Can the intersections of biology, medicine, and society be different? Better? How?Please take time to reflect upon the many elements of biology, medicine, and society that we discuss during our ten weeks of class, especially as they relate to questions concerning gender, sex, sexuality, race, ethnicity, and socio-economic status/social class. Consider what you find most inspiring or promising, as well as what you find most limiting or problematic as regards the historical and/or current relations between biology, medicine, and society. For your response: Please identify and elaborate upon how one or more issues related to the intersections between medicine and society could or should be approached differently than they are now. In other words: From your perspective – please discuss how the ideas, beliefs, practices, and values pertaining to the relations between biology, medicine, and society could be made better going forward into the future. You may approach your response in a broad sense, reflecting on large-scale social structures or institutions. On the other hand, some may find it helpful to narrow in on one particular aspect of medicine and society that we explore. Welcome! SOCI 135 Medical Sociology
Biology
Society
Dr. Christine Payne
Winter 2022
For This Week
❖Steve Wing
Limits of Epidemiology (pp. 74-86)
❖Steve Matthewman & Kate Huppatz
A Sociology of COVID-19 (pp. 675-683)
❖Unnatural Causes Clips (approx. 20 min. total)
https://unnaturalcauses.org/video_clips_detail.php?res_id=80
https://unnaturalcauses.org/video_clips_detail.php?res_id=219
https://unnaturalcauses.org/video_clips_detail.php?res_id=217
https://unnaturalcauses.org/video_clips_detail.php?res_id=210
For Next Week (Week 2)
❖Richard Lewontin et al.
The Determined Patriarchy (pp. 131-163)
❖Emily Martin
The Egg and the Sperm: How Science Has Constructed a Romance
Based on Stereotypical Male and Female Roles (pp. 485-501)
❖Discussion Board 1 Due Friday January 14th
Virtual Zoom Weekly Office Hours
Tuesdays & Thursdays from 2:30-3:30 pm PST
Office Hours Links Updated Each Week under ‘Announcements’ on Canvas
Let’s Get Started!
❖Introduction
If you would like to, please feel welcome to send me a brief introductory email
(capayne@ucsd.edu). If not, all good! ☺
❖Our Syllabus
Requirements, Grading, Goals, Accommodation & Resource Support
❖Preliminary Reflections – What Is This Course All About?
Preliminary Concepts, Big Picture Questions, Recurring Course Themes
❖Week 1 Lectures on Significance of Studying Medical Issues in/of Social Contexts
Preliminary Reflections
(Please jot down your initial ideas and keep for Week 10)
❖What does it mean to be healthy? Physically, psychologically, emotionally?
❖What resources/organizations/time, etc. does it take to achieve well-being?
❖What does it mean to be unwell?
❖What contributes to illness?
❖What might be done to alleviate physical or mental illness?
❖What might be done to promote flourishing?
Preliminary Reflections
(Please jot down your initial ideas and keep for Week 10)
1.) What is Sociology?
What, if anything, makes it unique from other disciplines and other ways of thinking?
2.) What is Medicine?
What, if anything, makes it unique from other ideas and practices related to the body, health, illness, etc.?
3.) What is Medical Sociology?
What exactly does it mean to study medicine via the discipline of Sociology?
4.) How does attending to social experiences and environments help us better flourish in life?
Examples?
BIG PICTURE
❖Sociology – “The Study of Society” (Not the most helpful definition!)
What constitutes a society? What components or ‘pieces’ congeal (or not)
such that multiple individuals with personal desires, practices, and problems
come together to attempt to ameliorate past, present, and potential future
collective concerns? How do societies cohere or conflict? Why?
❖Medicine
This one can be tricky. Generally speaking, medicine is a set of (relatively)
standardized theories and practices aimed at helping individuals and groups
prevent, manage, or cure physical or psychological illnesses by means of
talking, testing, diagnosing, and applying treatments to improve health and
well-being.
Medical Sociology
The study of medicine via a sociological lens means attempting
to make sense of, and potentially make interventions into, the
health or lack thereof of individuals and groups.
Medical sociology aims to demonstrate the interrelationships
that exist between the well-being of groups in various societies
and cultures –currently as well as historically. In particular,
medical sociology examines the role of class, race, gender,
sexuality, age, ability status, and additional socio-cultural and
political factors in relationship to physiological and
psychological concerns.
A Final Preliminary Question
Do societies and cultures determine biomedical health?
Or does biomedical health influence societies and cultures?
Who or What is in “the driver’s seat?”
Preliminary Concepts
❖Epistemology – The Study of Knowledge
How do we know what we know?
What constitutes real, true, objective knowledge?
What knowledge has legitimacy or authority?
On What Basis?
❖Politics – Questions of Power
Who Wields Power? Who Doesn’t?
Macro, Meso, Micro in Scale; Global, National, Regional, Local, Interpersonal in Scope
On What Basis?
❖Ethics – Questions of ‘The Good’
What’s Good? Not Good? Right? Wrong? How should individuals and/or groups act?
On What Basis?
❖Critique – Not Taking Ideas, Practices, Values for Granted/At Face-Value
Steve Wing – Limits to Epidemiology
❖Epidemiology
Public health-centered medical study and practice that operates at the level of
populations (as opposed to single individuals).
The search for patterns in health and illness within and across populations
The search for distributions in health and illness across social variables
The search for risk factors in and across populations
The search for prevention or treatment/cure of said risk factors
Simply Put – Using large-scale data related to biological and social/cultural
factors in order to prevent, track, treat/cure public health illness and/or promote
and maintain public health.
Medicine as Natural AND Social Science
❖Example: Smoking
Epidemiology/Public Health did an excellent job demonstrating links between smoking & risk of cancer.
The working premise was to observe and then attempt interventions with respect to smoking at the level of
individual consumption.
Educational campaigns were enacted, Surgeon General’s warnings were placed on tobacco products, and
sales decreasingly declined: in wealthier populations.
Time and energy were not devoted to studying and making interventions into the increased production
and marketing of tobacco products towards poorer populations.
“Thus, the cause of the lung cancer epidemic was identified as cigarette smoking, an individual behavior, while
tobacco agribusiness, the commercial sale of cigarettes, and the social circumstances that make smoking a
rewarding habit, could not be recognized by epidemiological studies as targets for intervention. When educational
efforts and social options led some groups to reduce smoking levels, tobacco companies redirected advertising to
replace those markets with others, often assisted by governments with their own financial stakes in tax revenues
and contributions to trade balances.”
(pp. 80-1; emphases mine)
On One Hand…
Epidemiology is geared towards understanding and intervening at the level of
populations AND of taking into consideration social factors – factors like race,
gender, class, etc.
On the Other Hand…
Wing is arguing that even with the use of “big data” and even taking into
consideration major social/cultural variables (race, gender, SES, etc.) the larger
systemic social structures and ongoing historical contexts are still often missing
from the epidemiological picture.
“Epidemiology can dramatically improve its contribution to public health and
achieve a far greater level of social responsibility by recognizing the historical
contexts of public health phenomena and the sciences that address them”
(pp. 73; emphasis mine)
Studying Static Social Factors
vs. Studying Systemic Historical Contexts
❖Example: Radiation Exposure and Risks of Illness
What about Radiation? – Where is it? How & Why is it?
What about Exposure – Who is exposed to what (or not)? How? Why?
What about Risk? Why are certain populations more or less vulnerable?
Questions Concerning Generalizability
A primary goal of much traditional epidemiology is an x → y series of relationships.
Despite attention to social variables, such x → y relationships are often shorn of systemic context. Why?
In order to provide a series of more or less generalizable explanations
(Example: “There is a link between exposure to asbestos and developing mesothelioma”)
Additionally, these generalizable explanations are frequently based in biomedical/clinical frameworks
(Example: Asbestos disrupts the functioning of lungs, heart, etc. via tumors, thereby increasing chest pain,
shortness of breath, etc. Treatment → chemotherapy, radiation, surgery)
Please Note: Wing and others critical of a search for generalizable and biomedically-based exposure → disease
theories, preventions, and treatments are NOT suggesting that these are unhelpful!
What Wing IS suggesting is…
Focus on the ‘Roots’ or Underlying Structures
From Which Risks Arise in the First Place
•
•
•
•
•
•
Environmental Pollutants
Malnutrition
Smoking/Drinking/Drug Use
Air, Water, and Soil Quality
Sanitation/Hygiene
Health Effects of Climate Change
etc.
From a broader sociological and historical context, we can begin to see patterned (non-random)
social-structural contexts that disproportionately effect members of different populations.
Traditionally, epidemiology often links risk factors and outcomes to behaviors of individuals.
Wing’s Punchline: Systemic economic inequalities, racism, sexism, access, education, etc. matter.
Unnatural Causes
Social Conditions Real Consequences
Unnatural Causes: Is Inequality Making Us Sick?
Clip 1
Is our health determined by our innate biological makeup?
Our genetic inheritance?
Are we predisposed to certain healthy or unhealthy lives?
Is ill-health a purely individual choice-driven issue?
Or do we “carry history [and society] in our bodies” and develop differently based upon our specific social contexts?
Clip 2
The U.S. has the highest G.D.P. (market money) in the “developed” world.
The U.S. also has an enormous and growing gap between the rich and poor.
The ‘Social Health Gradient/Ladder’
Class/SES correlates with health and illness. More Money, Better Health. Less Money, Worse Health (in aggregate).
Systemic Social Inequalities = Literally Matters of Life and Death
Unnatural Causes: Is Inequality Making Us Sick?
Clip 3
Historical and current consequences of social & environmental racism, neglect
(e.g., loans, housing, investment, education, pollution, open spaces, sanitation, clinics, etc.)
Chronic Stress → Chronically High Levels of Cortisol → Increased Risk of Chronic Illness
Clip 4
Life-long status as a minority member of society; chronic racism as risk factor
(e.g., premature/low birth weights, maternal & infant mortality rates for Black mothers 2x those of white
mothers)
Money matters, education matters, diet, exercise, check-ups, matter.
Nevertheless – holding these variables constant does not fully explain the aforementioned health disparities.
RACISM matters as a variable – at the same time that racism intersects with the aforementioned factors.
Systemic Social Inequalities = Literally Matters of Life and Death
Steve Matthewman & Kate Huppatz – A Sociology of COVID-19
“Unprecedented Social Experiment”
Series of Intersecting Crises
Physiological, Psychological, Health Care, Economic, Educational, Social, Political
“Inequality Is Our Preexisting Condition”
❖Production of Pandemics – “Outbreaks are Inevitable. Pandemics are Optional.”
❖Revelation, Creation, and Exacerbation of Vulnerabilities
“we do little to understand the place of risks in our world if we do not scrutinize the very things that
produce them”
(pp. 676; emphasis mine)
Steve Matthewman & Kate Huppatz – A Sociology of COVID-19
‘Disaster Capitalism’ – Profits to Be Made From Preparedness, Protection, Policing, Care, etc.
Challenges to Forms of Expertise
Whose Knowledge and What Knowledge is Legitimate, Authoritative, Objective, etc.
