Contested health advice: celebrity doctor vs celebrity chef

In response to Pete Evans’ advice that “calcium from dairy can remove the calcium from your bones”, Dr Brad Robinson used Facebook to ask Evans.

“Can we make a deal? You don’t give medical advice and I won’t tell you how to best shuck oysters. Agreed?”

Sounds reasonable, yet the lines aren’t so clear.

The medical community has been engaged in a long and ambiguous embrace with celebrity chefs, nutritionists and various other popularizers of medical advice. The dietary advocacy of St. Jamie Oliver (aka mockney gobshite), for example, has been lauded in the British Medical Journal for doing “more for the public health of our children than a corduroy army of health promotion workers”.

1700

Jamie Oliver in his latest documentary, Jamie’s Sugar Rush. Photograph: Channel 4.

While it is unlikely that Pete Evans will receive similar praise in the Medical Journal of Australia, the medical community has (along with a host of other actors) contributed to the conditions for celebrity life-guides to flourish.

For instance, medical and public health concern over the health-effects of micro-practices such as playing computer games, microwave dinners, dairy consumption, sugary drinks, feeding infants formula, alcohol consumption, or mode of transportation contributes to the production of a population seeking clear and authoritative guidance.

The sources through which such guidance is disseminated extends well beyond the clinic, but it isn’t wholly divorced from the clinic either.

Lifestyle magazines, health websites, television programs and smartphone apps commonly feature “medical experts” as a means of legitimating the guidance on offer. And the use of these tools, especially apps or m-health, is increasingly encouraged by physicians. For example, the Royal Australian College of General Practitioners states that:

M-Health tools can provide continuous, pervasive healthcare at any time or location. By using m-Health, healthcare professionals and patients have the opportunity to continuously monitor health conditions and access health information outside of the general practice environment.

Considering that a significant proportion of the 3 billion apps available via Google Play or iTunes are health-related, the idea of simple demarcation between legitimate and illegitimate advice is naive at best.

The debate over who can give health-related advice is not new. However, the rise of various technologies, coupled with the dual movement of anxiety and fetishization of food in the present, creates an environment where a clear demarcation of legitimate from illegitimate sources of guidance is hard to find.

The fact that Dr Brad Robinson used Facebook to voice his concerns is revealing – especially as his page seems to largely function to promote the success of his private obstetrics and gynaecology practice.

Of course none of this is to suggest that there is no basis from which to judge different guidance or to highlight the spurious nature of Evans’ advice. The point is simply that the medical community has contributed to the creation of life-guide celebrities and that the contest of over medical knowledge and guidance is more complex than simply saying people like Evans should shut up until he has a white coat and stethoscope.

Ivan Illich and the Idol of Lifestyle

Ivan Illlich, the Austrian philosopher, Catholic priest and iconoclast, was asked to give a lecture to a group of American Lutheran pastors on the topic of life. Rather outlining a philosophy of life, Illich called life an idol.

Illich said the pastors were dismayed by his characterisation. After all Jesus is the ‘bread of life’, ‘the way, the truth and the life’, and promises abundant life.

"Ivan Illich" by Source (WP:NFCC#4). Licensed under Fair use via Wikipedia - http://en.wikipedia.org/wiki/File:Ivan_Illich.jpg#/media/File:Ivan_Illich.jpg

“Ivan Illich” by Source (WP:NFCC#4). Licensed under Fair use via Wikipedia – http://en.wikipedia.org/wiki/File:Ivan_Illich.jpg#/media/File:Ivan_Illich.jpg

What could it mean to call life an idol?

For Illich, life is an idol worshiped and used by marketers, theologians, politicians, scientists, journalists, and activist to motivate, reveal and hide all sorts of responses, actions and emotions. Yet, there is never any attempt to provide an adequate definition.

In his acerbic style Illich says ‘when I used the word life today, I could just as well just cough or clear my throat or say “shit”’.

For Illich, life becomes an idol because it is an empty signifier that can be filled with whatever meaning an authoritative and persuasive speaker gives. In his terms, life is an amoeba word. A word that when thrown into a conversation ‘makes waves, but it doesn’t hit anything. It has all these connotations, but it does not designate anything precisely’.

Other amoeba words could be freedom, family, democracy, race, secular, or gender. Illich was not suggesting that the things these words signify or represent are necessarily unimportant or shit. Rather they tend to hide or assume what is at stake.

Amoeba words are imprecise yet produce deep cultural and emotional resonance. Perhaps the more important a topic is the more amoeba words appear.

The use of lifestyle is a case in point. Despite its banal appearance it is a divisive word. It divides lives as “in” and part of “us” from those that are “out” and part of “them”. Sure, lifestyle is used to market insurance or sell funeral packages, but it is also used to identify what is valued and can be disregarded.

The idol of lifestyle is used to justify the careful inclusion of some lives and in the same movement violent exclusion of others.

