Category / ethics

by crmayes

IVF and the Birth of Bioethics in Australia

In the four decades since the birth of the ‘test-tube’ baby, the field of bioethics has been at the forefront of trying to understand what advancing biotechnologies mean for society, writes Alfred Deakin Institute researcher, Dr Christopher Mayes.

July 25, 2018 marked 40 years since the first baby was born via in vitro fertilisation (IVF), signalling a radical shift in human reproduction. The birth of Louise Brown in Oldham General Hospital, England in 1978 realised the technological capacity to fertilize a human egg outside of the body, opening new possibilities as well as provoking anxieties.

While the medical research team in England achieved the world-first live IVF birth, a team of researchers from Royal Women’s Hospital, Monash University and Queen Victoria Hospital in Melbourne were in close competition. Under the direction of Carl Wood and Alan Trounson, these Melbourne-based researchers achieved the world’s first IVF pregnancy in 1973 and the birth of the third IVF baby in 1980.

Since these dramatic early developments, IVF has become a relatively routine procedure. But it wasn’t just babies being born through the development of IVF; the technology also birthed a new field that became known as ‘bioethics’.

1980s and the emergence of bioethics

IVF created the possibility of fertilising an egg with sperm outside the human body. This procedure addressed a range of infertility problems, such as blocked or damaged fallopian tubes and low sperm count or motility.

It also presented a dizzying array of new possibilities, including: creating embryos from donated sperm, ova, or both; screening embryos for genetic diseases or desired traits prior to implantation; surrogacy arrangements; experimentation on embryonic life; ectogenesis (growth of a baby in an artificial womb); freezing eggs or sperm for future use; and cloning.

The potential for IVF to radically alter reproduction as well as family formation provoked an explosion of conferences, seminars, committees and institutions that sought to address resulting ethical and legal questions.

In 1980, Monash University established the Monash Centre for Human Bioethics with Peter Singer as its founding director. Shortly after, in 1981, the Catholic Archdiocese in Brisbane created the Queensland Bioethics Centre under the directorship of Sr Regis Mary Dunne. These centres sought to educate the public and influence policy debates on the ethical and social implications of developments in biomedicine.

The legal field was also responding to the new developments. In 1982, the Attorney General of Victoria appointed Professor Louis Waller to chair a committee exploring the implications of reproductive technologies in terms of the law as well as legal ethics. This led to the Victorian parliament passing the Infertility (medical procedures) Act 1984, a world-first legislation addressing IVF.

Other states soon followed but the federal government wanted a uniform approach and, in 1985, the Family Law Council released a report titled Creating Children: A Uniform Approach to the Law and Practice of Reproductive Technology in Australia, which detailed a national approach to reproductive biotechnologies.

In 1988, the federal government established the National Bioethics Consultative Committee (NBCC) to address, among other things, surrogacy, information in relation to donated eggs and sperm, and genetic counselling. Coinciding with the release of an NBCC report advising legislation to permit surrogacy, state and federal health ministers disbanded the body. Yet some NBCC members were included on the newly-formed Australian Health Ethics Committee (1991).

During the 1980s, these committees and institutions contributed to the creation of policies and legislation designed to regulate IVF use, and the directions and limits of scientific research – especially in relation to embryos. These debates also contributed to the birth of bioethics in Australia.

Conflicts and disputes

Not everyone was happy with the way bioethics was emerging. A young Kevin Andrews, for example, used his maiden speech in federal parliament to lament that “some of the same personnel from the widely-discredited National Bioethics Consultative Committee” were included on the Australian Health Ethics Committee. And it was not just Andrews who had concerns about the new field of bioethics.

Doctors and scientists were wary of external meddling in their practice and research while Catholic theologians and ethicists were troubled by the devaluing of embryonic life, which they considered sacred. Feminists were suspicious of male-dominated committees deciding what could or could not be done to women’s bodies and the technological control of reproduction, and secular bioethicists were concerned by the real or apparent influence of the Church. Politicians, meanwhile, were worried that committees they had created were now undermining their role in creating legislation.

These concerns over bioethics and the direction of biomedical research were intimately tied to fears and hopes about future society. Were we heading towards a utopia or dystopia?

Unforeseen or ignored developments?

Although its physical and psychological burdens are not widely discussed, IVF has become standard procedure. In 2014, 12,875 babies were born via IVF in Australia. While the procedure is relatively common and largely accepted as an ethically acceptable form of reproduction, questions from the earliest debates remain.

Catholic and radical feminist commentators were the most vocal critics of the new reproductive technologies. At times these seemingly divergent perspectives overlapped, particularly in regard to concerns relating to technological and corporate control of reproduction.

Catholic leaders were primarily concerned with the moral status of embryos, whether IVF contravened “laws of nature” and the separation of the sexual act from reproduction. These concerns did not gain much traction among policymakers or laity – polls in the early 1980s revealed 67% of Catholics surveyed approved of the practice and that a proportionate number of Catholics were on waiting lists to access IVF.

The feminist critique of reproductive medicine drew attention to areas largely ignored by the majority of ethicists, scientists and politicians. Robyn Rowland and Renate Klein from Deakin University were leading voices in calling attention to the influence of commercial values on the motives and ethics of clinicians. In the early-1980s, Robyn Rowland argued that IVF physicians look “less altruistic as their efforts to generate profits intensify” and queried the secrecy over a new commercial enterprise developed by the early Melbourne-based researchers and Monash University.

Rowland argued that “a collaboration between research and commercial interests uses women in essentially experimental programs and asks the participants and the public to underwrite the expense so that the researchers can enter into commercial contracts for profit.”

In 2014, Monash IVF floated on the stock market for over $300 million dollars. In writing a history of IVF in Australia, John Leeton, who was part of Carl Wood’s team at Monash IVF, characterized Rowland’s criticisms as “extreme and misguided”. Yet in light of the enormous profits enjoyed by fertility clinics, as well as the distorting effect of commercial interests, Rowland’s critique remains relevant today.