Language and Practices of ‘Disposability’ – Particular Individuals & Particular Groups
Biopower and Eugenics
Surveillance –State/Government Corporate
Acts of Solidarity; Mutual Aid; People-Power of the Commons
Learning and Practicing Long-Term Lessons re: Collective Action, Community, Care
Demonstrating/Demanding Alternative (Better!) Ways of Structuring Society
“Disasters…[are] inherently political events because they pose questions about who should be allowed to recompose the world and how”
(pp. 679; Guggenheim, 2014:4)
Some Week 1 Levity!
Welcome Back! Week Two
Biological Determinism & the Ideological Loop
For This Week (Week 2)
Biological Determinism and Ideological Loops
❖Richard Lewontin et al.
The Determined Patriarchy (pp. 131-163)
❖Emily Martin
The Egg and the Sperm: How Science Has Constructed a Romance
Based on Stereotypical Male and Female Roles (pp. 485-501)
❖Discussion Board 1 Due Friday January 14th
For Next Week (Week 3)
Medical Knowledge & Practice in Relation to Gender & Race I
❖Nelly Oudshoorn
Beyond the Natural Body: An Archeology of Sex Hormones
Ch. 2 – “The Birth of Sex Hormones” pp. 15-41
❖Anne Fausto-Sterling
“The Five Sexes: Why Male and Female are Not Enough” pp. 20-24
❖Anne Fausto-Sterling
“The Five Sexes, Revisited” pp. 19-23
❖Discussion Board 2 Due Friday January 21st
Virtual Zoom Weekly Office Hours
Tuesdays & Thursdays from 2:30-3:30 pm PST
Office Hours Links Updated Each Week under ‘Announcements’ on Canvas
Focus on the ‘Roots’ or Underlying Structures
From Which Risks Arise in the First Place
•
•
•
•
•
•
Environmental Pollutants
Malnutrition
Smoking/Drinking/Drug Use
Air, Water, and Soil Quality
Sanitation/Hygiene
Health Effects of Climate Change
etc.
From a broader sociological and historical context, we can begin to see patterned (non-random)
social-structural contexts that disproportionately effect members of different populations.
Traditionally, epidemiology often links risk factors and outcomes to behaviors of individuals.
Wing’s Punchline: Systemic economic inequalities, racism, sexism, access, education, etc. matter.
Unnatural Causes
Social Conditions Real Consequences
Steve Matthewman & Kate Huppatz – A Sociology of COVID-19
“Unprecedented Social Experiment”
Series of Intersecting Crises
Physiological, Psychological, Health Care, Economic, Educational, Social, Political
“Inequality Is Our Preexisting Condition”
❖Production of Pandemics – “Outbreaks are Inevitable. Pandemics are Optional.”
❖Revelation, Creation, and Exacerbation of Vulnerabilities
“We do little to understand the place of risks in our world if we do not scrutinize the very things that
produce them”
(pp. 676; emphasis mine)
Steve Matthewman & Kate Huppatz – A Sociology of COVID-19
‘Disaster Capitalism’ – Profits to Be Made From Preparedness, Protection, Policing, Care, etc.
Challenges to Forms of Expertise
Whose Knowledge and What Knowledge is Legitimate, Authoritative, Objective, etc.
Language and Practices of ‘Disposability’ – Particular Individuals & Particular Groups
Biopower and Eugenics
Surveillance –State/Government Corporate
Acts of Solidarity; Mutual Aid; People-Power of the Commons
Learning and Practicing Long-Term Lessons re: Collective Action, Community, Care
Demonstrating/Demanding Alternative (Better!) Ways of Structuring Society
“Disasters…[are] inherently political events because they pose questions about who should be allowed to recompose the world and how”
(pp. 679; Guggenheim, 2014:4)
Richard Lewontin et al. – “The Determined Patriarchy”
Patriarchy – The historical and current holding of relatively more power and privilege (on average) of
those who identify or are assumed to be men.
In terms of gender, how does the division of labor often (not always!) look?
In other words: Who Does What?
Jobs, roles, obligations, leadership, expertise, expectations etc. Why?
Society/Division of Labor as Pyramid
Biological Determinism/Essentialism
❖Basic Argument of Biological Determinism
Attempts to explain how and why society is the way it is by appealing to
one or another aspect of supposedly immutable/innate/fundamental
biological characteristics of individuals:
• Genes
• Hormones
• Brains
Etc.
Biological Determinism
PUNCHLINES:
1.) Reduction of society down to biology***
Society = Individuals = Biologically Determined Characteristics
2.) Social relations as reflection of biological traits***
Biologically Determined Characteristics = Individuals = Society
***Same argument, regardless of whether one starts with the 1st or 2nd premise
Ideological Loop
1.) Assumptions about Gender (or Race, or Class, or Age, or Sexuality, etc.)
2.) Inform ways of understanding science; become naturalized
3.) Reinforce/legitimize assumptions about gender and/or other social
identities/expressions/experiences.
Social relations and assumptions are read into nature and then read back out to justify how society is structured.
Naturalistic Fallacy
Is = Ought/Should Be This Way
Starting Point: Values Derived From Descriptions of ‘Fact’
Result: Society is the way it is – whether we like it or not
Background Assumptions/Reasonings
1a). The social structure emerges because of biology
2a). How can you argue with biology?
3a). Should you try arguing with biology? Is that not impossible and/or morally suspect?
Results/Consequences
1b). Empirically Inaccurate Science (“It is what it is,” “Those are just the facts,” etc.)
2b.) Fatalistic Assumptions Made Against Possibility of Critiquing/Changing Society – (“You Can’t Argue with Nature”)
3b.) Moralistic Claims Made Against Trying to Challenge/Change Society – (“Shouldn’t Be Going Against Nature”)
Ideological Loop Punchlines
“Explain” and then Justify the Status Quo
❖Makes change seem empirically difficult and normatively wrong:
Society ‘is what it is’ – it is determined by biology
Social relations & structures are assumed to be necessary and good
❖Taking seriously questions and issues relating to:
Personal agency, choice, justice, and freedom becomes difficult.
•
Critiques of Biological Determinism
❖Factual/empirical inaccuracy
❖Justification of exploitation and inequality as function of “natural” “neutral” “necessary” hierarchies
❖Inability to persuasively account for changes over historical time periods and across different
cultures
❖Where do categories/classifications and their meanings come from in the first place?
What even is gender? Race? Etc.…To Be Continued Soon!!
Use of Rhetoric & Imagery
Choice of words, analogies (metaphors & similes), images
Tools of explanation & persuasion
Written by certain authors for certain audiences
Language and Image Reflect and Reinforce
Mirror & Lens
Language – Not Just A Concern in Literature
“All the world’s a stage, and all the men and women merely players”
(As You Like It)
“But, soft! What light through yonder window breaks? It is the east, and Juliet the sun”
(Romeo & Juliet)
Metaphors & Analogies Abound in Science
Internet as Highway
Surfing the Internet
String Theory as a Symphony
War on Cancer
Colonizing Space
Metaphors & Analogies Abound in Science
Clockwork Universe
“Hard” vs. “Soft” Sciences, “Seminal” Work, “Fathers of x,y,z”
Spaghetti Code in Software
Soft vs. Hardware
Virus/Bugs
Evolutionary Tree
Tree of Life
Nature as Woman – “Mother Nature”
Feminine as Nurturing and Violent/Irrational
In Need of Taming/Controlling
Use of Forced Interrogation
Explicit and Implicit Rape/Torture Analogies
Modern Western STEM as Gendered
Masculine (More Valuable)
Feminine (Less Valuable or Bad)
Objectivity
Subjectivity
Reason/Dispassionate/Detached
Emotion/Intuition/Heart
Mind
Body
Rationality
Irrationality/Chaotic/Senseless
Culture/Science
Nature
Nature Unveiling Herself Before Science
(Louis-Ernest Barrias; 1899)
Niccolo Machiavelli (1469-1527)
“Fortune [truth/knowledge] is a woman and it is necessary if
you wish to master her to conquer her by force; and it can be
seen that she lets herself be overcome by the bold rather than by
those who proceed coldly, and therefore like a woman, she is
always a friend to the young because they are less cautious,
fiercer, and master her with greater audacity”
(Emphases Mine)
Francis Bacon (1561-1626)
“For you have but to follow and as it were hound nature in her
wanderings, and you will be able when you like to lead and
drive her afterward to the same place again…
Neither ought a man to make scruple of entering and
penetrating into those holes and corners, when the inquisition
of truth is his whole object…”
(Emphases Mine)
Richard Feynmen (1918-1988)
“That was the beginning, the idea seemed so obvious to me
and so elegant that I fell deeply in love with it.
And, like falling in love with a woman, it is only possible if
you do not know much about her, so you cannot see her faults.
The faults become apparent later, but after the love is strong
enough to hold you to her…
(Emphases Mine)
Feynmen cont.
…“So what happened to the old theory that I fell in love with as a
youth?
Well, I would say it’s become an old lady, who has very little that’s
attractive left in her, and the young today will not have their hearts
pound when they look at her anymore.
But, we can say the best we can for any old woman, that she has become
a very good mother and has given birth to some very good children.
And I would like to thank the Swedish Academy of Science for
complimenting one of them”
(Emphases Mine)
Paul Feyerabend (1924-1994)
“Such a development, far from being undesirable, changes
science from a stern and demanding mistress into an attractive
and yielding courtesan who tries to anticipate every wish of her
lover.
Of course, it is up to us to choose either a dragon or a pussycat
for our company”
(Emphases Mine)
Emily Martin
The Egg and the Sperm:
How Science Has Constructed a Romance Based on Stereotypical Male-Female Roles
Martin
Eggs – Feminized (according to stereotypical social assumptions)
•
•
•
•
•
•
•
Static/Slow
Lazy/Unproductive
Inefficient
Shed like so much Waste/Detritus each month
Finite
Get Penetrated/Activated/Awakened/Saved – Sleeping Beauty
Entrap/Snare – Spider
Sperm – Masculinized (according to stereotypical social assumptions)
•
•
•
•
•
•
Mobile/Fast
Productive
Efficient
Seemingly Infinite
Compete to Penetrate/Activate – Chivalrous Rescuing Knight in Shining Armor
Get Caught Unsuspectingly by Sly Waiting Predator – Unwittingly Helpless Victim to Wiles of Women
Ideological Loop
1.) Assumptions about Gender (or Race, or Class, or Age, or Sexuality, etc.)
2.) Inform ways of understanding science; become naturalized
3.) Reinforce/legitimize assumptions about gender and/or other social
identities/expressions/experiences.
Martin’s Punchlines
1.) Make biomedical (and all other) materials empirically accurate
2.) Be(come) aware of the use of language and imagery in science
“Let’s wake up some sleeping metaphors…
3.) Make interventions into ideological loops that seem necessary and/or good
…in order to rob them of the power to naturalize social imagery and conventions” (pp. 501)
4.) Don’t only seek out equality (among genders or any other groups)
e.g. “Everyone/every group has their positives and negatives, their contributions etc.”
Martin – This is way better than nothing, but it is not enough
5.) Don’t only come up with new theories, models, explanations (lock & key analogy etc.)
More thoughtful language, more empirical accuracy, reduction in socially derogatory understandings.
Martin – This is way better than nothing, but it is not enough
6. Martin is Asking Us to Consider:
Why Do We Anthropomorphize Objects like Eggs and Sperm in the First Place?