George H.W. Bush infamously told the 1992 Rio Earth Summit that the American way of life was not negotiable. The rest of the world may burn, but the American lifestyle has such a high value that it will not be compromised.

Tony Abbott’s recent comments about lifestyle choices and remote Aboriginal communities reveal the divisive nature of the term.

“What we can’t do is endlessly subsidise lifestyle choices if those lifestyle choices are not conducive to the kind of full participation in Australian society that everyone should have”

There are lifestyles that ‘fully participate in the life of our country’ and there are lifestyles that are outside of “our country”. Being “inside” grants security, celebration and flourishing, while being “outside” leads to abandonment and exposure. Of course, to be outside is a choice and therefore removes responsibility for care from the “inside”.

Screenshot 2015-03-11 18.26.22

Like Illich’s observations, the idol of life and amoeba words continue to abound in political and popular discourse. Perhaps coughing or saying shit in their stead may interrupt the pronouncements of false prophets and disrupt the flow of worshiping these false gods.

See – Cayley, David. 1992. Ivan Illich in conversation. Concord, Ontario: House Of Anansi

Make good choices, kid: biopolitics of children’s bodies and school lunch reform in Jamie Oliver’s Food Revolution (2015)

 

Perhaps my favourite description of Jamie Oliver is “mockney gobshite”. This analysis, however, seems a little more sophisticated and looks at the biopower of moralizing discoursed around food, schools and young bodies in the US.

Foucault News

Gibson, K.E., Dempsey, S.E.
Make good choices, kid: biopolitics of children’s bodies and school lunch reform in Jamie Oliver’s Food Revolution
(2015) Children’s Geographies, 13 (1), pp. 44-58.

DOI: 10.1080/14733285.2013.827875

Abstract
In recent debates surrounding childhood nutrition and US school lunch reforms, the child’s body serves as a contested battleground in a destructive politics of blame over obesity and diabetes. Scalar discourses of the body play a significant role in constructing food-related problems and their solutions. We illustrate our claims through a critical analysis of Jamie Oliver’s Food Revolution; a celebrated national television program centered on chef Oliver’s attempts to address childhood nutrition through school lunch reform. Informed by Foucault’s biopolitics, our analysis highlights how moralizing scalar discourses of the body frames nutrition as an individual problem of personal choice. Food politics, when played out at the scale of young bodies, masks class divisions, marginalities, and governmental policies that…

View original post 59 more words

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.

My Grandmother on the ‘Universal Food Chopper’ and Domestic Labour

Below is a short piece written by my Grandmother (Eileen Mayes, 1906 – 1993). It was initially published in ‘John Barnett’s All Ways on Sunday File’ in 1989.

This piece interests me not only for its familial connection and posterity, but its relation to recent trends questioning the new domesticity and women’s labour

Picture from a Mail Order Catalogue

Eileen Mayes 

Some time ago I found a mail order catalogue among old papers. There wasn’t much left of it, no cover and lots of the pages missing, but among those that were left I found a picture almost seventy years old.

She’s wearing a long dress with a frilled hem, a high-boned collar in pre-1914 style; she’s got a flower tucked gaily into her piled-up hair. She could be somebody’s Great-Aunt Gwendoline and she’s smiling sweetly as she demonstrates a Universal Food Chopper-Mincer to you.

It’s had a lot of use, this old catalogue, the pages worn and dog-eared with being turned over and over again and I wondered how often Great-Aunt Gwendoline had thumbed through them. Poor deat, even with her Universal Food Chopper she didn’t have much in her kitchen to smile about. Compared with modern kitchens, it would rank as a labour camp.

Oh, she had a refrigerator, at least that’s what the catalogue calls it – ‘Holds 66 lbs of ice’, and if she wanted ice cream there was the ‘Gem’ freezer with ‘solid oak bucket’ to provide it – and plenty of exercise in the making! However, she had one advantage over us today: her cooking utensils, though primitive, were cheap; a nutmeg grater cost a penny, a rolling pin was ninepence or a ‘Colonial’ one could be had for sixpence. Her glass preserving jars came from America and her knives, says the catalogue, were ‘best English steel’. These, of course, had to be cleaned constantly by hand on a knife board, price sevenpence in the catalogue. An English Knife Cleaner was a bit more expensive. This was a circular contraption in which you stuck the knives and then turned a handle. The catalogue says ‘As used by the King’, conjuring up a delightful picture of a portly King Teddy stashing his gold-plated knives into the machine and merrily turning the handle.

Poster for Landers, Frary & Clark, the “Universal food chopper, and a few of the things it chops,” New Britain, about 1899.
Poster for Landers, Frary & Clark, the “Universal food chopper, and a few of the things it chops,” New Britain, about 1899.

Husbands are conned into ordering a cake-mixer: ‘Every newly-married husband should buy one. It turns a poor cook into a Good Cook.’ This little miracle worker, hand-driven by the ‘little woman’, naturally, costs no more than the marriage licence, a mere seven and sixpence.