The listing of companies such as Monash IVF and Virtus IVF on the stock exchange not only means that they operate at a profit for shareholders, but also have an obligation to continually seek profits and new markets.

In recent years, social egg freezing (SEF) has been regarded by commercial IVF companies as opening up new lucrative markets. While IVF primarily focuses on women and couples with infertility problems, SEF is the practice of freezing unfertilized eggs so women may use them when they have found the right partner or achieved certain career or educational goals. The practice is marketed as an “insurance policy” that allows women to put off concerns about their “biological clock”.

There is an ongoing debate about the efficacy and ethics of this practice. But one thing that’s clear is all women between puberty and menopause are now seen as potential customers. There is limited data available about who is using these services and when. Fertility clinics suggest that it is ideal for women to freeze their eggs in their 20s and early-30s. However, data from the UK Government’s independent regulator reveals that 68% of women using SEF are over 35.

The expansion of fertility clinics into SEF raises questions about the changing reality of biomedical practice – is it simply a commercial relationship where the logics of “buyer beware” operate? Or is a medical relationship where professionals have an ethical obligation to their patients?

Neither utopia nor dystopia

The commercial dimension of biomedicine rarely featured in the bioethical debates of the 1980s. But biotechnology is now a lucrative industry that’s attractive for investors.

Commercial influences on the development of IVF – and its expansion into questionable markets – should not diminish the amazing achievements 40 years ago. We have not entered the dystopia that many feared; but nor have we reached utopia.

It’s this space in-between that bioethicists continue to work in, questioning developments of biomedicine and new technologies, such as CRISPR, commercial surrogacy, personalised medicine and artificial intelligence.

 

[This was first published 7 August 2018 in Deakin University “Research News“, with editorial assistance from Reema Rattan]

by crmayes

Public health communication & the blurry line from anti-obesity to pro-ana

Public health communication is not easy. Various industries, special interest groups and lobbyists are only too willing to skew messages about health. As such, public health researchers and advocates tend to be sensitive to the different ways a health message can be appropriated.

However, public health advocates, particularly in the area of nutrition, are inconsistent in their concern that people will misuse health-related messages. If a piece of research suggests that something traditionally thought to be “sinful” – alcohol, chocolate, or fat – is not as bad as first thought, then anxious caveats will urge restraint. Yet, if a piece of research over-sells the benefits of something traditionally thought to be “saintly” – exercise or dieting – then there is silence.

Two examples illustrate the first response.

Example 1 – Health benefits of alcohol

Every so often a mainstream media source will pick up on some research that suggests that alcohol – usually red wine – can have some health benefits. Without fail a public health spokesperson or researcher will be very quick to either discredit the research or explain to the public that the research does not provide a license for unrestrained consumption.

For instance, public health nutritionist, Marion Nestle, laments in her book Food Politics that clear guidance is complicated by ‘the inconvenient finding that moderate drinking provides health benefits – alcohol protects against coronary heart disease.’ Whether this research still holds is beside the point, Nestle’s lament that alcohol could have health-benefits reflects a distrust of the public’s ability to negotiate complex or uncertain nutrition messages.

Researchers like Nestle in the US and Mike Daube in Australia are at pains to ensure the public does not misuse or misinterpret claims about the health-benefits of alcohol.

Example 2 – Relationship between weight and health is not as clear as first thought

In 2013, the Journal of the American Medical Association published an epidemiological study from Katherine Flegal and colleagues that found people who are obese grade 1 (BMI of 30-<35) had no increased risk of dying prematurely and overweight (BMI of 25-30) people may actually have greater life expectancy.

Stacy Carter and Helen Walls documented the fall-out of this res2014-12-01 16.22.32-1earch among public health researchers.

Walter Willett of Harvard School of Public Health was indignant. He described the research on NPR as ‘really a pile of rubbish’ and that ‘no one should waste their time reading it’. A UK National Obesity Forum representative told the BBC, ‘It’s a horrific message to put out at this particular time. We shouldn’t take it for granted that we can cancel the gym, that we can eat ourselves to death with black forest gateaux’.

Like the responses to research suggesting the health-benefits of alcohol, these responses to Flegal et al’s research highlight a deep anxiety that the public will misuse public health messages in a manner that undermines their health.

Anti-obesity or Pro-ana? So long as we’re skinny…right?

Despite knee-jerk concern that alcohol or weight-related research will be misused by publics, there is very little (if any) concern that anti-obesity campaigns will lead people to eat too little, exercise too much or that such messages will reinforce and legitimise disordered eating practices such as anorexia or bulimia.

Almost every time I lecture on critical obesity discourses someone will question why there is such a overwhelming focus on obesity and little focus on anorexia or bulimia. Someone will also point out that a lot of the anti-obesity messages can be construed to reinforce idealised expectations about body image.

Compare the use of computer-generated imagery in these two public service announcements (PSAs).

  1. Measure Up – anti obesity

https://www.youtube.com/watch?v=9dL4lN6GKi4&w=560&h=315

2. The Mirror – anorexia

The parameters for the non-pathologised and non-medicalised body is very narrow, especially for young women. In addition to people questioning the differing responses to obesity and anorexia or bulimia, I have had two students tell me that they used weight-focused public health messages to mask damaging practices such as under-eating and over-exercising.

Last year, Dr Richard Newton from the Butterfly Foundation noted that an increase of children and young people with disordered eating and dieting behaviours coincides with ‘a society that is putting an increasing emphasis on avoiding obesity, controlling weight and shape through dieting’.

Psychiatrist Dr Peter O’Keefe also said that anti-obesity messages contribute to the ideal that ‘if you’re thin you’re good, if you’re not, you’re bad’.

These are serious concerns with real consequences for the lives of young people. Yet the zeal for preventing obesity and perceived urgency of the problem, gives public health advocates little time or reason to pause and consider the ways anti-obesity messages can be interpreted.

