issue, and it’s one we’ve talked about before, more than once. The design of things – pretty much all things – reflects assumptions about what kind of people are going to be using the things, and how those people are going to use them. That means that design isn’t neutral. Design is a picture of inequality, of systems of power and domination both subtle and not. Apple didn’t consider what people with eating disorders might be dealing with; that’s ableism. Apple didn’t consider what menstruating women might need to do with a health app; that’s sexism.

    The fact that the app cannot be removed is a further problem. For all intents and purposes, updating to a new OS is almost mandatory for users of Apple devices, at least eventually. Apple already has a kind of control over a device that’s a bit worrying, blurring the line between owner and user and threatening to replace one with the other. The Health app is a glimpse of a kind of well-meaning but ultimately harmful paternalist approach to design: We know what you need, what you want; we know what’s best. We don’t need to give you control over this. We know what we’re doing.

    This isn’t just about failure of the imagination. This is about social power. And it’s troubling.

    Sarah Wanenchak is a PhD student at the University of Maryland, College Park. Her current research focuses on contentious politics and communications technology in a global context, particularly the role of emotion mediated by technology as a mobilizing force. She blogs at Cyborgology, where this post originally appearedand you can follow her at @dynamicsymmetry.

    Saturday Stat: 23% of U.S. Children Live in Poverty

    If the well-being of our children is an indicator of the health of our society we definitely should be concerned.  Almost one-fourth of all children in the U.S. live in poverty.

    The Annie E. Casey Foundation publishes an annual data book on the status of American children.  Here are a few key quotes from 2014 (all data refer to children 18 and under, unless otherwise specified):

    • Nationally, 23 percent of children (16.4 million) lived in poor families in 2012, up from 19 percent in 2005 (13.4 million), representing an increase of 3 million more children in poverty.
    • In 2012, three in 10 children (23.1 million) lived in families where no parent had full-time, year-round employment. Since 2008, the number of such children climbed by 2.9 million.
    • Across the nation, 38 percent of children (27.8 million) lived in households with a high housing cost burden in 2012, compared with 37 percent in 2005 (27.4 million).

    As alarming as these statistics are, they hide the terrible and continuing weight of racism.  Emily Badger, writing in the Washington Post, produced the following charts based on tables from the data book.

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    Children live in poverty because they live in families in poverty.  Sadly, despite the fact that we have been in a so-called economic expansion since 2009, most working people continue to struggle.  The Los Angeles Times reported that “four out of 10 American households were straining financially five years after the Great Recession — many struggling with tight credit, education debt and retirement issues, according to a new Federal Reserve survey of consumers.”

    Martin Hart-Landsberg is a professor of economics at Lewis and Clark College. You can follow him at Reports from the Economic Front.

    Tuskegee Syphilis Study Recruitment Letter

    Flashback Friday.

    The Tuskegee Syphilis Experiment is one of the most famous examples of unethical research. The study, funded by the federal government from 1932-1972, looked at the effects of untreated syphilis. In order to do this, a number of Black men in Alabama who had syphilis were misinformed about their illness. They were told they had “bad blood” (which was sometimes a euphemism for syphilis, though not always) and that the government was offering special free treatments for the condition. Here is an example of a letter sent out to the men to recruit them for more examinations:

    The “special free treatment” was, in fact, nothing of the sort. The researchers conducted various examinations, including spinal taps, not to treat syphilis but just to see what its effects were. In fact, by the 1950s it was well established that a shot of penicillin would fully cure early-stage syphilis. Not only were the men not offered this life-saving treatment, the researchers conspired to be sure they didn’t find out about it, getting local doctors to agree that if any of the study subjects came in they wouldn’t tell them they had syphilis or that a cure was available.

    The abusive nature of this study is obvious (letting men die slow deaths that could have been easily prevented, just for the sake of scientific curiosity) and shows the ways that racism can influence researchers’ evaluations of what is acceptable risk and whose lives matter. The Tuskegee experiment was a major cause for the emergence of human subjects protection requirements and oversight of federally-funded research once the study was exposed in the early 1970s. Some scholars argue that knowledge of the Tuskegee study increased African Americans’ distrust of the medical community, a suspicion that lingers to this day.

    In 1997 President Clinton officially apologized for the experiment.

    Originally posted in 2009.

    Gwen Sharp is an associate professor of sociology at Nevada State College. You can follow her on Twitter at @gwensharpnv.

    A Reluctant Defense of Sunscreen for Men

    Lotion is socially constructed as feminine in the U.S. and so some men, attempting to avoid the prevailing insults of our time – gay, fag, bitch, pussy, douche, girl, and woman – are disinclined to use it.

    Eeeew, lotion!

    You know who you are, guys.

    Sunscreen is a category of lotion and so putting on sunscreen is equivalent to admitting you’re the sun’s bitch.  Men are supposed to let the sun bake their face into a tough, craggy masculinity that says “yeah, I go outdoors and, when I do, I don’t give a shit.”