Some Week 2 Levity!
Welcome Back! Week Three
Medical Knowledge & Practice in Relation to Race & Gender Pt. I
For This Week (Week 3)
❖Nelly Oudshoorn
Beyond the Natural Body: An Archeology of Sex Hormones
Ch. 2 – “The Birth of Sex Hormones” pp. 15-41
❖Anne Fausto-Sterling
“The Five Sexes: Why Male and Female are Not Enough” pp. 20-24
❖Anne Fausto-Sterling
“The Five Sexes, Revisited” pp. 19-23
❖Discussion Board 2 Due Friday January 21st
For Next Week (Week 4)
❖ Linda Hunt & Mary Megyesi -“The Ambiguous Meanings of the Racial/Ethnic Categories Routinely used in Human Genetics Research”
pp. 349-361
❖ Janet Shim -“Constructing ‘Race’ across the Science-Lay Divide: Racial Formation in the Epidemiology and Experience of Cardiovascular Disease”
pp. 405-436
2020 AMA policy recognizes racism as a public health threat; 2020 AMA Board of Trustees pledges action against racism, police brutality:
https://www.ama-assn.org/press-center/press-releases/new-ama-policy-recognizes-racism-public-health-threat
https://www.ama-assn.org/press-center/ama-statements/ama-board-trustees-pledges-action-against-racism-police-brutality
❖ Claudia Wallis“ – Why Racism, Not Race, Is a Risk Factor for Dying of COVID-19”
https://www.scientificamerican.com/article/why-racism-not-race-is-a-risk-factor-for-dying-of-covid-191/
❖ Lisa Bowleg – “We’re Not All in This Together: On COVID-19, Intersectionality, and Structural Inequality”
https://ajph.aphapublications.org/doi/10.2105/AJPH.2020.305766
❖ Nicole Aschoff – “COVID-19 Should Be a Wake-Up Call for Feminists” Jacobin.
https://jacobinmag.com/2020/04/covid-19-coronavirus-pandemic-feminism
❖ Discussion Board 3 Due Friday January 28th
Virtual Zoom Weekly Office Hours
Tuesdays & Thursdays from 2:30-3:30 pm PST
Office Hours Links Updated Each Week under ‘Announcements’ on Canvas
Biology & Society,
Nature & Culture
Dualisms
❖No middle
❖No continuum
❖No ‘outside’/beyond, etc.
❖Differentially Valued – There are frequently explicit and/or implicit
‘understandings’ that hierarchies structure genders, sexes, etc.
Masculine
(More Valuable)
Feminine
(Less Valuable or Plain Bad)
Objectivity
Subjectivity
Reason/Dispassionate/Detached
Emotion/Intuition/Heart
Mind
Body
Rationality
Irrationality/Chaotic/Senseless
Culture/Science
Nature
The “Science” of Binary Genders and Sexes
❖Sex/Body & Gender/Identity/Expression
Cis – “On this side”
Trans – “Across”/ “On the other side”
Non-Binary – Not “either/or”
Genderfluid – Fluid (non-fixed) gender
Ascription vs. Assertion – (External Assumptions vs. Self-Assertions)
Social Construction
Exist and Shift
Experiences and Consequences are Very Real
Social Construction
Theoretical arguments and empirical studies that contend that concepts, categories, practices,
interpretations, and the establishment of facts emerge and develop in particular contexts – and
continue to change across historical time and across/within particular societies and cultures.
BUT…
What is Social Construction in
Relation to Science and Medicine??
Aren’t science and medicine just…well…science and medicine?
Facts are facts, data is data, method is method, findings are findings?
Concepts, Categories, Practices & Interpretations
Constructions Made by Humans – Do Not Fall Out of the Sky Ready-Made
Social, Historical, Cultural, Political, Ethical in Character; Specific Contexts Matter
Fluid; Not Static – Change Occurs Over Time
Neither Inevitable or Predetermined – Could Have/Might Yet Be Different
Objects, Ideas, Categories, Practices, and Understandings Shift – This Is (Potentially) Liberating
The Truth of Medical Reality Exists and Shifts
❖Construction as Metaphor – Collectively Building, Creating, Producing
❖Construction as Indication of Historical/Developments Over Time
❖Construction as Indication of ‘Exposing’ – Hidden/Forgotten Context, Ideologies
Please Note: Construction Almost Never Means ‘Not Real’…
“No, Adam, I can’t walk through the wall” ☺
Recognizing that ‘medical’ is socially produced in particular contexts for particular reasons…
“False/Untrue/Unreal”
Nelly Oudshoorn: Beyond the Natural Body
Social Construction in Medicine in Action
❖Case study of social construction in action over time
‘Facts of the matter’ develop and change
❖Socio-cultural & political-economic contexts condition medicine
Science, technology, and medicine do not exist in vacuums
❖Social norms/expectations shape knowledge & applications of facts
❖Knowledge & applications of facts shape social norms/expectations
The Biological As Social
“Although the concept of gender was developed to contrast the naturalization of
femininity, the opposite has happened.
Feminist theories of socialization did not question the biological sex of those subjects
that become socialized as woman; they took sex and the body for granted as
unchanging biological realities that needed no further explanation…
Anthropologists and historians provided very powerful insights that challenged the
notion of a natural body. However, they went only halfway. These studies focused on
experiences with the body and on how these experiences are molded by time and
culture.
This still leaves room for the argument that, despite differences in bodily experiences,
these experiences do refer to a universal, physiological reality…”
(Oudshoorn, pp. 2-3; emphasis mine)
The Making of Sex Hormones
❖Multiple Competing Disciplinary Styles
Anatomy, Gynecology, Biochemistry
Questions, Frameworks, Interpretations
Only Partially Overlapping Networks of People, Places, and Resources
❖‘Pre-Scientific’ Socio-Cultural Assumptions
Binary Expectations re: Sex (& Gender & Sexuality)
‘Discovered’ (or not!) in ‘Brute’ Nature (ideological loop!)
Reinforcement or Transformation of Assumptions
The Making of Sex Hormones cont.
❖Shifting Understandings of Origin(s), Function(s)
From Description(s) → Explanation(s) (Mechanisms)
‘Just’ About Sexual Characteristics/Functions → Entire Complex Bodies
❖From Sexual Binaries & Essences → Sexual Differentiations & Ratios
Gonads (and Brains) → Isolated Chemical Secretions → Synthetic Compounds
To Be Continued…
Fausto-Sterling – The Five Sexes:
Why Male and Female are Not Enough
❖Intersex
Category indicating individuals born with/develop primary and/or secondary
female and male sexual characteristics
Intersex individuals sometimes expected or forced to ‘fit’ either/or binary
re: sexual and gender identity, experience, presentation/expression
“Normal” vs. “Abnormal”
On what basis?
Who decides?
On what basis?
THE BIOLOGICAL IS ALSO SOCIAL
Fausto-Sterling: The Five Sexes cont.
❖External Authorities, Values, Norms: Socialization
Medical, Legal, Educational, Political-Economic, Familial, Religious
But Also…
❖Self-Policing: Internalization
Do I ‘fit’?
Am I doing this ‘right’?
Biopower
Social Control of Peoples and Populations via the Active Production of ‘Kinds’ of Lives
Biopower – Power Over Life
Peoples and Populations as Bio-Social ‘Issue’
(Literal) LIFE = The Object of Study and the Objective Goal of Intervention
❖ Individual Bodies – Disciplined via Institutional Norms, Practices, Expectations
Maintain ‘normal’ ‘natural’ bodies and lives
Rhetoric of Neutrality and Role of Experts/Expertise (Governmental, Medical, Psychological/Psychiatric, Educational, etc.)
❖ Populations – Regulated via Political-Economic States
Centralization of Power aimed at Managing and Policing Both “Norms” and “Outliers”
Regimentation & Standardization
•
Classification, Categorization
Sexuality, Gender, Sex, Race, Ethnicity, Nationality, etc.
•
Active (vs. Passive) Self-Production of Peoples & Populations
“Positive” Productions – We are shaped by others, but we also SHAPE OURSELVES
Biopower cont.
❖Rhetoric (Again!)
Identifying, Sorting, Evaluating, and Producing
Certain “Kinds” of People and/or Populations
‘Normal’, ‘Health,’ ‘Socially-Desirable’
‘Management of Optimal’ Traits, Dispositions, Behaviors
‘Strong’ populations; ‘Secure’ nations; ‘High-Functioning’ citizens, workers
‘Robust’ and ‘Well-Regulated’ Humanity
Optional Documentary Extra Credit Opportunity
‘Transformation’
Some Week 3 Levity!
Welcome Back! Week Four
Medical Knowledge & Practice in Relation to Race & Gender Pt. II
For This Week (Week 4)
❖ Linda Hunt & Mary Megyesi -“The Ambiguous Meanings of the Racial/Ethnic Categories Routinely used in Human Genetics Research”
pp. 349-361
❖ Janet Shim -“Constructing ‘Race’ across the Science-Lay Divide: Racial Formation in the Epidemiology and Experience of Cardiovascular Disease”
pp. 405-436
2020 AMA policy recognizes racism as a public health threat; 2020 AMA Board of Trustees pledges action against racism, police brutality:
https://www.ama-assn.org/press-center/press-releases/new-ama-policy-recognizes-racism-public-health-threat
https://www.ama-assn.org/press-center/ama-statements/ama-board-trustees-pledges-action-against-racism-police-brutality
❖ Claudia Wallis – “Why Racism, Not Race, Is a Risk Factor for Dying of COVID-19”
https://www.scientificamerican.com/article/why-racism-not-race-is-a-risk-factor-for-dying-of-covid-191/
❖ Lisa Bowleg – “We’re Not All in This Together: On COVID-19, Intersectionality, and Structural Inequality”
https://ajph.aphapublications.org/doi/10.2105/AJPH.2020.305766
❖ Nicole Aschoff – “COVID-19 Should Be a Wake-Up Call for Feminists” Jacobin.
https://jacobinmag.com/2020/04/covid-19-coronavirus-pandemic-feminism
❖ Discussion Board 3 Due Friday January 28th
For Next Week (Week 5)
❖ Nelly Oudshoorn
Ch. 5 – “The Marketing of Sex Hormones” pp. 82-111
Ch. 6 – “The Transformation of Sex Hormones into The Pill” pp. 112-137
❖ Maya Manian – “Immigration Detention and Coerced Sterilization: History Tragically Repeats Itself”
Immigration Detention and Coerced Sterilization: History Tragically Repeats Itself
❖ Emily Medosch – “Not Just ICE: Forced Sterilization in the United States”
❖ Michelle Goodwin – “The Racist History of Abortion and Midwifery Bans”
❖ Ellen Willis – “Abortion: Is a Woman a Person?” pp. 333-335
❖ Discussion Board 4 Due Friday February 4th
Virtual Zoom Weekly Office Hours
Tuesdays & Thursdays from 2:30-3:30 pm PST
Office Hours Links Updated Each Week under ‘Announcements’ on Canvas
Biopower
Social Control of Peoples and Populations via the Active Production of ‘Kinds’ of Lives
Biopower – Power Over Life
Peoples and Populations as Bio-Social ‘Issue’
(Literal) LIFE = The Object of Study and the Objective Goal of Intervention
❖ Individual Bodies – Disciplined via Institutional Norms, Practices, Expectations
Maintain ‘normal’ ‘natural’ bodies and lives
Rhetoric of Neutrality and Role of Experts/Expertise (Governmental, Medical, Psychological/Psychiatric, Educational, etc.)