Sadly, if a piece of research suggests that it’s ok to eat a piece of cake, warnings and caveats are screamed from the rooftops. But if the research says exercise more, eat less, and lose weight, then there is only nodding agreement. After all, why give an inch when we are at war with our bodies – mine and yours.

by crmayes

‘You Are What You Eat’: The Place of Food in Caring for the Self and Others

This article first appeared on the ABC Religion & Ethics website, 12 Oct 2016

In 1825 the French gastronome Jean Anthelme Brillat-Savarin declared, “Tell me what you eat and I will tell you what you are.” By this he seemed to mean that he could tell something about a person’s character and class by what they eat.

Forty years later, Ludwig Feuerbach echoed Brillat-Savarin with the pithier, “You are what you eat.” Feuerbach’s intent however was to highlight the materiality of what it is to be a human being – you are material like what you eat is material.

His phrase has since developed a life of its own. A quick Google search reveals multiple documentaries, hundreds of books and thousands of articles and blogs taking “You are what you eat” for their title. Most of these are very prescriptive. You are fat, unhealthy, diseased or unhappy because you eat too much of one thing and not enough of the other.

While varying in rigour and sophistication, proponents of the “you are what you eat” mantra express the sentiment that there is a connection between the food we eat and some ill-defined moral, aesthetic and psychosocial reality.

This sentiment, however, did not originate in the nineteenth century with Brillat-Savarin or Feuerbach. They are part of a much longer tradition that extends back to the food practices of almost all ancient peoples.

Broadly speaking, in the ancient world food was deeply entwined with social, political and religious life. Often this was expressed terms of purity and impurity, which in turn would indicate who was inside and outside of the community. A well known, although immensely complex, example is the Mosaic dietary laws as recorded in Leviticus and Deuteronomy. The dietary laws ordered the daily, political and ceremonial life of the ancient Hebrews and set them apart from surrounding peoples. What you could eat, whom you could eat with and how the food was prepared were governed by these rules.

It was in the context of the tightening of these laws that Jesus sought to break the link between diet and religious-moral status – “it is not what goes into the mouth that defiles a person, but what comes out of the mouth; this defiles a person” (Matthew 15:11). A lot of ink has been spilt over these words. Generally speaking, Jesus’s point is that assiduous observance of the Mosaic dietary law does not create a pure and holy person. It is not what a person eats, but the orientation of their heart and its alignment with the will of God that makes them clean.

The ancient Greeks were also concerned about the relationship between food and status within the polis. This was not in the binary of pure or impure as practiced by the ancient Hebrews, but was seen in terms of prudence or temperance. As Hub Zwart has shown, Greek dietetics was a way of life through which an individual would subject themselves to a regimen of self-discipline and self-governance to develop an eating habit that is rationally ordered. Food diaries and other self-inspection devices were used for these purposes.

To stray from a dietetic regimen would not necessarily indicate that one was unclean, but that like an animal they could not control their appetite. And if they couldn’t govern their appetite, then they probably couldn’t govern more significant things such as the household or the city.

Greek approaches to food and sex were similar in this regard. The example of Nicocles the ruler of Cyprus illustrates this point. According to Isocrates, Nicocles explains his conjugal fidelity in saying, “I am the king, and because as somebody who commands others, who rules others, I have to show that I am able to rule myself.” Nicocles could have sex with whomever he wished, but if he wished to rule others and the city with glory and authority then he had to rule himself first. The Greek free man was at liberty to seek culinary and sexual pleasures, however if he sought to cultivate an existence characterized by self-mastery and beauty, then he recognized the particular rules of conduct that were constitutive of that subjectivity.

In more recent times, these ways of thinking about the relationship between food and moral character has been transformed. Nutrition science has narrowed the frame so that the effect of food is limited to physiological health. The social, moral and religious understandings of food give way to understandings provided by chemistry and microbiology.

A shift in ethical theory also contributed to the transformation in understanding of the ethical relevance of food. Rather than cultivating an ethical character through certain practices, the concern is over the consequence of choices, duty to others and the capacity to act as an autonomous individual.

These transformations of food play out in debates about the ethics of consumption and the right to know what is in our food. Much of the focus on ethical consumption is on duties or the consequences of certain choices for others. While I have been sceptical about the extent to which ethical consumption can solve global problems such as slavery or climate change, I do think the retrieval of ancient practices of care of the self is an important way for developing an ethical relationship to food.

Some of these resources for this retrieval can be found in Michel Foucault’s work on the “care of the self.”

In his final years, Foucault directed his attention toward Greco-Roman ethics and the constitution of the ethical subject around the use of pleasure. In the books The Use of Pleasure and The Care of the Self, as well as numerous lectures, seminars and interviews, Foucault investigates the constitution of the subject through specific techniques, practices and knowledges of the self.

Ethics in this context does not indicate principle-based normative action that, if followed, is considered morally praiseworthy. Rather Foucault refers to ethics as a practice that forms the subject, guides action and mediates the subject’s relation to oneself, others and the world.

In his analysis of the constitution of the subject through an ethics understood as practice, Foucault isolates four aspects in the process of subjectification: the ethical substance, the mode of subjection, the ascetic work, and the telos of the ethical subject. The relationship among the four aspects is not linear but dynamic and interconnected.

Using the Greeks as an example, Foucault suggests that the “ethical substance” was pleasure, the “mode of subjectification” was politico-aesthetic choice, the ascetic form or ethical work was a variety of the techniques used to govern particular relations around pleasure and, finally, the telos or goal was the mastery of oneself. While the content of these aspects (for instance, concern over pleasure) may no longer be relevant, this orientation towards ethical cultivation and care of the self may still be relevant.

The philosopher Paul Thompson uses Foucault’s approach to argue for a revitalisation of agrarian virtue in relation food practices. In his book The Agrarian Vision, Thompson embraces the idea of agrarian virtue not as an ethics learned from books or philosophy classes, but as an ethics that is lived and demonstrated in the character of the person. “Farming itself,” writes Thompson, “was thought to form the character of rural people.”

