Tag Archives: health/medicine

Medicare vs. National Health Care: How U.S. Seniors Do in Cross-National Perspective

“We need to get rid of Obamacare,” says Ed Gillispie in a NYT op-ed. The reason: Obamacare’s “gravitational pull toward a single-payer system that would essentially supplant private insurance with a government program.”

Gillespie, who lays out his credentials at the start of the article – he ran for Senate in Virginia and lost – notes that Obamacare is unpopular. But he omits all mention of a government-run single-payer system that happens to be very popular – Medicare. No Republican dare run on a platform of doing away with it. Gillespie himself accused Obamacare of cutting Medicare, a statement that Politifact found “Mostly False.”

So how are seniors doing? Compared to their pre-Medicare counterparts, they are  probably healthier, and they’re probably shelling out less for health care. But compared to seniors in other countries, not so well. A Commonwealth Fund survey of eleven countries finds that seniors (age 65 and older) in the U.S. are the least healthy – the most likely to suffer from chronic illnesses.* 

Over half the U.S. seniors say that they are taking four or more prescription drugs; all the other countries were below 50%:

And despite Medicare, money was a problem. Nearly one in five said that in the past year they “did not visit a doctor, skipped a medical test or treatment that a doctor recommended, or did not fill a prescription or skipped doses because of cost.” A slightly higher percent had been hit with $2,000 or more in out-of-pocket expenses. 

In those other countries, with their more socialistic health care systems, seniors seem to be doing better, physically and financially.  One reason that American seniors are less healthy is that our universal, socialized medical care doesn’t kick in until age 65. People in those other countries have affordable health care starting in the womb. 

Critics of more socialized systems claim that patients must wait longer to see a doctor. The survey found some support for that. Does it take more than four weeks to get to see a specialist? U.S. seniors had the highest percentage of those who waited less than that. But when it came to getting an ordinary doctor’s appointment, the U.S. lagged behind seven of the other ten countries.

There was one bright spot for U.S. seniors. They were the most likely to have developed a treatment plan that they could carry out in daily life. And their doctors  “discussed their main goals and gave instructions on symptoms to watch for” and talked with them about diet and exercise.

Gillespie and many other Republicans want to scrap Obamacare and substitute something else. That’s progress I suppose. Not too long ago, they were quite happy with the pre-Obamacare status quo. Throughout his years in the White House, George Bush insisted that “America has the best health care system in the world.” Their Republican ideology precludes them from learning from other countries. As Marco Rubio put it, we must avoid “ideas that threaten to make America more like the rest of the world, instead of helping the world become more like America.”

But you’d think that they might take a second look at Medicare, a program many of them publicly support.

* Includes hypertension or high blood pressure, heart disease, diabetes, lung problems, mental health problems, cancer, and joint pain/arthritis.

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

The Paradox of Women’s Sexuality in Breast Feeding Advocacy and Breast Cancer Campaigns

My sister-in-law Charlotte was recently loudly admonished by a flight attendant on an international flight for allowing her “breast to fall out” after she fell asleep while nursing her baby. A strong advocate for breastfeeding, Charlotte has shared with me her own discomfort with public breastfeeding because it is considered gross, matronly, and “unsexy.”

I heard this over and over again from women I have interviewed for my research:  Women who breastfed often feel they have to cover and hide while breastfeeding at family functions. As one mom noted, “Family members might be uncomfortable so I leave room to nurse—but miss out on socializing.”  This brings on feelings of isolation and alienation. Because of the “dirty looks” and clear discomfort by others, women reported not wanting to breastfeed in any situation that could be considered “public.”

Meanwhile, I flip through the June 2012 issue of Vanity Fair and see this ad:

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We capitalize on the sexualization of the breast to raise awareness about breast cancer. Yet, we cringe at the idea of a woman nursing her child on an overnight flight.

What’s happening here? These campaigns send contradictory messages to women about their breasts and the way women should use them, but they have something in common as well: both breastfeeding advocacy and breast cancer awareness-raising campaigns tend to reduce women to body parts that reflect the social construction of gender and sexuality.

Breast cancer awareness campaigns explicitly adopt a sexual stance, focusing on men’s desire for breasts and women’s desire to have breasts to make them attractive to men. Breast milk advocates focus on the breast as essential for good motherhood. Breastfeeding mothers sit at the crossroads: Their breasts are both sexualized and essential for their babies, so they can either breastfeed and invoke disgust, or feed their child formula and attract the stigma of being a bad mother.