❖ Populations – Regulated via Political-Economic States
Centralization of Power aimed at Managing and Policing Both “Norms” and “Outliers”
Regimentation & Standardization
•
Classification, Categorization
Sexuality, Gender, Sex, Race, Ethnicity, Nationality, etc.
•
Active (vs. Passive) Self-Production of Peoples & Populations
“Positive” Productions – We are shaped by others, but we also SHAPE OURSELVES
Biopower cont.
❖Rhetoric (Again!)
Identifying, Sorting, Evaluating, and Producing
Certain “Kinds” of People and/or Populations
‘Normal’, ‘Health,’ ‘Socially-Desirable’
‘Management of Optimal’ Traits, Dispositions, Behaviors
‘Strong’ populations; ‘Secure’ nations; ‘High-Functioning’ citizens, workers
‘Robust’ and ‘Well-Regulated’ Humanity
What Is ‘Race’?
Gender, Sex, and Race as Social Constructs – Historical-Social Contexts Matter
Reality of Change: Categories, Classifications, Meanings Exist and Shift
Intra-Group Differences, Inter-Group Similarities
How and Why Are Groups Constructed in Particular Contexts?
Ongoing Relations of Power
Power to Be, Power to Know, Power to Value, Power to Decide
And Power to Resist
‘Race’ as Social Construct
All-Too-Real Consequences
Linda M. Hunt & Mary S. Megyesi:
The Ambiguous Meanings of the Racial/Ethnic
Categories Routinely used in Human Genetics Research
What, precisely, does it mean to classify others (or one’s own self) as belonging
to a particular race or ethnicity?
What constitutes race? Ethnicity? Who makes these calls? Who gets the final
say? On what basis?
What role have classifications based upon race and/or ethnicity played in
biomedical research?
Race/Ethnicity: A ‘Useful Proxy’?
It is commonplace amongst many researchers of human genetics to consider categories
of race and/or ethnicity as heuristically useful designations applied to certain
individuals and groups.
Even if race/ethnicity are not easy, precise, or consistent classifications to designate –
genetically or otherwise – many see value in employing race and/or ethnicity when
studying health disparities.
Certain individuals are presumed to belong to certain groups, and certain groups are
presumed to be at higher risks for particular diseases than comparable groups.
The argument made is that by downplaying or ignoring the variables of race/ethnicity,
genetic researchers are less likely to hit upon the biomedical susceptibilities that
disproportionately affect some and not other groups, thereby making successful
preventions and interventions less likely and less efficacious.
Race as a Social Construct
Others demonstrate that ‘race’ is used as a stand-in for larger social-structural
inequalities among groups of people.
In addition, it is argued that using race in this stand-in fashion serves to
reinforce already existing assumptions about the relationship between genes and
so-called biological races (i.e., biological determinism).
Thus, ‘race’ as a variable in genetic research should be radically re-thought or
removed as a stand-alone or independent variable.
Classification: Concepts, Practices, Interpretations
Hunt and Megyesi examine the practices of racial & ethnic classification among researchers.
Interviewed 30 human genetics researchers in the U.S. & Canada
How/why individuals are classified the way that they are
Whether or not said classifications are based upon unexamined/implicit assumptions
Some use geography – often continental-level, sometimes national-level – as a stand in for race
(e.g., African, Irish, Asian, European, Japanese, etc.)
The assumption being made here is that for long stretches of human history, migration and
mating patterns were relatively localized/endogamous – hence, the presumed existence of
relatively homogenous or ‘pure’ series of gene pools.
However, it has been demonstrated that such assumptions about limited migration and local mating
patterns are not historically accurate.
Seemingly distinct geographical groups did and do mingle, making any simple or
straightforward declarations about the genetic similarities or differences found amongst
people and groups more complex than often presumed.
Classification: Concepts, Practices, Interpretations cont.
“A sound classification system should have three basic features:”
1.) Consistent principles of classification
2.) Categories which are mutually exclusive
3.) Capacity to absorb all cases
If classification schemas are declared to be rigorous and informative:
1.) Schema must not change much or at all regardless of who is using them
(‘boxes’ and their applications used identically across different research(ers)
2.) Characteristics of a category of classification should not overlap with the characteristics of another category
(one and only one category per person)
3.) Every individual should fit into the available categories
(e.g. no ‘Other’ box to check, no one should be left out)
Classification: Concepts, Practices, Interpretations cont.
H&M’s Findings: Different Researchers Utilize Different Classification Schema
Oftentimes, not only presumed geographical lineage, but also language and skin tone
were used as stand-in proxies for more specific classifications. Not Consistent.
Oftentimes, categories as presented by researchers overlapped. A researcher or subject
might be inclined to check more than one box – depending on asserted race,
geographic ancestry, language, physical appearance, etc. This, to the point that “mixed
race” individuals were often simply not used in research. Not Mutually Exclusive.
Oftentimes, classifications were made via subjects’ self-identification. But some
subjects (including a researcher interviewed) could not pin themselves down to any
particular choice presented. They checked ‘Other.’ Not Capturing All Cases.
Punchline
“…we thus are confronted with the central problem of attempting to classify people into
racial/ethnic groups: the groups themselves are inherently arbitrary and context
specific.
Population groups simply do not have clear boundaries: group identity is by its very
nature fluid and changing, genetic and phenotypic variations are widely shared, and
individuals are quite commonly members of more than one group.
Thus, procedures attempting to classify people into clearly bounded groups necessarily
will require arbitrary and context specific decisions – whether by the researcher’s
judgments, the rules of an algorithm or choices of the individual subjects themselves”
Janet K. Shim
Constructing ‘Race’ across the Science-Lay Divide:
Racial Formation in the Epidemiology and Experience of Cardiovascular Disease
Racial Disparities in Distribution of Cardiovascular Disease (CVD): Why?
❖Epidemiological vs. Lay Understandings of ‘Race,’ Ethnicity, Culture
Race/Ethnicity as ‘Proxies for Culture’
vs. Racism, Inequality, Discrimination as Systemic Health Risks, Burdens, Stressors
❖Questions of Classification
Conceptualization, Operationalization, & Interpretations of Real or Assumed Differences
Boxes (+) (-) (??)
Race as ‘Proxy for Culture’?
❖Epidemiologists routinely incorporate questions of race and/or ethnicity into their
questionnaires/surveys, observations, and reports as key variables relating to risk.
❖‘Race’ as ‘risk factor’ is often used to identify and explain higher and lower rates of disease
across different populations in a society.
❖Unlike their human genetic researcher counterparts, epidemiologists tend to use
classifications of race/ethnicity as proxies for behavioral or life-style ‘choices.’
AKA: Race/Ethnicity as Stand-in For ‘Culture’
e.g.:
Are there higher rates of smoking among some and not other groups in a population?
What do the diets/nutritional patterns of different groups in a population look like?
What sorts of physical activity do different groups in a population engage in?
How often is preventative care sought by members of different groups in a population?
Racial Formation via Ascriptions (Assumptions)
Many ‘lay’ people** interviewed by Shim noted that their race(s)/ethnicity(s) were
often ascribed to them by others.
These racial ascriptions are made by epidemiological researchers as well as by the
wider society in which folks’ ‘race’ is formed.
Formation suggests that what is considered to be a ‘race’, as well as who is or is not
considered to ‘belong to a certain race’ is related to history – and power relations.
(e.g.) Someone may have many different racial or ethnic ties in their immediate and
historical background, but society at large may lump certain people into groups
together – often based upon how physical appearance, surname, etc.
** ‘Lay’ = individuals who are not formal professional experts
Race as Proxy for Structural Inequalities,
Discrimination, Segregation, & Chronic Stress
As one lay participant noted: “…If you have a hard life, it stays on you…”
(pp. 424)
Feelings of identity conflict – being ascribed/assumed to be a certain race/ethnicity etc. while not
understanding/asserting that to be the case.
Feelings of suppression – wanting to speak out, but weighing the costs and benefits of doing so. Fear of not
‘fitting in’ or being taken seriously. Bottling up and not being true to yourself.
Anxiety and depression caused from a lack of job security, decent wages, childcare concerns, transportation and
housing concerns, safety concerns, educational concerns, medical concerns, (a particularly frustrating Catch -22
within the context of this essay), environmental pollutants/safety concerns.
These and other structural inequalities and hierarchies of power/social relations relate to the prevalence of risk
among certain populations AND simultaneously can constrain promotion/preventative practices. The chronic
stress of racialized hierarchies and unequal power relations can lead to coping strategies that are unhealthy, AND
being marginalized may make preventative measures difficult (where to buy fresh groceries, how to get enough
quality rest, down-time, or leisure, play, exercise, access to and affordability of health clinics/hospitals etc.)
And Yet…
Epidemiological ‘Holy Trinity’: Race, Sex, Age
Even as many epidemiologists express – via interviews with Shim or amongst
themselves at the conferences and roundtables she observed – a discomfort with
the ambiguous way in which race and/or ethnicity is often defined, deployed, and
interpreted within their studies on risk factors and outcomes across different
populations, in practice and in published research, many continue to employ
standard questions about these seemingly independent variables.
Bureaucratic inertia? Following standardized procedures regardless of doubts?
“You have to measure race” etc.
Shim sees in this something akin to professional ritual
Race as Culture? cont.
Many epidemiologists use race and/or ethnicity as a proxy for habitual group decision making, behaviors,
customs, and cultural lifestyle ‘choices.’
Why, specifically, do many epidemiologists find this approach appealing?
1.) Cultural customs, habits, and behaviors are empirically observable; cross-group comparisons can be
made in a relatively standardized scientific fashion.
2.) A focus upon cultural ways of life can presumably be easily complemented by health
promotion/prevention campaigns. (e.g., ‘do this’, ‘avoid this,’ etc.)
3.) ‘Culture’ proves to be very flexible. Culture can encompass a wide variety of moving parts. This is
appealing as a supposedly non-essentialist way of discussing and intervening across different populations.
4.) Speaking of ‘external’ culture as opposed to ‘internal’ biology appears to avoid biological determinism.
But does race as culture become a ‘one-step removed’ essentialism itself??
(e.g. certain groups act like x, certain groups don’t do y, etc.)
Race As Constructed & Contextual Lived Reality
At the same time that culture is seen to be flexible – it changes across time and
place, within and among groups – it simultaneously works in formal research as a
relatively static variable that purports to explain disparities in diseases.
In transforming culture into a relatively stable and independent variable,
prior stereotypes and assumptions about race and ethnicity are reinforced.
This misses the variability within so-called races or ethnic groups
Individuals are lumped into particular higher or lower risk populations
A 2017 Medical School Textbook
Crucial Questions of Broader Structural Contexts
❖What about smoking? What about diet? What about place of residence, activity
levels, education, occupation, etc. ???
❖These are not simply individual or group ‘lifestyle choices’ rooted in a
supposedly shared culture.