For example, in cultivating the land individuals develop an awareness of the limits and conditions of life, which in turn encourages a humble and patient character. By encountering the fragile temporality of life, a person views food, health, prosperity and land not as calculable commodities but as gifts. It is argued that by humbly and respectfully relating to the land as a gift, agrarian virtues of self-reliance, interdependence, sustainability and community are cultivated.

Of course, it could be argued that this is all very nice, but as less than 2% of the Australian population actually farms these ideas are quite irrelevant. Thompson argues that even if the social and material conditions of agrarianism are not currently present to produce virtue, people “can come to understanding of virtue when such a society is taken as a model.” Thompson suggests that these virtues can be cultivated in a “vicarious manner.” Although the actual social and material conditions of agrarian life would make it easier to cultivate agrarian virtues, Thompson suggests that surrogates such as poetry, literature, farm experiences and farmers’ markets make it possible to cultivate virtues.

Thompson’s cultivation of agrarian virtue is just one example of an attempt to renew thinking about the relation between food and the self. There are many others. However, these approaches are not without their problems.

For starters they can be terribly bourgeois. As the historian Thomas Govan wrote in the 1960s, it is the teachers, writers, philosophers and poets who propagate this nostalgic notion of virtuous food practices – those “who milked no cows, shovelled no manure, and picked no cotton or peas.” Writing in the same period, Richard Hofstadter suggested that the “more commercial society became … the more reason it found to cling in imagination to the noncommercial agrarian values.”

The mid-twentieth century nostalgia for non-commercial values has reappeared in the food practices of urban-dwellers in first decades of the twenty-first century. Farmers’ markets, homesteading, community-supported agriculture, slow-food, or dumpster diving are all old yet new food practice that some people are adopting.

Echoing Govan and Hofstadter, critics today have pointed out the way an overwhelming sense of these virtues has blinded some advocates to past and present gendered, class and race inequalities. I have discussed aspects these at greater length elsewhere.

However, a related problem is when the benefits of intentional food practices are overstated. Growing tomatoes on your windowsill may be a useful practice for cultivating a particular attitude towards food and the environment, but it is not going to stop climate change or revolutionise the food system. These limitations, however, should not mean that we simply disregard any value in thinking and acting differently in the way we acquire, prepare and consume food.

It isn’t surprising that the critiques of romantic nostalgia and bourgeois individualism aimed at alternative food are also levelled at Foucault’s idea on care of the self. Lois McNay, for examples, contends that Foucault’s care of the self focuses too heavily on the individual and “amounts to an amoral project for privileged minorities.”

These are important criticisms that cannot be fully dealt with here, except to emphasise that the care and cultivation of the self is not performed in self-imposed isolation or exile. It is in the context of relations with others – an ethics of the self in community.

Likewise, food practices are not performed in isolation, but are social practices that structure ways of relating with others. Food is a central site for relating to oneself and others in material, social and moral registers. The etymology of companion as “bread fellow” or “to break bread with” illustrates the shared ethical practice of food.

There are many examples of the way food is being used to transform individuals and communities, particularly as a means to reconcile differences and dispel fears of the other. For example, an Israeli hummus restaurant is offering a 50% discount to tables seating both Arab and Jewish diners. The Welcome Dinner Project is using a shared meal to connect newly arrived people with more established Australians. The rising interest in Aboriginal foods presents an opportunity for deeper understanding of Aboriginal foodways, which has often been denigrated and dismissed as “primitive.”

The transformative potential of these practices also carries the risk of co-option, either through commercial exploitation or the shallow sentiment of chasing culinary exotica. These practices can also be crushed under the weight of unrealistic expectations. Getting people to share a meal is not going to solve the conflict in Israel and Palestine, eradicate xenophobia, or redress the dispossession of Indigenous Australians. But such practices of the self with others can serve to transform the lives of those sitting at the table.

“You are what you eat” has become hackneyed and calcified with moralistic health messages. Perhaps instead we should start thinking and acting on the idea that “as we eat with others, we become who we are.”

by crmayes

Whose home is this? Hiding violence in the background

Last Saturday I helped setup some of the artwork for the Creative Conversations exhibition (click the link for details).* The exhibition has a number of diverse works exploring themes relating to asylum-seekers, climate change, migration and borders. I was particularly struck by a work using the medium of wallpaper – Whose home is this? by Lauren Fraser

IMG_0193-0From a distance the wallpaper looks like a series of imprecise rectangular clusters separated by irregular terracotta coloured strips. As I got closer, however, the imprecise clusters became tiny faces and bodies held tightly together by a labyrinth of fences and walls. The wallpaper sits behind, yet is framed by, domestic items of a lamp, couch and cushions.

Reflecting on themes of asylum and the temporality of life, Fraser says that this ‘settled setting juxtaposes with the restless, relentless backdrop’ of human faces in holding cells. This is pertinent in Australia where we are told that our borders, our way of life and our homely comforts must be protected.

Yet, in the background of these domestic comforts are the faces of those whose lives’ are disposable victims of crimes committed by unidentifiable perpetrators, or at least perpetrators are unwilling to accept they are complicit.

Fraser’s work reminded me of Ursula Le Guin’s short-story – The Ones Who Walk Away from Omelas. Le Guin describes an idyllic town, Omelas, where there is peace and the citizens experience unbelievable happiness. Yet, the peaceful and harmonious existence of the citizens of Omelas comes at a cost. Not to them, but to a child kept in a dark cellar under the town.

The child is unloved, naked and unfed. A kind word can never be spoken to the child. That is the bargain that makes Omelas such a pleasant town for the citizens.IMG_0194-0

As Le Guin notes, while some of the adolescents are uncomfortable with the arrangement,

they all understand that their happiness, the beauty of their city, the tenderness of their friendships, the health of their children, the wisdom of their scholars, the skill of their makers, even the abundance of their harvest and the kindly weathers of their skies, depend wholly on this child’s abominable misery.