    Because caring about one’s health is for pussies, some scholars argue that being male is the single strongest predictor of whether a person will take health risks.  In fact, thanks in part to the stupid idea that lotion carries girl cooties, men are two to three times more likely to be diagnosed with skin cancer.

    So, fine dudes, here’s some sunscreen for men.  For christ’s sake.

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    Thanks to @r0setayl0r and @ryesilverman for sending along the product!  Check it out on our truly humorous pointlessly gendered products Pinterest board.

    Lisa Wade is a professor of sociology at Occidental College and the co-author of Gender: Ideas, Interactions, Institutions. You can follow her on Twitter and Facebook.

    Overweight Americans Have the Lowest Risk of Premature Death

    Last year the Journal of the American Medical Association released a study aiming to determine the relationship between body mass index and the risk of premature death. Body mass index, or BMI, is the ratio between your height and weight. According to the National Institutes of Health, you are “normal weight” if your ratio is between 18.5-24.9.  Everything over that is “overweight” or “obese” and everything under is “underweight.”

    This study was a meta-analysis, which is an analysis of a collection of existing studies that systematically measures the sum of our knowledge.  In this case, the authors analyzed 97 studies that included a combined 2.88 million individuals and over 270,000 deaths.  They found that overweight individuals had a lower risk of premature death than so-called normal weight individuals and there was no relationship between being somewhat obese and the rate of early death. Only among people in the high range of obesity was there a correlation between their weight and a higher risk of premature death.

    Here’s what it looked like.

    This is two columns of studies plotted according to the hazard ratio they reported for people.  This comparison is between people who are “overweight” (BMI = 25-29.9) and people who are “normal weight” (BMI = 18.5-24.9).  Studies that fall below the line marked 1.0 found a lower rate of premature death and studies above the line found a higher rate.

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    Just by eyeballing it, you can confirm that there is not a strong correlation between weight and premature death, at least in this population. When the scientists ran statistical analyses, the math showed that there is a statistically significant relationship between being “overweight” and a lower risk of death.

    Here’s the same data, but comparing the risk of premature death among people who are “normal weight” (BMI = 18.5-24.9) and people who are somewhat “obese” (BMI = 30-34.9).  Again, eyeballing the results suggest that there’s not much correlation and, in fact, statistical analysis found none.

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    Finally, here are the results comparing “normal weight” (BMI = 18.5-24.9) and people who are quite “obese” (BMI = 35 or higher). In this case, we do see a relationship between risk of premature death in body weight.

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    It’s almost funny that the National Institutes of Health use the word normal when talking about BMI. It’s certainly not the norm – the average BMI in the U.S. falls slightly into the “overweight” category (26.6 for adult men and 25.5 for adult women) — and it’s not related to health. It’s clearly simply normative. It’s related to a socially constructed physical ideal that has little relationship to what physicians and public health advocates are supposed to be concerned with.  Normal is judgmental, but if they changed the word to healthy, they have to entirely rejigger their prescriptions.

    So, do we even have an obesity epidemic? Perhaps not if we use health as a marker instead of some arbitrary decision to hate fat.  Paul Campos, covering this story for the New York Times, points out:

    If the government were to redefine normal weight as one that does not increase the risk of death, then about 130 million of the 165 million American adults currently categorized as overweight and obese would be re-categorized as normal weight instead.

    That’s 79%.

    It’s worth saying again: if we are measuring by the risk of premature death, then 79% of the people we currently shame for being overweight or obese would be recategorized as perfectly fine. Ideal, even. Pleased to be plump, let’s say, knowing that a body that is a happy balance of soft and strong is the kind of body that will carry them through a lifetime.

    Cross-posted at Adios Barbie.

    Lisa Wade is a professor of sociology at Occidental College and the co-author of Gender: Ideas, Interactions, Institutions. You can follow her on Twitter and Facebook.

    A Simple Lesson on the Social Construction of Race

    Flashback Friday.

    The images below are all screen shots from the fantastic American Anthropological Association website on race.  They are designed to show how we take what is in reality a nuanced spectrum of skin color and turn it into racial categories.  In this first image, they show how we could, conceivably, separate human beings into short, medium, and tall based on height:

    In this second image, they show how, by adding two additional figures, both taller than the tallest in the previous image, the way in which we designate people can easily change.

    And this third image demonstrates how, when we actually consider all potential heights, where we draw the line between short and medium and medium and tall is arbitrary and, ultimately, not very useful.

    Skin color is like height.  If we just look at three groups with very different skin colors, there appears to be a significant and categorical difference between those three groups of people.

    But, if we consider a wide range of people, it becomes clear that skin color comes in a spectrum, not in categories (such as the five from which U.S. citizens are forced to choose on the census).

    Much more on the social construction of race at our Pinterest board.

    This post originally appeared in 2008.

    Lisa Wade is a professor of sociology at Occidental College and the co-author of Gender: Ideas, Interactions, Institutions. You can follow her on Twitter and Facebook.

    “Dude, You Need to Get into Nursing”: How Organizations Recruit Men to Nursing

    While there has been significant attention to recruiting women into STEM fields, what about the converse – recruiting men to female-dominated fields?  My recent article in Gender & Society analyzes the recruitment strategies of key health care players, examining themes of masculinity in text, speech, and images.