❖Practices emerge out of particular historical and cultural contexts.
Reminder: Medicine as Social Science
Examining health and illness within broader social contexts.
•
•
•
•
•
•
•
Environmental pollutants
Malnutrition
Smoking/Drinking/Drug Use
Air, Water, and Soil Quality
Sanitation/Hygiene
Health effects of Climate Change
COVID
From a broader (sociological and historical context) we can begin to see the non-random socialstructural contexts that disproportionately effect members of different populations.
Yes, all of the above risks exist and they are associated with rates of disease.
But why the disproportions? Enter: underlying economic contexts, racism, access, education, etc.
Reminder
American Medical Association (AMA) 2020
Pledges & Policies Concerning Historical and Ongoing Racism
❖Systemic Racism
Structural and legalized systems that result in differential access to goods and services,
including health care services
❖Cultural Racism
Racial stereotypes portrayed in culturally shared media and experiences
❖Interpersonal Racism
Explicit and implicit racial prejudice, including explicitly expressed racist beliefs and
implicitly held racist attitudes and actions based upon or resulting from these prejudices
Recognition of Racism – including Police Brutality – as Systemic Pubic Health Risk
Recognition of AMA’s Historical Role in Perpetuating Racial Health Disparities
Race, Gender, Class, and COVID
❖Racism as Public Health Risk
Systemic (Non-Random) Patterns of Infection, Disease, and Death Disparities
Imperative to Properly Document and Disaggregate Data
More Exposure, Less Protection
Ongoing Systemic Disparities: Employment, Housing, Education
Prisons, Jails, Immigration Detention Centers, Houselessness
Compounding Effects from Chronic Social Disparities (Access, Affordability, Quality of Resources)
Compounding Effects from Chronic Disease Burdens (Tied to Ongoing Social Disparities)
❖“We’re All in This Together”
Rhetorically in the Abstract? – Okay. But Concretely in Lived Reality? – No.
The Legacy of HIV/AIDS – Ongoing Patterns of Public Health Crisis Responses
“…Deadly Viruses Spotlight Fissures of Structural Inequality”
Intersectional Analysis Is Crucial
“We are all” socially distancing to flatten the curve, public health officials tell us. But
cognitive, social, physical, and moral distancing from groups marginalized by structural
inequality is perpetual. Intersectionality, a critical theoretical framework, provides an
indispensable prism through which to examine the intersectional effects of COVID-19.
Intersectionality highlights how power and inequality are structured differently for
groups, particularly historically oppressed groups, based on their varied interlocking
demographics (e.g., race, ethnicity, gender, class).
Intersectionality troubles the notion of a collective “we” and “all” with the harsh and
inconvenient truth that when social injustice and inequality are rife, as they were long
before COVID-19, there are only what intersectionality scholar Kimberlé Crenshaw calls
“specific and particular concerns”
(Lisa Bowleg, emphasis mine)
Intersectional Analysis Is Crucial
“Now, and when COVID-19 ends, we – policymakers, public health officials, and all of us
who care about public health – have a moral imperative to center and equitably address the
health, economic, and social needs of those who bear the intersectional brunt of structural
inequality. This could move us a bit closer to all being in this together.
Or we could maintain the inequitable status quo and acknowledge “we’re all in this
together” for what it is: another hollow platitude of solidarity designed to placate the
privileged and temporarily uncomfortable and inconvenienced”
(Lisa Bowleg)
Race, Gender, Class, and COVID cont.
❖A Wake-Up Call to Feminists
“The pandemic has revealed, albeit in a brutal manner, the areas in which feminists need to mobilize and
organize moving forward”
Systematic (Non-Random) Gendered Patterns in Divisions of Labor
Low-Paying, Precarious Employment, Unemployment, Unsafe Working Conditions
Children, Family Care, Housework Labor
Domestic Violence
Relations of Precarity, Dependency – Lack of Real Material Support, Stability
Women’s Relative or Total Lack of Personal, Economic, Political, Social Autonomy
“Women’s access to…necessities is often either highly contingent or nonexistent”
❖“Essential Workers”
Hierarchies of Value/Worth
Questions of Biopower
Which Bodies Matter?
Who Lives? Who Dies?
Concepts, Values, Practices of “Expendability”
Some Week 4 Levity – Kind Of… :/
Welcome Back! Week Five
Ideologies & Technologies of Reproduction:
Eugenical Control vs. Emancipatory Autonomy
For This Week (Week 5)
❖ Nelly Oudshoorn
Ch. 5 – “The Marketing of Sex Hormones” pp. 82-111
Ch. 6 – “The Transformation of Sex Hormones into The Pill” pp. 112-137
❖ Maya Manian – “Immigration Detention and Coerced Sterilization: History Tragically Repeats Itself”
Immigration Detention and Coerced Sterilization: History Tragically Repeats Itself
❖ Emily Medosch – “Not Just ICE: Forced Sterilization in the United States”
❖ Michelle Goodwin – “The Racist History of Abortion and Midwifery Bans”
❖ Ellen Willis – “Abortion: Is a Woman a Person?” pp. 333-335
❖ Discussion Board 4 Due Friday February 4th
For Next Week (Week 6)
❖Midterm #1 Available end of day Thursday February 3rd
(on Canvas under ‘Assignments’)
❖Tuesday February 8th – Midterm #1 Review
❖Midterm #1: Due Thursday February 10th
end of day (11:59 pm) on Canvas under ‘Assignments’
Virtual Zoom Weekly Office Hours
Tuesdays & Thursday from 2:30-3:30 pm PST
I Will Be Unable To Meet During Office Hours on Tues. Feb. 1st
Office Hours Links Updated Each Week under ‘Announcements’ on Canvas
Race, Gender, Class, and COVID
❖Racism as Public Health Risk
Systemic (Non-Random) Patterns of Infection, Disease, and Death Disparities
Imperative to Properly Document and Disaggregate Data
More Exposure, Less Protection
Ongoing Systemic Disparities: Employment, Housing, Education
Prisons, Jails, Immigration Detention Centers, Houselessness
Compounding Effects from Chronic Social Disparities (Access, Affordability, Quality of Resources)
Compounding Effects from Chronic Disease Burdens (Tied to Ongoing Social Disparities)
❖“We’re All in This Together”
Rhetorically in the Abstract? – Okay. But Concretely in Lived Reality? – No.
The Legacy of HIV/AIDS – Ongoing Patterns of Public Health Crisis Responses
“…Deadly Viruses Spotlight Fissures of Structural Inequality”
Intersectional Analysis Is Crucial
“We are all” socially distancing to flatten the curve, public health officials tell us. But
cognitive, social, physical, and moral distancing from groups marginalized by structural
inequality is perpetual. Intersectionality, a critical theoretical framework, provides an
indispensable prism through which to examine the intersectional effects of COVID-19.
Intersectionality highlights how power and inequality are structured differently for
groups, particularly historically oppressed groups, based on their varied interlocking
demographics (e.g., race, ethnicity, gender, class).
Intersectionality troubles the notion of a collective “we” and “all” with the harsh and
inconvenient truth that when social injustice and inequality are rife, as they were long
before COVID-19, there are only what intersectionality scholar Kimberlé Crenshaw calls
“specific and particular concerns”
(Lisa Bowleg, emphasis mine)
Intersectional Analysis Is Crucial
“Now, and when COVID-19 ends, we – policymakers, public health officials, and all of us
who care about public health – have a moral imperative to center and equitably address the
health, economic, and social needs of those who bear the intersectional brunt of structural
inequality. This could move us a bit closer to all being in this together.
Or we could maintain the inequitable status quo and acknowledge “we’re all in this
together” for what it is: another hollow platitude of solidarity designed to placate the
privileged and temporarily uncomfortable and inconvenienced”
(Lisa Bowleg)
Race, Gender, Class, and COVID cont.
❖A Wake-Up Call to Feminists
“The pandemic has revealed, albeit in a brutal manner, the areas in which feminists need to mobilize and
organize moving forward”
Systematic (Non-Random) Gendered Patterns in Divisions of Labor
Low-Paying, Precarious Employment, Unemployment, Unsafe Working Conditions
Children, Family Care, Housework Labor
Domestic Violence
Relations of Precarity, Dependency – Lack of Real Material Support, Stability
Women’s Relative or Total Lack of Personal, Economic, Political, Social Autonomy
“Women’s access to…necessities is often either highly contingent or nonexistent”
❖“Essential Workers”
Hierarchies of Value/Worth
Questions of Biopower
Which Bodies Matter?
Who Lives? Who Dies?
Concepts, Values, Practices of “Expendability”
Reproductive Ideologies and Technologies
Big Picture
❖Knowing that eugenics has held and continues to hold a significant place in
the conceptualizations, practices, policies, and values of the U.S.
❖Seeing how ‘scientifically objective’ assumptions concerning heredity
directly and explicitly relate to questions of individual
‘function/dysfunction,’ social ‘desirability,’ and the enactment of
reproductive policies.
❖The complex & messy history of the emergence of hormonal birth control.
❖A caution against the ‘genetic fallacy.’
Nelly Oudshoorn: Beyond the Natural Body (again!)
Birth Control – From Taboo to Technology
❖Sending Contraceptive Information & Devices Prohibited by Law in U.S.
Until 1959 – NIH Not Funding Contraceptive Research
1960 – Enovid Receives FDA Approval for Explicit Use as Contraception
❖Initial Funding via Private Sources – Margaret Sanger via Katherine McCormick
No initial funding from federal/state governments, no initial funding from pharmaceutical companies
❖Initial Framing – Menstrual Disorders and Infertility
❖Initial Clinical & Field Test Sites
Gynecological Patients, Incarcerated, Mental Health Hospitals
Puerto Rico –
From Medical Students → To Housing Development Residents via Family Planning Clinics
“Captive Populations” (human ‘guinea pigs’) – Often Poor & Less Formally Educated Women
Proving Efficacy and Safety (Side Effects??!) of ‘Universal’ Contraception
A Caution Against Genetic Fallacies
❖We need to be aware of the history of hormonal birth control. The construction and application of hormonal
birth control and of family planning clinics have been connected historically with scientifically inaccurate and
ethically reprehensible eugenical ideas and practices.
❖Genetic Fallacy – ‘Genetic’ in sense of ‘Genesis’ = Origin/Beginning
1.) Learning about the history, context, and background of an object, practice, or movement
2.) And then incorrectly reasoning that the beliefs, values, and practices. that were attached to said
object/practice are still the defining characteristics of that object/practice.
(Example of Genetic Fallacy: The Pill was historically tied to eugenics, therefore, the Pill is bad)
❖Simply Put
Birth control & family planning are not inherently eugenical.
It is important to know history so that otherwise emancipatory tools do not get used for, or
appropriated in the name of, inhumane practices now or in the future.
The Politics & Ethics of Reproductive Ideas & Practices
Consider
❖Sterilization & Targeted Birth Control
Reproduction Discouraged/Denied
Vs.
❖Prohibitions on Birth Control (and abortion) Information & Use
Reproduction Encouraged/Enforced
❖Who is in charge of birth control – information, access, policies, use?
❖Who is ‘responsible’ for birth control?
❖How are reproductive technologies developed?
By Whom, On Whom? For Whom?