Both breastfeeding advocacy programs and breast cancer awareness-raising campaigns demonstrate how socially constructed notions of ownership and power converge with the sexualization and objectification of women’s breasts. And, indeed, whether breast feeding or suffering breast cancer, women report feeling helpless and not in control of their bodies. As Jazmine Walker has written, efforts to “help” women actually “[pit] women against their own bodies.”

Instead, we need to shift away from a breast-centered approach to a women-centered approach for both types of campaigns. We need to, as Jazmine Walker advocates, “teach women and girls how to navigate and control their experiences with health care professionals,” instead of pushing pink garb and products and sexualizing attempts to raise awareness like “save the ta-tas.”  Likewise, we need to support women’s efforts to breastfeed, if they choose to, instead of labeling “bad moms” if they do not or cannot. Equipped with information and bolstered by real sources of support, women will be best able to empower themselves.

Jennifer Rothchild, PhD is in the sociology and gender, women, & sexuality studies departments at the University of Minnesota, Morris. She is the author of Gender Trouble Makers: Education and Empowerment in Nepal and is currently doing research on the politics of breastfeeding.

Why Did Doctors Stop Giving Women Orgasms?

In her provocative book, The Technology of Orgasm, Rachel Maines discusses a classic medical treatment for the historical diagnosis of “hysteria”: orgasm administered by a physician.

Maines explains that manual stimulation of the clitoris was, for some time, a matter-of-fact part of medical treatment and a routine source of revenue for doctors. By the 19th century, people understood that it was an orgasm, but they argued that it was “nothing sexual.” It couldn’t “be anything sexual,” Maines explains, “because there’s no penetration and, so, no sex.”

So, what ended this practice? Maines argues that it was the appearance of the vibrator in early pornographic movies in the 1920s.  At which point, she says, doctors “drop it like a hot rock.” Meanwhile, vibrators become household appliances, allowing women to treat their “hysteria” at home. It wasn’t dropped from diagnostic manuals until 1957.

Listen to it straight from Maines in the following 7 minutes from Big Think:

Bonus: Freud was bad at this treatment, so he had to come up with some other cause of hysteria. After all, she says, “this was the guy who didn’t know what women wanted.” No surprise there, she jokes.

Cross-posted at Pacific Standard.

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.

How Fetal Photography Changed the Politics of Abortion

Flashback Friday.

You have likely seen photographs of fetus’ that seem to float in a dark womb.  The first of these were taken by Swedish photographer Lennart Nilsson. One of his photographs graced the cover of Life magazine in April of 1965.

Nilsson’s images forever changed the way that people think about pregnancy, mothers, and fetuses.  Before Nilsson, the visual of a fetus independent from a mother was not widespread. His pictures made it possible for people to visualize the contents of a woman’s womb independently of her body.  Suddenly, the fetus came to life.  It was no longer just something inside of a woman, no longer even in relationship to a woman; it was an individual with a face, a sex, a desire to suck its thumb.

Once the fetus could be individualized, the idea that a woman and her fetus could have contrasting interests was easier to imagine. In many countries even today, the idea that helping pregnant women is helping fetuses and helping fetuses means helping pregnant women is still the dominant way of thinking about pregnancy. Pro-choice and other fetus-defenders, such as those who want it to be illegal to smoke during pregnancy, used these images to disentangle the interests of the woman and the fetus. The vulnerability of Nilsson’s subjects, free-floating in space, made it easier to portray fetuses as in danger.

There is power in visualization and its technological advance and these images were a boon to the pro-life cause. Ironically, it was abortion that made these images possible. Nilsson posed the fetuses to look alive, and gives no indication otherwise, but they are actually photographs of aborted fetuses.

Although claiming to show the living fetus, Nilsson actually photographed abortus material obtained from women who terminated their pregnancies under the liberal Swedish law. Working with dead embryos allowed Nilsson to experiment with lighting, background and positions, such as placing the thumb into the fetus’ mouth.

– Quote from the University of Cambridge’s history of the science of fetal development

Liberal abortion rights laws resulted in a product that was used to mobilize anti-abortion sentiment.  Today it is par for the course to have been exposed to images like this. And the rest is history.

Originally posted in 2009.

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.

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.