Like the child under Omelas, a mass of human beings live miserable lives while we experience peace and stability and the occasional #firstworldproblem. This is the bargain of the sweat-shop, the bargain of fossil fuel exports, the bargain of de-radicalization laws targeting racial and religious minorities, and the bargain of free trade policies that are freer for some and than for others. This is the violence hidden in the background that makes our normal life run smoothly and peacefully.

It is significant that this work is hung on the wall of Newtown Mission, a 150+ year old Methodist Church. This location heightens the moral, political and historical tension of the work.

The Church in Australia has been a beneficiary of colonial violence that dispossessed Indigenous peoples of their lands and their culture. It has enabled that violence to be hidden in the background as an unfortunate part of a wider moral project of “civilizing” and “Christianizing”.

Yet unlike the utilitarian calculus of pleasure for many and pain for some that determines the bargain set by the citizens of Omelas, aspects of the Church have sought a counter-history that identifies with those who Jesus called the “least of these“. That is, those who the powers of the day discard as disposable waste, yet are described by Jesus as possessing a value that is more than the wealth of the world can afford.

Or in a more secular register, these are people who cannot be reduced to a footnote on a policy document. As the philosopher Michel Foucault says, suffering must never be ‘the silent residue of policy. It grounds an absolute right to stand up and speak to those who hold power.’

Those of us in Omelas, Australia, or wherever must reconsider our own material interests of domestic peace in the foreground and become aware not only of the wallpaper in the background, but the floor boards that hide the stolen land under our feet.

Sitting on the couch next to Fraser’s work is discomforting and unsettling. As it should be.

*The exhibition is being held at Newtown Mission (king St, opposite the Dendy Theatre) from 1 – 8th November.

by crmayes

Consumer Ethnocentrism: Part 1 Country of Origin Food Labels

In 1989 my uncle returned from a trip to the US with a pair of basketball shoes that were not yet available in Australia. Having seen them on the feet of American basketball stars, my friends and I coveted these shoes, and I was the first to own a pair. Taking them out of their box, I noticed the label at the back of the tongue: Made in Indonesia. I was disappointed. These shoes were not from the land of Magic Johnson or Michael Jordan but from an island I knew little about, 3000

kilometers to the north of Australia. Rather than the genuine product and official brand of champions, I was in possession of a cheap imitation. My sense of disappointment was not alleviated when an older boy assured me that the shoes were in fact fake.

The revelation that my basketball shoes were not made in America was my first conscious encounter with globalised manufacturing and trade. The now commonplace statement, ‘Made in Indonesia’, took some of the sheen off the brand, which was so carefully manufactured in marketing and design offices far removed (geographically, economically and culturally) from the factories in which the shoes were manufactured.

Buying like “us”

While I would like to say that the disappointment I felt in learning that the shoes were made in Indonesia was due to concern for the conditions of the workers, this would be disingenuous and perhaps a bit much to expect of a 9 year-old. My disappointment was due to the otherness of Indonesia. These shoes were not made by people like “us” – me, my friends, Magic Johnson or Michael Jordan. They were made by “them” – people I knew little of, except that they weren’t in the NBA, didn’t play basketball, didn’t appear in the multi-million dollar commercials, and according to a friend’s father, were waiting for an opportune time to invade Australia. These feelings of parochialism, or perhaps more accurately racism and xenophobia, were an early expression “consumer ethnocentrism”.

Ethnocentrism is the attitude that distinguishes between an “in-group” and “out-group”. Terence Shimp and Subhash Sharma developed the concept of consumer ethnocentrism to ‘represent the beliefs held by American consumers about the appropriateness, indeed morality, of purchasing foreign made products’ [1: 180]. According Shimp and Sharma’s study on the psychology of ethnocentric consumers ‘purchasing imported products is wrong because, in their minds, it hurts the domestic economy, causes loss of jobs, and is plainly unpatriotic’ [1]. While Shimp and Sharma focused on the 1980s American automobile industry, I suggest that consumer ethnocentrism is increasing in the food industry through current debates over country-of-origin labelling and local sourcing movements.

Global Food and Ethnocentric Consumption

The global food system has led to an increase in ignorance and confusion about where food comes from and the conditions under which it is produced. This ignorance is manifest in at least two forms. First, a general ignorance about the way food is produced and where it comes from, i.e. what season does asparagus

grow or what part of a pig does bacon come from? And second, where geographically does the asparagus I purchased in the supermarket come from or a more complex question, where was my microwave dinner produced, and were the ingredients all from the same location? Unlike my basketball shoes, the country-of-origin labelling on food products is not as clear. And some food products may use ingredients, manufacturing processes and labor from a variety of countries.

Since the early twentieth century, the Commerce (Trade Descriptions) Act 1905 and Commerce (Imports) Regulations 1940 has enforced country-of-origin labelling for clothing imported into Australia [2], with similar legislation in place in the US (Tariff Act of 1930). However, these laws do not address the importation of food products. Over the past decade, country-of-origin labelling for food products has become a significant issue for consumer’s, workers’ unions and food companies in the US [3, 4], Australia [5-7], and the European Union [8, 9].

Country-of-Origin Labelling and Food Safety

There are a number of reasons why consumer groups and sectors of the food industry want country-of-origin labelling regulations for food products. A common reason is food safety. With the interconnection of the global food system, governments and consumers are concerned by food poisoning outbreaks, such as bovine spongiform encephalopathy (BSE) or “mad-cow disease”, and possibility by the threat of cross-contamination [10]. The recent outbreak of Hepatitis A in Australia associated with Nanna’s Mixed Berries from Chinese factories has re-invigorated the country-of-origin labelling debate.

A second argument for the introduction of country-of-origin labelling is to protect domestic markets. For example, canned food company, SPC Ardmona, made 150 redundancies and closed a production factory in Australia. According to the Australian Manufacturing Workers’ Union this is partly due to a lack of adequate labelling laws that allow major supermarkets in Australia to stock cheap imported foods without being required to inform the consumer [7]. Furthermore, while the label may state “Made in Australia” this is allowed ‘even if only a few of the ingredients are grown in Australia’ [5]. As a result, companies that use local workers and ingredients are squeezed out of the market by cheaper imported goods.