Eugenics
❖Greek: Eu (Good/Well) Genos (Race/Kin)
❖Eugenics = “Well Born/Bred”
Assumption of Heritability of Traits Including:
Poverty
Criminality
“Feeble-Mindedness”
Race & Ethnicity
Disability
“Insanity”
Sexual “Deviance”
Epilepsy
Alcoholism
❖“Positive” and “Negative” Eugenics
Forms of ‘selective breeding’
Increase ‘good stock’ vs. decrease ‘bad stock’ – notice use of rhetoric and imagery!
Measuring, Sorting, and ‘Breeding’ Humans
https://www.youtube.com/watch?v=JeCKftkNKJ0 (approx. 12 min.)
Rise of Progressive-Era Movements Coincide
with Increasing Popularity of Eugenics
“Eugenics was a movement of the nation’s elite thinkers and many of its most
progressive reformers. As its ideology spread among the intelligentsia,
eugenics cross-infected many completely separate social reform and health
care movements, each worthwhile in its own right.
The benevolent causes that became polluted by eugenics included the
movements for child welfare, prison reform, better education, human hygiene,
clinical psychology, medical treatment, world peace, and immigrants’ rights, as
well as charities and progressive undertakings of all kinds”
(Edwin Black, War Against The Weak, pp. 125)
Society ‘as’ Biology
❖Gender, Class, Racial Conflicts and Inequalities as ‘Natural’ (Social Darwinism)
Use of Langue: Breeding, Stock, Contagion, Germs
Social Infection
Race Suicide/Race Purifiers
Class Sanitizers
❖At the Same Time…
Rise of Progressive Social Movements
Public Health and Sanitation
Vaccinations
Alcohol Prohibition
Moral Panic re: Sex Work
Women’s Voting Rights
Labor Regulations
Birth Control
New/NeuGenics
“For three – perhaps four – decades after the Treaty Against Genocide was adopted, the United States continued to sterilize
targeted groups because of their eugenic or racial character, real or supposed; continued to prevent marriages because of their
eugenic or racial character, real or supposed…After the Hitler regime, after the Nuremberg Trials, some twenty thousand
Americans were eugenically sterilized by states and untold others by federal programs on reservations and in U.S. territories such
as Puerto Rico. They said it was legal. They said it was science.”
(Edwin Black, War Against The Weak pp. 409)
Eugenics and Genetics
Current genetics is not synonymous or identical with eugenics. All of modern genetics is not simply eugenics by another name.
However, this does not mean eugenics is out of genetics – consider genetic engineering, insurance (family history, genetic
predispositions), mapping disease (at a cost), genetic castes, designer babies, etc.
Please View Before Next Week (Week 6):
Sterilized Behind Bars (approx. 17 minutes)
•\
Ellen Willis: Abortion: Is a Woman A Person?
Relationship Between:
Biological, ‘Functional,’ Politically/Ethically/Socially ‘Acceptable’
Week 5 “Levity” – Sort of…
For This Week (Week 6)
❖Tuesday February 8th – Midterm #1 Review
❖Midterm #1: Due Thursday February 10th
end of day (11:59 pm) on Canvas under ‘Assignments’
For Next Week (Week 7)
❖Monica Casper
“Feminist Politics and Fetal Surgery: Adventures of a Research Cowgirl on the Reproductive Frontier”
pp. 232-262
❖Luigi Esposito and Fernando M. Perez
“Neoliberalism and the Commodification of Mental Health”
pp. 414-442
❖Discussion Board 5 Due Friday February 18th
Virtual Zoom Weekly Office Hours
Tuesdays & Thursday from 2:30-3:30 pm PST
Office Hours Links Updated Each Week under ‘Announcements’ on Canvas
Midterm #1 Reminders
1.) For the identification (I.D) section (5 terms = 50 pts.)
Please define the terms presented in your own words – i.e., a ‘working definition’
Please provide one example from readings/documentaries/lectures/slides to illustrate each concept.
2.) For the short essay portion (2 prompts = 50 pts.x2 =100 pts.):
Please provide at least two examples from readings, documentaries, lectures, slides to substantiate your response to each prompt (4 examples
total for the short essay portion of midterm).
Approximately 3-4 paragraphs for each short essay response.
If direct citations/paraphrases are used (not required), please provide brief citation (last name, page number).
No separate works cited page required.
Please use complete sentences – not laundry lists like I’m using here. ☺
Please do not skip anything – partial credit is given.
All the very best! I’ll “see” everyone next Tuesday!
❖Epistemology
❖Politics
❖Ethics
❖Critique
Week One
Week One cont.
❖A Sociology of Covid-19
“Inequality Is Our Preexisting Condition”
❖Unnatural Causes
Health and Disease Not Simply/Strictly Biological – Social Variables Matter
Social Health Gradient/Social Health Ladder (Concerns Class/SES)
Chronic Racism & Chronic Stress as Risk Factors for Morbidity & Mortality
‘Holding Constant’ Education and Class/SES → Ongoing Systemic Racism Matters
Social Conditions → Real and Unequal Consequences
Systemic Social Inequalities = Literally Matters of Life and Death
Week One cont.
❖Epidemiology
Population-level Public Health Focus
Social, Cultural, Historical Analyses
Medicine as Natural and Social Science
Inclusion of Contextual Variables – “Root” Structural Conditions
Agents/Exposure/Risk
Promotion/Prevention, Diagnosis, Treatment/Cure
Systemic (Non-Random) Patterns of Relations, Conditions, Experiences
Systemic (Non-Random) Patterns of Intersecting Disparities, Disease, Death
Week Two
❖Biological Determinism/Essentialism
Logic, Consequences, Critiques
❖Ideological Loop
Logic, Consequences
Naturalization of Social/Cultural Assumptions
❖Naturalistic Fallacy
‘Naturally Is The Case = “Should/Ought Be the Case”
Week Two cont.
❖Rhetoric
Descriptions, Metaphors, Analogies
❖Imagery
‘Mother Nature,’ ‘Romance’ between Egg & Sperm, etc.
❖Binary Schemas (Dualisms)
Week Three
❖ Social Construction
Logic, Consequences, Critiques
❖ Sex vs. Gender
Ascription vs. Assertion
❖ Biological Body as Social
Oudshoorn and ‘Sex Hormones’
Fausto-Sterling and Biological Sex
❖ Question of Categorization/Classification ‘Boxes’ – Individuals and Groups
❖ Questions of Social Value/Worth – “Normal” vs. “Abnormal” etc.
❖ Biopower
External & Internal Control/Power Over Bodies, ‘Kinds’ or ‘Types’ of Lives
❖ Transformation Documentary
Week 4
❖What/How/Why Race and Ethnicity are Understood, Classified
Human Genetic Research & Public Health
❖‘Race’ as Proxy
For Geography, Language, Skin Tone
For Culture – Group Behaviors, Lifestyles, Habits
For ‘Explanation’ of Health Disparities
For Lived Reality Amid Structural Inequalities
❖‘Race’ as Social Construction/Formation/Process
Change (quantity, classification, meaning) Across Time and Place
Week 4 cont.
❖ American Medical Association Pledges and Policies
Racism as Public Health Risk
AMA’s Role in Perpetuating Disparities
❖ COVID-19 Disparities
Racism as Risk Factor
‘We’re Not All in This Together’
‘Wake Up Call for Feminists’
Predictable Patterns of Infection, Suffering, Death
Rates of Protection (or Lack Thereof), Rates of Exposure, Chronic & Compounding Disease Burdens
Accessibility of Prevention, Treatment (or Lack Thereof)
Need for Documentation and Disaggregation of Data
Need for Systemic/Structural Interventions and Long-Term Changes
Centrality of Intersectional Analyses
Biopower – Which Bodies and Lives Matter? Which Do Not?
Rhetoric of ‘Essential’; Reality of ‘Expendable’
Week Five
❖ Eugenics
“Positive” and Negative (“Selective Breeding”)
Assumptions Concerning Supposed Heredity
Individual ‘Function/Dysfunction;’ Social ‘Desirability’
❖ History of Hormonal Birth Control
Intersections of Progressive/Emancipatory Aims and Eugenical Bio. Determinism
Social Construction of Facts (Sex Hormones) & Technological Objects (The Pill)
❖ Explicit & Implicit Politics of Reproduction
Gendered Ideologies – Ideas, Values, Practices about ‘Morality’ of Contraception
Eugenics Ideologies – Racist and Classist Testing and Application of Contraception
Forced Contraception, Sterilization; Forced Birth
Eugenical (Biopower) Control vs. Emancipatory Choice, Autonomy, Justice
❖ Genetic Fallacy
❖ Sterilized Behind Bars Mini-Documentary
Some Midterm 1 Review Levity!
Welcome Back! Week Seven
Who Has Medical Expertise?
Questions of Professional & Lay Knowledges Part I
For This Week (Week 7)
❖Monica Casper
“Feminist Politics and Fetal Surgery: Adventures of a Research Cowgirl on the Reproductive Frontier”
pp. 232-262
❖Luigi Esposito and Fernando M. Perez
“Neoliberalism and the Commodification of Mental Health”
pp. 414-442
❖Discussion Board 5 Due Friday February 18th
For Next Week (Week 8)
❖ Kristin K. Barker
“Electronic Support Groups, Patient-Consumers, and Medicalization: The Case of Contested Illness”
pp. 20-36
❖ Kristin K. Barker & Tasha R. Galardi
“Dead by 50: Lay Expertise and Breast Cancer Screening”
pp. 1351-1358
❖ Steven Epstein
“The Construction of Lay Expertise: AIDS Activism and the Forging of Credibility in the Reform of Clinical Trials”
pp. 408-437
❖ Pru Hobson-West
“‘Trusting Blindly Can Be the Biggest Risk of All’: Organized Resistance to Childhood Vaccination in the UK”
pp. 198-215
❖ Discussion Board 6 Due Friday February 25th
Virtual Zoom Weekly Office Hours
Tuesdays & Thursday from 2:30-3:30 pm PST
Office Hours Links Updated Each Week under ‘Announcements’ on Canvas
Ellen Willis: Abortion: Is a Woman A Person?
Relationship Between:
Biological, ‘Functional,’ Politically/Ethically/Socially ‘Acceptable’
Monica Casper
Feminist Politics and Fetal Surgery:
Adventures of a Research Cowgirl on the Reproductive Frontier
A Meditation on Method and Critique
Reflexivity
Sustained critical self-reflection upon one’s perspectives, positions, & practices.
Making a series of self-conscious efforts to remain aware of the assumptions,
values, methods, and interpretations that one brings to and/or draws upon
throughout the research process.
Making a good faith effort to practice reflexivity throughout a research process:
Serves the goals of intellectual honesty and accountability
The overall objectivity of one’s study
Casper’s Methodological Concerns
❖Controversy
❖Studying ‘Up’
❖Accountability
❖Facts &Values, Knowledge & Politics Intersect
❖Questions as Much as Answers?
Intersections of Medicine, Economy, & Expertise
❖Commodification
Transformation of a thing into something that is exchangeable for a profit.
Goods, services, nature, human beings – all may be framed as potential source of profit.
