health/medicine

Part of what makes professional basketball appealing, for kids who love to play as well as fans, is the idea that a person can come from humble beginnings and become a star.  The players on the court, the narrative goes, are ones who rose to fame as a result of incredible dedication and extraordinary talent.  Basketball, then, is a way out of poverty, a true equal opportunity sport that affirms what we think America is all about.

Seth Stephens-Davidowitz crunched the numbers to find out if the equal opportunity story was true.   Analyzing the economic background of NBA players, he found that growing up in a wealthy neighborhood (the top 40% of household incomes) is a “major, positive predictor” for success in professional basketball.  Black players are also less likely than the general black male population to have been born to a young or single mother.  So, class privilege is an advantage for pro ball players, just like it is elsewhere in our economy.

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The richest Black men, then, are most likely to end up in the NBA, followed by those in the bottom 20% of neighborhoods by income.  Middle class black men may, like many middle class white men, see college as a more secure route to a successful future.  Research shows that poor black men often see sports as a more realistic route out of poverty than college (and they may not be wrong).  This also helps explain why Jews dominated professional basketball in the first half of the 1900s.

LeBron James was right, then, when he said, “I’m LeBron James. From Akron, Ohio. From the inner city. I am not even supposed to be here.”  The final phrase disrupts our mythology about professional basketball: that being poor isn’t an obstacle if one has talent and drive.  But, as Stephens-Davidowitz reminds us, “[a]nyone from a difficult environment, no matter his athletic prowess, has the odds stacked against him.”

Cross-posted at Pacific Standard.

Lisa Wade, PhD is an Associate Professor at Tulane University. She is the author of American Hookup, a book about college sexual culture; a textbook about gender; and a forthcoming introductory text: Terrible Magnificent Sociology. You can follow her on Twitter and Instagram.

We’re celebrating the end of the year with our most popular posts from 2013, plus a few of our favorites tossed in.  Enjoy!

A recent RadioLab podcast, titled The Bitter End, identified an interesting paradox. When you ask people how they’d like to die, most will say that they want to die quickly, painlessly, and peacefully… preferably in their sleep.

But, if you ask them whether they would want various types of interventions, were they on the cusp of death and already living a low-quality of life, they typically say “yes,” “yes,” and “can I have some more please.”  Blood transfusions, feeding tubes, invasive testing, chemotherapy, dialysis, ventilation, and chest pumping CPR. Most people say “yes.”

But not physicians.  Doctors, it turns out, overwhelmingly say “no.”  The graph below shows the answers that physicians give when asked if they would want various interventions at the bitter end.  The only intervention that doctors overwhelmingly want is pain medication.  In no other case do even 20% of the physicians say “yes.”

What explains the difference between physician and non-physician responses to these types of questions.  USC professor and family medicine doctor Ken Murray gives us a couple clues.

First, few non-physicians actually understand how terrible undergoing these interventions can be.  He discusses ventilation.  When a patient is put on a breathing machine, he explains, their own breathing rhythm will clash with the forced rhythm of the machine, creating the feeling that they can’t breath.  So they will uncontrollably fight the machine.  The only way to keep someone on a ventilator is to paralyze them. Literally.  They are fully conscious, but cannot move or communicate.  This is the kind of torture, Murray suggests, that we wouldn’t impose on a terrorist.  But that’s what it means to be put on a ventilator.

A second reason why physicians and non-physicians may offer such different answers has to do with the perceived effectiveness of these interventions.  Murray cites a study of medical dramas from the 1990s (E.R., Chicago Hope, etc.) that showed that 75% of the time, when CPR was initiated, it worked.  It’d be reasonable for the TV watching public to think that CPR brought people back from death to healthy lives a majority of the time.

In fact, CPR doesn’t work 75% of the time.  It works 8% of the time.  That’s the percentage of people who are subjected to CPR and are revived and live at least one month.  And those 8% don’t necessarily go back to healthy lives: 3% have good outcomes, 3% return but are in a near-vegetative state, and the other 2% are somewhere in between.  With those kinds of odds, you can see why physicians, who don’t have to rely on medical dramas for their information, might say “no.”

The paradox, then — the fact that people want to be actively saved if they are near or at the moment of death, but also want to die peacefully — seems to be rooted in a pretty profound medical illiteracy.  Ignorance is bliss, it seems, at least until the moment of truth. Physicians, not at all ignorant to the fraught nature of intervention, know that a peaceful death is often a willing one.