Food safety and the protection of domestic markets are significant issues, yet they can also become enmeshed with more explicit manifestations of consumer ethnocentrism. With products and brands representing “us” or “them”. In Part Two, I discuss the example of “in-group” ethnocentric consumption in relation to Dick Smith’s response to Kraft Foods ownership of Vegemite. In Part Three I use the call for US consumers to boycott French products in response to the French government’s refusal to join the “coalition of the willing” to highlight “out-group” ethnocentric consumption.

References

  1. Shimp, T.A. and S. Sharma, Consumer Ethnocentrism: Construction and Validation of the CETSCALE. Journal of Marketing Research, 1987. 24(3): p. 280-289.
  2. Australian Customs Service. Australian Customs Service Fact Sheet. 2007 [cited 2012 March 19]; Available from: http://customs.gov.au/webdata/resources/files/FS_clothing.pdf.
  3. Lusk, J.L., et al., Consumer Behavior, Public Policy, and Country-of-Origin Labeling. Applied Economic Perspectives and Policy, 2006. 28(2): p. 284-292.
  4. Loureiro, M.L. and W.J. Umberger, A choice experiment model for beef: What US consumer responses tell us about relative preferences for food safety, country-of-origin labeling and traceability. Food Policy, 2007. 32(4): p. 496-514.
  5. Peacock, M. Food Labelling inquiry chair disappointed Federal Government drops key recommendations. PM 2011 [cited 2012 February 6]; Available from: http://www.abc.net.au/news/2011-12-01/food-labelling-inquiry-chair-disappointed-federal/3707464.
  6. Blewett, N., et al., Labelling Logic: Review of Food Labelling Law and Policy. 2011, Commonwealth of Australia: Canberra.
  7. Australian Manufacturing Workers’ Union. SPC regional job losses show need for food labelling laws and watchdog on supermarkets. 2011 [cited 2012 March 19]; Available from: http://www.amwu.org.au/read-article/news-detail/749/SPC-regional-job-losses-show-need-for-food-labelling-laws-and-watchdog-on-supermarkets/.
  8. Miller, J.W., Country labeling sets off EU debate, in The Wall Street Journal. 2011, News Corporation: New York.
  9. Department of Environment, F.a.R.A. Country of origin labelling. 2011 [cited 2012 March 19]; Available from: http://www.defra.gov.uk/food-farm/food/labelling/country-origin/.
  10. Smith DeWaal, C., Food Protection and Defense: Preparing for a Crisis. Minnesota Journal of Law, Science and Technology, 2007. 8(1).
by crmayes

Lifestyle choice: a brief note

I’m currently completing a book manuscript called ‘The Biopolitics of Lifestyle’. So when Tony Abbott made his comments that Aboriginal’s living in remote communities are making a ‘lifestyle choice’, I thought “great, I may need to write another chapter”.

This is not simply a poor choice of words, but reflects a governmental rationality that seeks to place responsibility on to individuals. Education, health, welfare, employment all become ‘lifestyle choices’ for which the individual is responsible.

The affluent, gainfully employed, highly educated sections of society make good ‘lifestyle choices’, while the poor, sick, Indigenous and asylum seekers are characterised as making bad ‘lifestyle choices’.

Abbott is not the first to use this phrase to justify . In 2002, Philip Ruddock described asylum-seekers as making ‘lifestyle choices’.

“In the main, people who have sought to come to Australia and make asylum claims do not come from a situation of persecution; they come from a situation of safety and security,” he said.

“They may not be able to go back to their country of origin but they are making a lifestyle choice.” The Australian, ‘Ruddock blames “lifestyle” refugees’ by Alison Crosweller and Megan Saunders

This governmental rationality shifts responsibility away from governments and communities, and on to individuals. It also serves to trivialize some claims (living in a remote community or seeking asylum) by comparing them to frivolous consumer lifestyle choices (Pepsi or Coke, holden or ford, apple or pc).

Of course, when we talk about the Australian Lifestyle of ANZACs, footy, beach, sun, boats, and weekends, things get very serious. Governments use this notion of lifestyle to build monuments, go to war, and demonize minorities. But that is another matter all together.

In the current context the rationality of ‘lifestyle choice’ shifts responsibility onto individuals in remote communities and justifies the Western Australian government’s decision to cut services and remove people.

by crmayes

Depoliticising Indigenous Health via Consensus and Statistics

‘Politics’ has become a dirty word in Australia. To ‘politicise’ an issue is regarded as obfuscation. Good governments ‘govern’ and make ‘policies’. And good oppositions should work with governments to produce policies not debate endlessly, or so we’re told – usually by sitting governments.

While a lot of the ‘politics’ has devolved into oppositional tactics, political debate is essential for democracy.

At a minimum political debate should reveal the reasons and justifications for a particular policy. However, false consensus and the use of statistics are increasingly used to depoliticise debate of important issues. A recent example is Indigenous health.

Dangerous Consensus

indexIndigenous health is an area where “every opposition wants the government to succeed”. However, perhaps it is this consensus that has resulted in continual failure.

The 7th Closing the Gap report was presented in Parliament earlier this month. Prime Minister Tony Abbott gave a sobering speech, noting that most targets were not on track “despite the concerted effort of successive governments since the first report”.

Opposition Leader Bill Shorten, however, called on the Government to reverse the budget cuts to social services that disproportionately affect Indigenous populations and compound existing inequalities. Coalition MPs were unhappy with this suggestion. Some walked out and others said Shorten was playing political games on an important occasion.

The focus on consensus – that everyone wants to Close the Gap – has reduced Indigenous health and education to a national human interest story. It is bracketed from the realm of politics and serves either to inspire or a cathartic release. Sociologist Pierre Bourdieu writes that “human interest stories create a political vacuum. They depoliticize and reduce what goes on in the world to the level of anecdote and scandal”.