    Some recruitment items, like this early poster from the Virginia Partnership for Nursing, asked viewers “Are you man enough to be a nurse?” Aspects of hegemonic masculinity — characteristics associated with being the culturally defined “ideal man” — are common themes in the poster, including sports, military service, risk-taking, and an emotionally-reserved demeanor:

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    Since the “Are You Man Enough?” campaign in the early 2000’s, nurse leaders have tried to make recruitment messages less ostensibly gendered. In discussing the American Assembly for Men in Nursing’s (AAMN) new campaign, Don Anderson notes:

    Nursing recruitment efforts needed to evolve from asking men if they were masculine enough to be a nurse to something less gender specific

    Despite the effort to “de-genderify” nursing (Anderson’s word), masculinity is still front and center. Though the slogan is different, materials continue to emphasize culturally idealized forms of masculinity. One of the AAMN’s newest posters, “Adrenaline Rush,” avoids the “man enough” rhetoric, but maintains the theme of a stoic, emotionally-detached masculinity through visual cues.  Most of the nurse’s face is covered – limiting emotional expression—while risk-taking is emphasized.

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    But not all recruitment materials employ a macho form of masculinity. Johnson & Johnson’s 30-second clip “Name Game” portrays a caring and emotionally competent nurse:

    Key health care players, including an international organization (Johnson & Johnson), urban hospital systems, nursing programs, and organizations like the American Assembly for Men in Nursing (AAMN) have devoted resources to recruiting men into nursing. Analyzing their recruitment strategies reveals as much about contemporary tensions within masculinity as it does about the profession’s push for gender diversity.

    Check out more of the recruitment materials and a more in-depth analysis in the article, “Recruiting Men, Constructing Manhood: How Health Care Organizations Mobilize Masculinities as Nursing Recruitment Strategy.”  For a free copy, contact me at cottingham@unc.edu.

    Marci Cottingham is a postdoctoral fellow in the department of Social Medicine at the University of North Carolina – Chapel Hill. She received her Ph.D. in sociology from the University of Akron. Her research spans issues of gender, emotion, health, and healthcare. For more on her work, visit her site.

    Cross-posted at Pacific Standard.

    Insurance Companies and the Cost of Health Care

    When my primary care physician, a wonderful doctor, told me he was retiring, he said, “I just can’t practice medicine anymore the way I want to.” It wasn’t the government or malpractice lawyers. It was the insurance companies.

    This was long before Obamacare.  It was back when President W was telling us that “America has the best health care system in the world”; back when “the best” meant spending twice as much as other developed countries and getting health outcomes that were no better and by some measures worse. (That’s still true).

    Many critics then blamed the insurance companies, whose administrative costs were so much higher than those of public health care, including our own Medicare. Some of that money went to employees whose job it was to increase insurers’ profits by not paying claims.  Back then we learned the word “rescission”  – finding a pretext for cancelling the coverage of people whose medical bills were too high.   Insurance company executives, summoned to Congressional hearings, stood their ground and offered some misleading statistics

    None of the Congressional representatives on the committee asked the execs how much they were getting paid. Maybe they should have.

    Health care in the U.S. is a $2.7 trillion dollar business, and the New York Times has an article about who’s getting the big bucks.  Not the doctors, it turns out.  And certainly not the people who have the most contact with sick people – nurses, EMTs, and those further down the chain.  Here’s the chart from the article, with an inset showing those administrative costs.

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    As fine print at the top of the chart says, these are just salaries – walking-around money an exec gets for showing up.  The real money is in the options and incentives.

    In a deal that is not unusual in the industry, Mark T. Bertolini, the chief executive of Aetna, earned a salary of about $977,000 in 2012 but a total compensation package of over $36 million, the bulk of it from stocks vested and options he exercised that year.

    The anti-Obamacare rhetoric has railed against a “government takeover” of medicine. It is, of course, no such thing. Obama had to remove the “public option”; Republicans prevented the government from fielding a team and getting into the game. Instead, we have had an insurance company takeover of medicine. It’s not the government that’s coming between doctor and patient, it’s the insurance companies. Those dreaded “bureaucrats” aren’t working for the government of the people, by the people, and for the people. They’ve working for Aetna and Well-Point.

    Even the doctors now sense that they too are merely working for The Man.

    Doctors are beginning to push back: Last month, 75 doctors in northern Wisconsin [demanded] . . . health reforms . . . requiring that 95 percent of insurance premiums be used on medical care. The movement was ignited when a surgeon, Dr. Hans Rechsteiner, discovered that a brief outpatient appendectomy he had performed for a fee of $1,700 generated over $12,000 in hospital bills, including $6,500 for operating room and recovery room charges.

    That $12,000 tab, for what it’s worth, is slightly under the U.S. average.

    Cross-posted at Pacific Standard.

    Jay Livingston is the chair of the Sociology Department at Montclair State University. You can follow him at Montclair SocioBlog or on Twitter.