Cross-posted at Pacific Standard, The Huffington Post, and BlogHer.

Lisa Wade, PhD is an Associate Professor at Tulane University. She is the author of American Hookup, a book about college sexual culture; a textbook about gender; and a forthcoming introductory text: Terrible Magnificent Sociology. You can follow her on Twitter and Instagram.

We’re celebrating the end of the year with our most popular posts from 2013, plus a few of our favorites tossed in.  Enjoy!

A former editor at Cosmopolitan, Leah Hardy, recently wrote an exposé about the practice of photoshopping models to hide the health and aesthetic costs of extreme thinness. Below is an example featuring Cameron Diaz:

The story about Diaz, in The Telegraph, includes the following description of the image’s manipulation:

• Face: Cheeks appear filled out
• Bust: Levelled
• Thighs: Wider in the picture on the right
• Hip: The bony definition has been smoothed away
• Stomach: A fuller, more natural look
• Arms: A bit more bulk in the arms and shoulders

Another example was posted at The Daily What. Notice that her prominent ribcage has been photoshopped out of the photograph on the right, which ran in the October 2012 issue of  Numéro.

Hardy, the editor at Cosmo, explains that she frequently re-touched models who were “frighteningly thin.”  Others have reported similar practices:

Jane Druker, the editor of Healthy magazine — which is sold in health food stores — admitted retouching a cover girl who pitched up at a shoot looking “really thin and unwell”…

The editor of the top-selling health and fitness magazine in the U.S., Self, has admitted: “We retouch to make the models look bigger and healthier”…

And the editor of British Vogue, Alexandra Shulman, has quietly confessed to being appalled by some of the models on shoots for her own magazine, saying: “I have found myself saying to the photographers, ‘Can you not make them look too thin?'”

Robin Derrick, creative director of Vogue, has admitted: “I spent the first ten years of my career making girls look thinner — and the last ten making them look larger.”

Hardy described her position as a “dilemma” between offering healthy images and reproducing the mythology that extreme thinness is healthy:

At the time, when we pored over the raw images, creating the appearance of smooth flesh over protruding ribs, softening the look of collarbones that stuck out like coat hangers, adding curves to flat bottoms and cleavage to pigeon chests, we felt we were doing the right thing… We knew our readers would be repelled by these grotesquely skinny women, and we also felt they were bad role models and it would be irresponsible to show them as they really were.

But now, I wonder. Because for all our retouching, it was still clear to the reader that these women were very, very thin. But, hey, they still looked great!

They had 22-inch waists (those were never made bigger), but they also had breasts and great skin. They had teeny tiny ankles and thin thighs, but they still had luscious hair and full cheeks.

Thanks to retouching, our readers… never saw the horrible, hungry downside of skinny. That these underweight girls didn’t look glamorous in the flesh. Their skeletal bodies, dull, thinning hair, spots and dark circles under their eyes were magicked away by technology, leaving only the allure of coltish limbs and Bambi eyes.

Insightfully, Hardy describes this as a “vision of perfection that simply didn’t exist” and concludes, “[n]o wonder women yearn to be super-thin when they never see how ugly [super-]thin can be.”

UPDATE:  A comment has brought up the point that it’s bad to police people’s bodies, no matter whether they’re thin or fat.  And this is an important point (made well here) and, while I agree that some of the language is harsh, that’s not what’s going on here.  The vast majority of the models who need reverse photoshopping aren’t women who just happen to have that body type.  They are part of an social institution that demands extreme thinness and they’re working hard on their bodies to be able to deliver it.  This isn’t, then, about shaming naturally thin women, it’s about (1) calling out an industry that requires women to be unhealthy and then hides the harmful consequences and (2) acknowledging that even people who are a part of that industry don’t necessarily have the power to change it.

Cross-posted at Business Insider and The Huffington Post in Spanish, French, and German.

Lisa Wade, PhD is an Associate Professor at Tulane University. She is the author of American Hookup, a book about college sexual culture; a textbook about gender; and a forthcoming introductory text: Terrible Magnificent Sociology. You can follow her on Twitter and Instagram.