In breaking with the ritual bipartisanship, where Opposition and Government solemnly agree that “more should be done but it is all so very difficult”, Bill Shorten re-politicised Indigenous health, if only briefly.

While liberal political philosophy values consensus established via publicly justifiable reasons, when consensus is assumed, publicly justifiable reasons become redundant. The presumption of consensus between the two major parties on indigenous health (and anti-terror legislation and asylum seeker policy) lowers the expectation of rigorous political arguments for or against certain positions.

Shorten broke with the consensus game and exposed the gap between Abbott’s rhetoric of “concerted efforts” and the first budget he delivered. Budgets are not simply economic documents, but reflect political and moral decisions about the lives that are valued.

Politics of Life Expectancy

Not unrelated, last month Treasure Joe Hockey attracted ridicule with his comment in a 3AW interview ‘that somewhere in the world today, it’s highly probable, that a child is being born that is going to live to a 150’.

Close-the-Gap

Hockey’s comment received some support from Professor Peter Smith who points to advances in medicine and public health as reasons to expect a continued increase in human life expectancy.

Professor John Quiggin however suggested that these claims are highly dubious and ignore the fact that the extension of life expectancy in the 20th Century ‘came from a reduction in death rates for the young.’

Will Cairns also pointed to the success of reducing death rates. Writing in the Medical Journal of Australia that

our numbers plummet as we approach 100 years of age because all of these interventions [public health, disease treatment, nutrition] make no difference to the reality that we eventually wear out and die. Apart from the odd unverified outlier, only one person has ever been confirmed as living for more than 120 years.

Hiding Politics in the Statistics

Like the assumption of a consensus, Hockey’s use of life expectancy statistics to justify changes to the health system hides the political nature of these decisions.

Altering the financing of the health system through strategies such as co-payment schemes may appear reasonable. We are told Australia’s population is ageing and more people need to use the health system. However, what these statistics hide is the disparities of life expectancy in Australia.

While a child may be born today to live to 150 120, the latest ‘Closing the Gap‘ report reveals that Indigenous Australians born today can expect to live more than a decade less than non-Indigenous Australians.

The reality of significant gaps in life expectancy should be the cause for alarm and inspire the creation of a more equitable health system. Yet often population statistics hide the details. As Professor Mick Dobson notes, ‘Statistics of shortened life expectancy are our mothers and fathers, uncles and aunties who live diminished lives. We die silently under these statistics.’

Statistics: measuring and managing people

Vital statistics have been used to govern populations since the 17th century. But it’s important not slide over the word “statistics” too quickly as its literal meaning is hidden through repeated use.

Statistics is not simply about numbers but “state craft“. By knowing birth and death rates, and the incidence of disease it is possible to establish probabilities of epidemics, movement of people, and to order the State in a rational manner.

Vital statistics also enable the segmentation and division of populations. We see this all the time in professional sports. The explosion of statistics about batting averages, field goal percentage, or a players historical probability of kicking a goal from a certain angle against a certain team all help coaching staff to know who is performing and who is not.

Divisions in the details

Despite appearances, the use of statistics as political tool for governing a population is not neutral. Historian and philosopher Michel Foucault notes the way vital statistics introduce a power over life or biopolitics. The increased knowledge about nutrition, physiology and sexuality in the 19th century lead to the creation of norms from statistical averages that allowed political strategies to regulate human life. Close-the-Gap-005

Statistical analyses are used in public health to show the distribution of disease and enable interventions in populations. But as Foucault notes, these techniques also allow the identification of lives that are healthy and should be fostered and which lives are not performing and can be neglected.

A danger with the celebration of a statistically increasing life expectancy, is that it masks the very real health inequalities faced by many Australians. This is seen in a number of areas:

  • allow for certain health issues to be prioritised (e.g. ageing population), while others marginalised (e.g. health inequalities)
  • enable the allocation of funding towards some research (e.g. Medical Research Future Fund), while moving it away from other areas (e.g. preventive health)
  • suggest a particular financing models for the health system (e.g. co-payment), yet discount others (e.g. progressive taxation).

These are not simply economic decisions, but political and ethical decisions about which lives count. For too long the supposed neutrality of statistics and the assumption of consensus have allowed the political reality of Indigenous health inequalities to be hidden. To close the gap we need to recognise the historical and political processes that have made it and maintain it.

by crmayes

Morally Indigestible Listicles: Food, Experts, and the Burden of Choice

Never Eat

The Sydney Morning Herald (via the Telegraph, London) has published another “no-nonsense-straight-shooting-science-based” listicle of the foods YOU SHOULD NEVER EAT AGAIN! These lists seem to appear at least once every week on some form of news website.

This current list is prefaced with references to recent British Medical Journal studies that turned upside down “everything we thought we knew about eating and drinking healthily”. Instead of saturated fats being “the killer”, it turns out carbohydrates are!

Put down that bacon & egg roll and get yourself a KFC Double-Down sandwich!

Surprisingly the article doesn’t question why these new claims have a stronger knowledge base than previous claims or how we can be sure that in a week there won’t be another “nutritional revolution” that will turn this all on its head and finger protein as Grandpa’s real killer.

Leaving aside the science-base of these claims – not to imply this is unimportant – what is most disturbing about these articles (and this article in particular) is the emphasis on individual food choices as the determining factor of health. “Expert” claims that “every bacon sandwich you eat knocks half an hour off your life” reinforce ideas that my heart disease or your diabetes are reducible to that sandwich or chocolate bar eaten six years ago.

When these factoids are spoken by folks in white coats during times of austerity cuts to health services there is a real danger of compounding already existing public health policy problems by pretending that structural influences can be addressed via a nice social marketing campaign or a Jamie Oliver TV show that teaches people how to cook, garden and “never eat those foods again”.