There’s a complicated little number illustrated, an apple-peeler-corer-slicer, which, although it costs only two and threepence looks as though it might need a mechanic to set it up each time.

And then a item that recalls a quiz show. What is a Turk’s Head? A brand of tobacco, the name of a pub, or the upper part of a decapitated European? It’s a brush for sweeping walls, ‘All hair, price five shillings.’

And what a trial of strength washing day must have been for Great-Aunt Gwendoline! Whilst the water heated (she could use the bellows, price two and tuppence, if the fire was sulky) she’d collect her tin tub and the rubbing board (latest American, 1/3). She’d fill the troughs (best Karri) and perhaps get out a packet of Wyandotte ‘invaluable for washing clothes as it takes the place of soap’, then goes on to add somewhat ominously, ‘It also removes paint.’

What marvellous muscles Great-Aunt Gwendoline must have developed!

First there was the washing machine, clumsy, on four wooden legs looking as though it might serve as a churn in an emergency, and with a large wooden handle propelled – how did you guess? – by woman-power.

Finally when all the shirts and embroidered petticoats and drawers and household linen was starched and dry, there was the ironing. Flat irons cost a shilling, polishing irons to add further lustre – our Gwen must have been a tiger for work – at one and three. The man who made the irons was called Saddler, and his irons as ‘Sad’ irons. How appropriate.

Above the wood stove, on the mantle shelf, is the American alarm clock, price two and threepence, telling the long day is over. The hanging lamp, not so pretty as the one of flowered china and dangling glass pendants in the parlour, is lit and strkes an answering glow from the beautiful copper kettle. ‘Very best copper, price eight shillings.’

How incredibly hard you worked – and how lucky we are to be living in 1975 with all its labour-saving devices! And yet, I wonder – was Great-Aunt Gwendoline? – But that’s another argument and nothing to with a Mail Order Catalogue.

Bioethics, obesity and the harm principle

10391785_218590861868_7171885_n
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

Hyper Obedience, Malicious Compliance and NYC Cycling

In Security, Territory, Population Foucault analyses a number of themes of counter-conduct in relation to the Christian pastorate. Choosing counter-conduct, rather than dissidence, Foucault is drawing attention to the way relations of power shape and invest the body, postures, comportment and conduct. To resist these relations, they need to be countered with practices and strategies that “redistribute, reverse, nullify, and partially or totally discredit pastoral power in the systems of salvation, obedience, and truth”.

One such strategy is hyper-obedience – an “exaggerated and exorbitant element” of obedience. This is not merely disobedience against an authority, but an intimate work of the self on the self that disrupts the pastors authority.

Foucault describes this strategy as  “a sort of close combat of the individual with himself in which the authority, presence, and gaze of someone else is, if not impossible, at least unnecessary.” In adopting the countering-conduct of hyper-obedience the individual or group “stifles obedience through the excess of prescriptions and challenges that the individual addresses to himself.”

The logic of hyper-obedience is articulated more precisely by Gary Ransom, a change management consultant. When asked “What kind of obstacles should business leaders anticipate as they endeavour to manage change?” Ransom responds:

[T]here are even worse things than outright resistance. One of our financial services clients coined the term “malicious compliance”… essentially, doing exactly what’s asked of you – no more, no less. Malicious compliance can be a killer because it’s hard to reprimand and because it undermines the credibility of the whole process. People come back to you and say, “See? I did just what you asked, and look at how it screwed things up”.

In doing the very thing that is being asked, the employee frustrates the goals and processes of the authority asking them to act in a particular way. A similar approach has been suggested by Matthew Woessner in response to Penn State University’s wellness plan. According to Woessner the plan requires all staff to

“complete an online wellness profile” as well as undergo a “preventive physical exam” designed to “help employees and their spouse or same-sex domestic partner learn about possible health risks and take proactive steps to enhance their well-being.”

Failure to do this will result in a $100 monthly surcharged deducted from the employees paycheck. Woessner calls on his colleagues to resist not through disobedience, but compliance. He proposes that employees fill out forms with volumes of irrelevant “lifestyle” information and use personal doctors rather than the insurers mobile medical teams. According to Woessner,

if ten thousand Penn State employees set up previously unscheduled doctor visits, (particularly if they are scheduled as full check-ups) it will have the effect of frustrating the university’s narrow budgetary objectives, making the cost of implementing these “basic biometric screening” simply unsustainable. (More details here).

Woessner calls this approach civil disobedience. I would suggest it is hyper-obedience. But whatever it is, I hope it works.

Here is another humorous example:

Gary Ransom and Tom Knighton, “Stepping up to the challenge of change,” Managing Service Quality 6, no. 5 (1996): p.13.

see Foucault, Michel. Security, Territory, Population: Lectures at the Collège De France 1977-78. Translated by Graham Burchell. Edited by Arnold I. Davidson. New York: Palgrave Macmillan, 2007. (p. 200 – 201)