Yesterday the Pew Research Center released data on the news coverage of Typhoon Haiyan — a disaster that has killed at least 4,000 people — and the bungled Obamacare website roll-out.  Comparing 20 hours of news coverage over four major U.S. channels, they found dramatic differences.  The data below shows the hours and minutes spent on each topic at each channel (red = Obamacare, yellow = the typhoon).

First, the two partisan channels (Fox News and MSNBC) gave more time to Obamacare than the typhoon.  On MSNBC, there was four times as much coverage of Obamacare.  On Fox, there as a stunning 80 times as much coverage.  Al Jazeera America and CNN spent significantly more time on the typhoon, likely reflecting their more global focus and less of an ideological mission.

The channels also differed in how much time they spent on facts/reporting versus opinion/commentary.  Check it out:

While most all of us sometimes lazily refer to “the media” as if it’s a homogeneous thing, it’s important to remember that our perceptions of reality are strongly shaped by which media we consume.

Lisa Wade, PhD is an Associate Professor at Tulane University. She is the author of American Hookup, a book about college sexual culture; a textbook about gender; and a forthcoming introductory text: Terrible Magnificent Sociology. You can follow her on Twitter and Instagram.

Sociologists like to say that gender identities are socially constructed. That just means that what it is, and what it means, to be male or female is at least partly the outcome of social interaction between people – visible through the rules, attitudes, media, or ideals in the social world.

And that process sometimes involves constructing people’s bodies physically as well. And in today’s high-intensity parenting, in which gender plays a big part, this includes constructing – or at least tinkering with – the bodies of children.

Today’s example: braces. In my Google image search for “child with braces,” the first 100 images yielded about 75 girls.

Why so many girls braced for beauty? More girls than boys want braces, and more parents of girls want their kids to have them, even though girls’ teeth are no more crooked or misplaced than boys’. This is just one manifestation of the greater tendency to value appearance for girls and women more than for boys and men. But because braces are expensive, this is also tied up with social class, so that richer people are more likely to get their kids’ teeth straightened, and as a result richer girls are more likely to meet (and set) beauty standards.

Hard numbers on how many kids get braces are surprisingly hard to come by. However, the government’s medical expenditure survey shows that 17 percent of children ages 11-17 saw an orthodontist in the last year, which means the number getting braces at some point in their lives is higher than that. The numbers are rising, and girls are wearing most of hardware.

A study of Michigan public school students showed that although boys and girls had equal treatment needs (orthodontists have developed sophisticated tools for measuring this need, which everyone agrees is usually aesthetic), girls’ attitudes about their own teeth were quite different:

Clearly, braces are popular among American kids, with about half in this study saying they want them, but that sentiment is more common among girls, who are twice as likely as boys to say they don’t like their teeth.

This lines up with other studies that have shown girls want braces more at a given level of need, and they are more likely than boys to get orthodontic treatment after being referred to a specialist. Among those getting braces, there are more girls whose need is low or borderline. A study of 12-19 year-oldsgetting braces at a university clinic found 56 percent of the girls, compared with 47 percent of the boys, had “little need” for them on the aesthetic scale.

The same pattern is found in Germany, where 38 percent of girls versus 30 percent of boys ages 11-14 have braces, and in Britain – both countries where braces are covered by state health insurance if they are needed, but parents can pay for them if they aren’t.

Among American adults, women are also more likely to get braces, leading the way in the adult orthodontic trend. (Google “mother daughter braces” and you get mothers and daughters getting braces together; “father son braces” brings you to orthodontic practices run by father-son teams.)

Teeth and consequences

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Today’s rich and famous people – at least the one whose faces we see a lot – usually have straight white teeth, and most people don’t get that way without some intervention. And lots of people get that.

Girls are held to a higher beauty standard and feel the pressure – from media, peers or parents – to get their teeth straightened. They want braces, and for good reason. Unfortunately, this subjects them to needless medical procedures and reinforces the over-valuing of appearance. However, it also shows one way that parents invest more in their girls, perhaps thinking they need to prepare them for successful careers and relationships by spending more on their looks.

When they’re grown up, of course, women get a lot more cosmetic surgery than men do – 87 percent of all surgical procedures, and 94% of Botox-type procedures – and that gap is growing over time.

As is the case with lots of cosmetic procedures, people from wealthier families generally are less likely to need braces but more likely to get them. But add this to the gender pattern, and what emerges is a system in which richer girls (voluntarily or not) and their parents set the standard for beauty – and then reap the rewards (as well as harms) of reaching it.