In the UK (where this article originated) David Cameron recently flagged that sick benefits may be cut from people who are obese and do not lose weight. The rationale for this idea is that obese people can lose weight simply by making “correct” and “healthy” food choices. However, according to Cameron, they aren’t making these choices because life is too good on benefits. Hence, cut the benefits and healthy food choices will be made.

While these listicle articles may be dismissed as “not too serious” or “a bit of fun”, they depend on and reinforce a moralistic and biopolitical perspective on the relation between food, choice and health. This perspective is often used to justify budget cuts to health services due to the expectation that health is simply a matter of individuals making the right choices.

In an article for Public Health Ethics, my colleague Donald B. Thompson and I argue that this perspective is morally and scientifically unjustified. Below is the introduction. If you’d like read the whole thing but the pay wall gets in the way send me an email.

Continue reading →

by crmayes

Bioethics, obesity and the harm principle

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Fat people should pay more to fly, because they weigh more and hence use more fuel.
Fat people can’t make good food choices so they should be coerced and stigmatized into making the right choice.
These and other spurious ideas are permitted to float around opinion pages of leading newspapers and journals because a) we think we have a fat people problem; b) shocking, blunt and simplistic solutions to complex problems are key ingredients to “click-bait”; and c) if we can reduce complex problems to economic calculations then we can pretend moralistic interventions into peoples lives are “neutral” because, hey it’s the raw numbers talking.
Anyway, in the below paper published this week I argue against Peter Singer and Dan Callahan’s attempts to justify direct interventions into the lives of fat people based on a simplistic use of the harm principle and a deep ignorance of empirical and public health research on obesity. Or as H.L. Mencken quipped, “For every human problem, there is a solution that is simple, neat, and wrong.”
If you can’t get beyond the paywall send me an email or message.

The Harm of Bioethics: A Critique of Singer and Callahan on Obesity

Abstract

Debate concerning the social impact of obesity has been ongoing since at least the 1980s. Bioethicists, however, have been relatively silent. If obesity is addressed it tends to be in the context of resource allocation or clinical procedures such as bariatric surgery. However, prominent bioethicists Peter Singer and Dan Callahan have recently entered the obesity debate to argue that obesity is not simply a clinical or personal issue but an ethical issue with social and political consequences.

This article critically examines two problematic aspects of Singer and Callahan’s respective approaches. First, there is an uncritical assumption that individuals are autonomous agents responsible for health-related effects associated with food choices. In their view, individuals are obese because they choose certain foods or refrain from physical activity. However, this view alone does not justify intervention. Both Singer and Callahan recognize that individuals are free to make foolish choices so long as they do not harm others. It is at this point that the second problematic aspect arises. To interfere legitimately in the liberty of individuals, they invoke the harm principle. I contend, however, that in making this move both Singer and Callahan rely on superficial readings of public health research to amplify the harm caused by obese individuals and ignore pertinent epidemiological research on the social determinants of obesity. I argue that the mobilization of the harm principle and corresponding focus on individual behaviours without careful consideration of the empirical research is itself a form of harm that needs to be taken seriously.

Keywords: obesity; Peter Singer; Dan Callahan; harm principle; public health

Mayes, C. (2015), The Harm of Bioethics: A Critique of Singer and Callahan on Obesity. Bioethics, 29: 217–221. doi: 10.1111/bioe.12089

by crmayes

From Mental Illness to Personal Responsibility: A Technological Transformation of Bulimic Purging

The continuing crusade against overweight and obese individuals has taken yet another bizarre and grotesque turn with the unveiling of “AspireAssist”, a personal “stomach pump [that] sucks food out of the user’s belly before the body can fully digest it”.

AspireAssist

Such a development is not all that surprising. The so called obesity epidemic has transformed ethical and social norms to position those with bodies, habits or attitudes that represent obesity as fair game – the hunting metaphor is apposite.

The state of emergency that is the obesity epidemic has seen public health advocates earnestly recommend that obese children be placed in foster care, bioethicists argue that obese adults should be stigmatised and discriminated against, and hospital CEOs suggesting it is acceptable to refuse to hire overweight or obese people.

In this milieu of panic and desire for strategies that “really work”, AspireAssist has developed a personal stomach pump. The video on the ABC News website is more detailed, but the clip below is clear enough.

According to AspireAssist it “works by removing a portion of the food from the stomach before it is absorbed”. By using AspireAssist 20mins after eating, the pump removes 30% of the stomachs contents to reduce the amount of calories, nutrients, fats etc absorbed by the body and thereby making the individual slimmer. My interest in AspireAssist is not the extraordinary and ethically questionable attempt to normalize bodies to conform to artificial measurements such as the BMI. But the way this technology transforms a practice that most medical professionals characterise as a mental disorder.

This act of removing the contents of the stomach to achieve the goal  “normal” weight and body image is not dissimilar to bulimia nervosa, a condition that since the 1980s has been regarded as a mental illness. The DSM-IV describes individuals with bulimia nervosa as engaging “in inappropriate behavior to avoid weight gain (e.g., self-induced vomiting), and are overly concerned with body shape and weight. However, unlike individuals with anorexia nervosa, binge-eating/purging type, individuals with bulimia nervosa maintain body weight at or above a minimally normal level.”

For an individual to excuse themselves from the table to go and vomit in the toilet 20mins after sharing a meal with friends would be, according to the DSM-IV,  inappropriate. Such behavior ordinarily invokes social concern and justifies medical intervention. However, the technology of the stomach-pump transforms medically defined deviance (purging) into medically approved compliance. Performing a near identical function to purging, the use of the personal stomach-pump does not incite medical intervention as it is the medical intervention and it does not invoke social concern as it is a response to the social concern of obesity.

AspireAssist’s stomach pump probably won’t become a common tool. The panopticon was not widely implemented either. But like the panopticon, the personal stomach-pump represents a rationality of a specific (bio)political moment in which the bodies of individuals are considered to pose such a threat to the population (and themselves) that spectacular interventions are justified that transform the logics of pathologies into the logics therapies.