Including Knowledge and its Public Applications
❖Reification
‘Normal’
‘Natural’
‘Necessary’
‘It is What It Is Because It Inevitably Has to Be and/or Should Be This Way’
What Is Supposed to Be Explained/Decided is Being Assumed/Taken for Granted
Neoliberalism
❖A set of political-economic ideas and practices characterized by:
Focus on private ownership, control, direction, funding, oversight
Focus upon free markets, free trade, competition, lower taxes
Shifting power from the public/state and towards the private/profit sector.
Privatization of goods, services, resources
Free or publicly-funded/directed → private ownership, profit
❖Proponents of neoliberal ideas and practices frequently present neoliberalism in terms of:
Individuality, choice, flexibility, deregulation, & personal responsibility
❖Critics of neoliberal ideas and practices frequently present neoliberalism in terms of:
Precarity/insecurity, austerity, personal risk, declining standards of living, reification
Luigi Esposito and Fernando M. Perez
Neoliberalism and the Commodification of Mental Health
Conceptions of Society, Self & Mental Health
❖Ontology – Questions Concerning Existence/Being
Normal vs. Pathological; Functional vs. Dysfunctional
The Biomedical Self
❖Categories/Classification Schema as Social Constructions
From Social Construction of Illness → Corporate Construction of Disease
❖Medicalization of Human Life
Treatment (and Insurance) Driven
Self and Associated Diseases/Disorders as ‘Natural Kinds’ – Biological Determinism
Neutral Medical Facts Treated via Objective Science using Value-Free Standards
❖Privatization of Illness – Personal Problems vs. Social Issues
Social Contexts Shorn – Neoliberal Pressures and Constraints Taken as Given
Reification of Society and our Place in it as: Natural, Normal, Necessary
“We emphasize how neoliberalism promotes not simply a market economy but a market
society in which market imperatives, instead of being confined to some part of the
economy… come to suffuse the whole social fabric’’
(pp. 420)
❖Market as ‘Natural’
Deviation as ‘Unnatural’ (i.e., ‘going against nature’ or ‘the natural order of things’)
❖‘Real’ Cause of Ailments/Distress as Biological
Identifiable Only After Elimination of ‘Subjective’ Variables/Biases
i.e., elimination of political, economic, social conditions as variables
❖Consideration of ‘External’ Public Realities – Norms, Institutions, Inequalities
= ‘Excuses’ for ‘Bad/Irresponsible’ Individual Behavior
❖Economic, Social & Political Inequalities → Individualized Biological ‘Inequalities’
“Mental health must necessarily be conceptualized and achieved within the ontological confines of the
marketplace”
(pp. 418)
❖ ‘The Market’ as Self-Sufficient, Self-Regulating Always-Already Existing Reality → No Further Explanation Needed
❖ Competition, Gain, Self-Sufficiency Presumed as Given and as Good
“Conceptions of self, health, and normalcy that are defined on the basis of commercial appeal” (pp. 419)
That Said Actions, Attitudes, Affects Result in Problems and Pain = Individualized Problem In Need of…
Individualized Diagnosis and Treatment (or at least Ways for Coping!)
❖ Adjustment of Individuals to Market Reality
Inability or Refusal to Integrate to Said Reality = Deviant, Irrational, Pathological
Anxiety & Depression – Self-Contained Elements within Particular Individuals
Solution → ‘Patient-Centered’ Care via Pharmacological Interventions & Associated Therapies
Modification via Medicalization & Pharmecuticalization
“…Evaluating the merit of all actions according to what is deemed as valuable, acceptable, or desirable by ‘‘the market’’’
(pp. 416)
❖ Commodification of Mental Health → $$$ To Be Made
Patient as Customer, Physicians & Psychiatrists as Product/Service Providers, Corporate Profit
Relationship of Expertise & Democracy
❖At odds?
❖Ought to be?
❖On what basis?
Expertise
(Hierarchies of
Knowledge)
❖Responsibility & Responsiveness
Medicine to public or vice versa? Both/and?
Who is ultimately accountable? Either/or? Both/and?
Democracy
(Everyone gets a direct
or representative seat
at the table)
Decision Making
What Do You Think??
In a (functioning) democracy, how are decisions made?
Questions of equity, fairness, accuracy, applicability
❖Direct Democracy
Explicit public participation in areas of decision-making that affect us all
❖Representative Democracy
Delegate particular tasks and their attendant knowledges
If nothing else, one person = one voice/vote and majority rules
What if many people are barred from participating?
What if many people choose not to participate?
What if the numerical majority makes an ill-informed or questionable decision?
What if the numerical minority champions a more informed position?
What if the numerical majority holds an informed position but is barred from consideration or participation?
Some Week 7 Levity!
Grumpy Koalas Sound Like Party Horns. ☺
(We hope they got happier! )
Welcome Back! Week Eight
Who Has Medical Expertise?
Questions of Professional & Lay Knowledges Part II
For This Week (Week 8)
❖ Kristin K. Barker
“Electronic Support Groups, Patient-Consumers, and Medicalization: The Case of Contested Illness”
pp. 20-36
❖ Kristin K. Barker & Tasha R. Galardi
“Dead by 50: Lay Expertise and Breast Cancer Screening”
pp. 1351-1358
❖ Steven Epstein
“The Construction of Lay Expertise: AIDS Activism and the Forging of Credibility in the Reform of Clinical Trials”
pp. 408-437
❖ Pru Hobson-West
“‘Trusting Blindly Can Be the Biggest Risk of All’: Organized Resistance to Childhood Vaccination in the UK”
pp. 198-215
❖ Discussion Board 6 Due Friday February 25th (Last One!) ☺
For Next Week (Week 9)
❖For Tuesday – Please Watch First 1 hr. 20 minutes of Sicko
(Optional Extra Credit Available)
❖For Thursday – We Will Hold Class for First 40 minutes to Discuss Sicko and Weekly Course Materials
For Remainder of Thursday’s Class Time, Please Watch Remainder of Sicko
❖Jennifer Cohen
“COVID-19 Capitalism: The Profit Motive versus Public Health” pp. 176-178
❖Whitney N. Laster Pirtle & Tashelle Wright
“Structural Gendered Racism Revealed in Pandemic Times: Intersectional Approaches to
Understanding Race and Gender Health Inequities in COVID-19” pp. 168-179
Virtual Zoom Weekly Office Hours
Tuesdays & Thursday from 2:30-3:30 pm PST
Office Hours Links Updated Each Week under ‘Announcements’ on Canvas
Decision Making
What Do You Think??
In a (functioning) democracy, how are decisions made?
Questions of equity, fairness, accuracy, applicability
❖Direct Democracy
Explicit public participation in areas of decision-making that affect us all
❖Representative Democracy
Delegate particular tasks and their attendant knowledges
If nothing else, one person = one voice/vote and majority rules
What if many people are barred from participating?
What if many people choose not to participate?
What if the numerical majority makes an ill-informed or questionable decision?
What if the numerical minority champions a more informed position?
What if the numerical majority holds an informed position but is barred from consideration or participation?
Relationship of Expertise & Democracy
❖At odds?
❖Ought to be?
❖On what basis?
Expertise
(Hierarchies of
Knowledge)
❖Responsibility & Responsiveness
Medicine to public or vice versa? Both/and?
Who is ultimately accountable? Either/or? Both/and?
Democracy
(Everyone gets a direct
or representative seat
at the table)
Expertise
❖Professional Expertise
❖Lay (Non-Professional) Expertise
❖Embodied Expertise
Specialized knowledge derived from one’s uniquely situated physical &
psychological characteristics & practices.
Being an expert about one’s own lived experiences and conditions
Medicalization
❖The processes by which a particular physical, psychological, or emotional
condition or experience comes to be understood and treated as a medical
condition or concern.
❖When conditions or experiences are medicalized, they are understood to fall
under the purview of medical prevention, diagnosis, treatment, and/or cure.
AKA – The Authority of Medicine and Professional Medical Expertise.
❖Positive – Medicalization May Be Welcomed
Seeking to be taken seriously/validated and helped in some capacity by the formal medical system
❖Negative – Medicalization May Be Questioned, Resisted, or Rejected
New/increasing stigma due to characteristic/condition designated as “medical,” “normal/abnormal,” etc.
Kristin K. Barker
Electronic Support Groups, Patient-Consumers, and Medicalization:
The Case of Contested Illness
Fibromyalgia Syndrome Sufferers
Lay Expertise, Embodied Expertise, Professional Physician Expertise
Significance of Internet – Online Support, Knowledge, Advice
Shopping for & Negotiating with Physicians (Desire for Physician Compliance)
Simultaneously Skeptical and in Need of Biomedical Sphere
Negotiation of Medicalization
Democratizing? Empowering?
Detracting From Professional Standards and Training?
Increasing Medicalization (+) or (-)?
Kristin K. Barker & Tasha R Galardi
Dead By 50: Lay Expertise and Breast Cancer Screening
• Epidemiological Population-Level Medical Concerns
• Personal Individual-Level Concerns
• Again – Significance of Internet
Connection, Validation, Advice
• Again – Questions of Medicalization
(+) or (-)?
• Status of Evidence Based Recommendations & Practices
• Professional vs. Lay Expertise
WHICH Medical Experts?
Steven Epstein
The Construction of Lay Expertise:
AIDS Activism and the Forging of Credibility in the Reform of Clinical Trials
❖Becoming Visible, Vocal, Credible, Legitimate
❖Organic Intellectuals, Self-Taught Medical Training
❖Both Asserting and Assessing Claims
❖Linking Epistemology with Ethics
Objective Knowledge with Values
Issue of Limited Trials/Treatments
❖Importance of social identities/locations of expertactivists
Questions and Conflicts of Representation
Question of ‘Selling Out,’ Cooptation
Optional Extra Credit Documentary
United in Anger
(2012) Director: Jim Hubbard. 1.5 hrs.
Pru Hobson-West
‘Trusting Blindly can be the Biggest Risk of All’:
Organized Resistance to Childhood Vaccination in the UK
Questions of Trust
Trust as Faith (Secular Science Assumed Sacred)
Vs.
Empowerment via Skepticism
Personal Responsibility, Individual Differences
Vs.
Standardization, Social/Collective Consequences
Questions of Risk
Non-Random?
Action in face of Perceived Uncertainty
Some Week 8 Expertise Levity!
Just Meant for a Giggle No Disrespect Intended for Chiropractors and Chiropractic Patients!!
Welcome Back! Week Nine
Medical Sociology in Comparative Perspective: Health Care
Virtual Zoom Weekly Office Hours
Tuesdays & Thursday from 2:30-3:30 pm PST
Office Hours Links Updated Each Week under ‘Announcements’ on Canvas
For This Week (Week 9)
❖For Tuesday – No Class Meeting. Please Watch First 1 hr. 20 minutes of Sicko
(Optional Extra Credit Available)
❖For Thursday – We Will Hold Class for First 40 minutes to Discuss Sicko and Weekly Course Materials
For Remainder of Thursday’s Class Time, Please Watch Remainder of Sicko
❖Jennifer Cohen
“COVID-19 Capitalism: The Profit Motive versus Public Health” pp. 176-178
❖Whitney N. Laster Pirtle & Tashelle Wright
“Structural Gendered Racism Revealed in Pandemic Times: Intersectional Approaches to
Understanding Race and Gender Health Inequities in COVID-19” pp. 168-179
For Next Week (Week 10)
❖Tuesday March 8th – Midterm #2 Review
❖Midterm #2: Due Thursday March 10th by end of day (11:59 pm)
On Canvas Under ‘Assignments’
❖Reminder: Final Paper due Tuesday March 15th
Pru Hobson-West
‘Trusting Blindly can be the Biggest Risk of All’:
Organized Resistance to Childhood Vaccination in the UK
Questions of Trust
Trust as Faith (Secular Science Assumed Sacred)
Vs.