Cross-posted at Family Inequality, Adios Barbie, and Jezebel.

Philip N. Cohen is a professor of sociology at the University of Maryland, College Park, and writes the blog Family Inequality. You can follow him on Twitter or Facebook.

We don’t prohibit all dangerous behavior, or even behavior that endangers others, including people’s own children.

Question: Is the limit of acceptable risks to which we may subject our own children determined by absolute risks or relative risks?

Case for consideration: Home birth.

Let’s say planning to have your birth at home doubles the risk of some serious complications. Does that mean no one should do it, or be allowed to do it? Other policy options: do nothing, discourage home birth, promote it, regulate it, or educate people about the risks and let them do what they want.

Here is the most recent result from a large study reported on the New York Times Well blog, which looks to me like it was done properly, from the American Journal of Obstetrics & Gynecology. Researchers analyzed about 2 million birth records of live, term (37-43 weeks), singleton, head-first births, including 12,000 planned home births.

The planned-home birth mothers were generally relatively privileged, more likely to be White and non-Hispanic, college-educated, married, and not having their first child. However, they were also more likely to be older than 34 and to have waited to see a doctor until their second trimester.

On three measures of birth outcomes, the home-birth infants were more likely to have bad results: low Apgar scores and neonatal seizures. Apgar is the standard for measuring an infant’s wellbeing within 5 minutes of birth, assessing breathing, heart rate, muscle tone, reflex irritability and circulation (blue skin). With up to 2 points on each indicator, the maximum score is 10, but 7 or more is considered normal and under 4 is serious trouble. Low scores are usually caused by some difficulty in the birth process, and babies with low scores usually require medical attention. The score is a good indicator of risk for infant mortality.

These are the unadjusted rates of middle- and low-Apgar scores and seizure rates:

These are big differences considering the home birth mothers are usually healthier. In the subsequent analysis, the researchers controlled for parity, maternal age, race/ethnicity, education, gestational age at delivery, number of prenatal care visits, cigarette smoking during pregnancy, and medical/obstetric conditions. With those controls, the odds ratios were 1.9 for Apgar<4, 2.4 for Apgar<7, and 3.1 for seizures. Pretty big effects.

Two years  ago I wrote about a British study that found much higher rates of birth complications among home births when the mother was delivering her first child. This is my chart for their findings:

Again, those were the unadjusted rates, but the disparities held with a variety of important controls.

These birth complication rates are low by world historical standards. In New Delhi, India, in the 1980s 10% of 5-minute-olds had Apgar scores of 3 or less. So that’s many-times worse than American home births. On the other hand, a number of big European countries (Germany, France, Italy) have Apgar<7 rates of 1% or less, which is much better.

A large proportional increase on a low risk for a high-consequence event (like nuclear meltdown) can be very serious. A large absolute risk of a common low-consequence event (like having a hangover) can be completely acceptable. Birth complications are somewhere in between. But where?

Seems like a good topic for discussion, and having some real numbers helps. Let me know what you decide.

Cross-posted at Family Inequality.

Philip N. Cohen is a professor of sociology at the University of Maryland, College Park, and writes the blog Family Inequality. You can follow him on Twitter or Facebook.

No costume could more perfectly capture this October at SocImages.  From The Ethical Adman’s collection of the worst sexy costumes of the year, this breast cancer-themed, absurdly sexy, looks-nothing-like-a-leopard costume.  Posts collide.

When I clicked on the link, they tried to give me a free pair of panties.  Maybe you’ll get lucky.

Lisa Wade, PhD is an Associate Professor at Tulane University. She is the author of American Hookup, a book about college sexual culture; a textbook about gender; and a forthcoming introductory text: Terrible Magnificent Sociology. You can follow her on Twitter and Instagram.

We originally posted about this six years ago.  But, yep, they’re still selling it: The “Anna Rexia Dreamgirl” costume.

Copy reads: “You can never be too rich or too thin.”  Costume comes with a measuring tape belt.  In 2007, it was also featured in “plus size”:

H/t @RGWonser.

Lisa Wade, PhD is an Associate Professor at Tulane University. She is the author of American Hookup, a book about college sexual culture; a textbook about gender; and a forthcoming introductory text: Terrible Magnificent Sociology. You can follow her on Twitter and Instagram.