Empowerment via Skepticism
Personal Responsibility, Individual Differences
Vs.
Standardization, Social/Collective Consequences
Questions of Risk
Non-Random?
Action in face of Perceived Uncertainty
‘Unnatural Causes’
Social Conditions Real Consequences
Sicko (2007)**
❖What does the U.S. healthcare system look like and why?
❖What are the consequences of this – for better or for worse?
**Please note: Sicko was filmed and released prior to the 2010 implementation of the Affordable Care Act (ACA).
Pre and Post Affordable Care Act
Pre and Post Affordable Care Act
Pre and Post Affordable Care Act
(Nonelderly) Uninsured in U.S. in 2019
Approximately 28.9 million (out of approximately 328.2 million)
That’s approximately 11% (nonelderly) of the population
…And that’s only accounting for those who are willing/able to answer this question
Private – Federal/State Administered “Marketplace” Plans, Employer
Coverage, Directly from Insurance Company
Public – Federally and/or State-Funded
Medicare – Folks 65 and older or folks younger than 65 with disability (regardless of income)
Medicaid – Partial or fully-funded coverage for low-income folks (eligibility coverage varies by state)
Some folks are eligible for both
Check out Kaiser Family Foundation for details/more information:
Out-of-Pocket Expenses Exploding Relative to Wages
(Copays often not applied to deductibles)
Jennifer Cohen
COVID-19 Capitalism:
The Profit Motive versus Public Health
Logic of Profit Accumulation & Logics of Achieving and Maintaining Public Health – Contradictory?
❖ Questions of Responsibility
Individual Responsibility and Choices → Health Outcomes
State/Government Responsibility and Choices → Health Outcomes
Intervening Factor Between ‘Choices’ and Outcomes = Markets
❖ Questions of “Choices” Made Within Particular Contexts and Under Particular Conditions
Individual Choices Do Not Occur in Vacuum
What Options Are Available? Accessible? Affordable? Feasible?
e.g., Individuals Cannot ‘Demand’ Commodities They Cannot Afford or Otherwise Access
❖ Questions of Resources
Allocation/Distribution
Cohen cont.
❖Crisis Conditions (e.g., COVID-19)
Competition and Cooperation May Be Diametrically Opposed Rationales
Price Gouging, Hoarding = Economically Rational;*** Detrimental to Public Health
‘A Few Bad Apples’ Ignores Structural Contradictions (“Built-In” Oppositions of Goals)
❖‘Sound’ Business Practices In Context of Immense Suffering and Death
Profiting From Human Tragedy
Not Simply an Economic Question. These are Social, Political, and Ethical Questions
One Person’s Ability to ‘Act Rationally’ Translates To Another’s Inability to Act Responsibly
Inability to Act in Their Own and Other People’s Best Interest
i.e., not getting sick, getting others sick, overworking healthcare systems
*** Assuming Particular Economic Systems
Cohen cont.
“If health is a public good (nonexcludable), as it
arguably is, the ways markets misallocate provide a
rationale for state responsibility.
The state does not beat out the individual for
ethical grounds to take responsibility for health, it
beats the market”
Questions of Biopower
Which Bodies Matter?
Who Lives? Who Dies?
Concepts, Values, Practices of “Expendability”?
Some Week 9 Levity!
https://www.youtube.com/watch?v=2dSNEzXJfxw
ESSAYS & COMMENT
De LACrace Volcano, Jack Unveiled, 1994
18
THE SCIENCES •
JJllyIAJI.~Jlst 2000
THE FIVE SEXES, REVISITED
The emerging recognition that people come in bewildering
sexual varieties is testing medical values and social norms
BY ANNE FAUSTO-STERLING
A
ous genitalia. And that discussion, in turn, is the tip of a
ofthe packed meeting room in the Sherbiocultural iceberg-the gender iceberg-that continues
aton Boston Hotel, nervous coughs made
to rock both medicine and our culture at large.
the tension audible. Chase, an activist for
Chase made her first national appearance in 1993, in these
intersexual rights, had been invited to address the May 2000
very pages, announcing the formation of ISNA in a letter
responding to an essay I had written for The Sciences, titled
meeting of the Lawson Wilkins Pediatric Endocrine Society (LWPES), the largest organization in the United States
“The Five Sexes” [MarchiApril 1993]. In that article I argued
for specialists in children’s hormones. Her talk would be
that the two-sex system embedded in our society is not adethe grand finale to a four-hour symposium on the treatquate to encompass the full spectrum ofhuman sexuality. In
its place, I suggested a five-sex
ment of genital ambiguity in
system. In addition to males
newborns, infants born with
MUCH HAS CHANGED SINCE 1993. and females, I included
a mixture of both male and
“herms” (named after true
female anatomy, or genitals
Intersexuals have materialized
hermaphrodites, people born
that appear to differ from
.before our very eyes.
with both a testis and an
their chromosomal sex. The
ovary); “rnerms” (male pseutopic was hardly a novel one
dohermaphrodites, who are
to the assembled physicians.
born with testes and some aspect of female genitalia); and
Yet Chase’s appearance before the group was remarkable.
Three and a half years earlier, the American Academy of
“ferms” (female pseudohermaphrodites, who have ovaries
combined with some aspect of male genitalia).
Pediatrics had refused her request for a chance to present the
I had intended to be provocative, but I had also written
patients’ viewpoint on the treatment of genital ambiguity,
dismissing Chase and her supporters as “zealots.” About two
with tongue firmly in cheek. So I was surprised by the extent
dozen intersex people had responded by throwing up a pickofthe controversy the article unleashed. Right-wing Chriset line. The Intersex Society ofNorth America (ISNA) even
tians were outraged, and connected my idea of five sexes
issued a press release: “Hermaphrodites Target Kiddie Docs.”
with the United Nations-sponsored Fourth World Conference on Women, held in Beijing in September 1995.
It had done my 1960s street-activist heart good. In the
short run, I said to Chase at the time, the picketing would
At the same time, the article delighted others who felt conmake people angry. But eventually, I assured her, the doors
strained by the current sex and gender system.
Clearly, I had struck a nerve. The fact that so many peothen closed would open. Now, as Chase began to address
ple could get riled up by my proposal to revamp our sex and
the physicians at their own convention, that prediction was
coming true. Her talk, titled “Sexual Ambiguity: The
gender system suggested that change-as well as resistance
Patient-Centered Approach,” was a measured critique of
to it-might be in the offing. Indeed, a lot has changed since
the near-universal practice ofperforming immediate, “cor1993, and I like to think that my article was an important
rective” surgery on thousands ofinfants born each year with
stimulus. As if from nowhere, intersexuals are materializing
before our very eyes. Like Chase, many have become politambiguous genitalia. Chase herself lives with the conseical organizers, who lobby physiciansand politicians to change
quences of such surgery. Yet her audience, the very
current treatment practices. But more generally, though perendocrinologists and surgeons Chase was accusing ofreacthaps no less provocatively, the boundaries separating masing with “surgery and shame,” received her with respect.
culine and feminine seem harder than ever to define.
Even more remarkably, many ofthe speakers who preceded
her at the session had already spoken of the need to scrap
Some find the changes under way deeply disturbing. Othcurrent practices in favor of treatments more centered on
ers find them liberating.
psychological counseling.
What led to such a dramatic reversal of fortune? CerHO IS AN INTERSEXUAL-AND HOW MANY
tainly, Chase’s talk at the LWPES symposium was a vindiintersexuals are there? The concept of
intersexuality is rooted in the very ideas
cation of her persistence in seeking attention for her cause.
of male and female. In the idealized, Platonic, biological
But her invitation to speak was also a watershed in the evolvworld, human beings are divided into two kinds: a perfecting discussion about how to treat children with ambiguS CHERYL CHASE STEPPED TO THE FRONT
W
jllly/Allgllst 2000 • THE SCIENCES
19
ly dimorphic species. Males have an X and a Y chromosome, testes, a penis and allofthe appropriate internal plumbing for delivering urine and semen to the outside world. They
also have well-known secondary sexual characteristics,
including a muscular build and facial hair. Women have two
X chromosomes, ovaries, allofthe internal plumbing to transport urine and ova to the outside world, a system to support
pregnancy and fetal development, as well as a variety ofrecognizable secondary sexual characteristics.
That idealized story papers over many obvious caveats:
some women have facial hair, some men have none; some
women speak with deep voices, some men veritably
squeak. Less well known is the fact that, on close inspection, absolute dimorphism disintegrates even at the level of
basic biology. Chromosomes, hormones, the internal sex
structures, the gonads and the external genitalia all vary more
than most people realize. Those born outside of the Platonic dimorphic mold are called intersexuals.
In “The Five Sexes” I reported an estimate by a psychologist expert in the treatment ofintersexuals, suggesting
that some 4 percent of all live births are intersexual. Then,
together with a group of Brown University undergraduates, I set out to conduct the first systematic assessment of
the available data on intersexual birthrates. We scoured the
medical literature for estimates of the frequency of various
categories of intersexuality, from additional chromosomes
to mixed gonads, hormones and genitalia. For ‘Some conditions we could find only anecdotal evidence; for most,
however, numbers exist. On the basis of that evidence, we
calculated that for every 1,000 children born, seventeen are
intersexual in some form. That number-1. 7 percent-is a
ballpark estimate, not a precise count, though we believe it
is more accurate than the 4 percent I reported.
Our figure represents all chromosomal, anatomical and
hormonal exceptions to the dimorphic ideal; the number
ofintersexuals who might, potentially, be subject to surgery
as infants is smaller-probably between one in 1,000 and
one in 2,000 live births. Furthermore, because some populations possess the relevant genes at high frequency, the
intersexual birthrate is not uniform throughout the world.
Consider, for instance, the gene for congenital adrenal
hyperplasia (CAH). When the CAH gene is inherited from
both parents, it leads to a baby with masculinized external
genitalia who possesses two X chromosomes and the internal reproductive organs ofa potentially fertile woman. The
frequency of the gene varies widely around the world: in
New Zealand it occurs in only forty-three children per million; among the Yupik Eskimo ofsouthwestern Alaska, its
frequency is 3,500 per million.
I
N T ER SEX UALIT Y HAS ALWAYS BEEN TO SOME
extent a matter of definition. And in the past
century physicians have been the ones who
defined children as intersexual-and provided the remedies. When only the chromosomes are unusual, but the
external genitalia and gonads clearly indicate either a male
or a female, physicians do not advocate intervention.
Indeed, it is not clear what kind of intervention could be
advocated in such cases. But the story is quite different
when infants are born with mixed genitalia, or with ex20
THE SCIENCES’ }lIly/AlIglI.