Saturday, January 28, 2012

Defining Race


Although I found much of the information about the correlation between race and incidents of low birth weight presented by Conley, Strully, and Bennett in The Starting Gate to be useful and compelling, I was plagued by one nagging question in the back of my mind while I was reading: What do they mean when they say race? To the best of my knowledge, a specific definition of race was never put forth in the book, and this left me feeling a bit confused.
Depending on the context, race may mean many different things to different people. In some instances it may refer to skin color, while in other instances it may refer to common ancestry, however these two things are not necessarily related. For example, sub-Saharan Africans and Australian Aborigines have similar skin colors, but very different ancestries. Also self-reported race may be different from either skin color or ancestry. For example, a person may classify himself or herself as black, but have a significant percent of ancestors from Europe or have a fair skin tone. This makes the term “race” rather vague unless it is specifically defined.
Race is also a tricky term because the divisions between races, whether in skin color or ancestry, are not always clear-cut. Because there has been so much racial mixing, especially in the United States, a person may have characteristics of more than one race and this makes it difficult to define them as one or the other. According to the latest U.S. census, approximately 2.9 percent of Americans, or 9 million people, define themselves as multiracial and that number is rapidly growing.
When we are not sure exactly what the term race means, it becomes difficult to make inferences based on the data presented in the book. Although I think that looking at differences in certain diseases among different races is a useful tool for determining both social and biological factors contributing to the disease, it has to be well defined otherwise it becomes less meaningful. 

Society over Genetics

Dalton Conley’s “The Starting Gate” provides an interesting perspective on low birth weights in relation to biology, genetics and society. The combination of nature and nurture that the book uses to explain low birth weight seems like a logical way to try and explain why we see a higher percentage of low birth weight in the black community than we do in the white community. However, I believe that the relation to income of the parents has a greater affect on the overall health of the baby than genetic factors. Higher income results in more healthcare possibilities such as adequate nutrition and health attention by doctors than a family with low income would. This provides the baby with a better chance of beating any previous genetic conditions that could result in lower birth-weight like it does with any other illness that may be caused by genetics. On average, white couples have a higher economic standing than black couples. I think this has more of an affect on there being a higher percentage of black parents producing a low-birth weight child than their race. Even though there may be some genetic factors that lead to a lower birth-weight of a child, the evidence that this book puts forth, especially in the section of immigrant Mexican families compared to the families that have been in America for a longer period of time, show that these issues can be beat. People who have lived in America longer have access to better healthcare and proper nutrition that can lead to a healthy baby.

Problems such as drinking, smoking, and other harmful activities during pregnancy are more related to knowledge than income. People with higher economic standing are more likely to have more education than people with a lower economic standing which can account for this gap in the probability of lower birth weights as well. This is not to say that all families with a low income do not possess the knowledge to produce a healthy baby. This is simply pointing out that the chances that the mother partook in activities that decreased the chances of producing a healthy baby are higher in a low-income household. Out of all the examples that Conley states, I believe that society has a greater affect on the outcome of the baby’s health than its genetics or biology.

Vicious Cycle of Low Birth Weight Babies

It is perplexing to contemplate why more African Americans babies tend to be born low birth weight compared to white babies. One cannot figure out whether or not it is because their race or if it is due to the baby's mother. If it was due to race, then it can be concluded that African Americans are more prone to a gene that causes them to be born with low birth weight. If it was due to the mother, then it can be concluded that there must be something in the mother's environment while she was pregnant which caused her to be prone to give birth to a low birth weight baby. I do not think it is due to genetics, I believe it is more of the later. The African American women tend to be of a lower socioeconomic status. They have to deal with more stress in their life and live in poorer conditions which might result in a higher number of African American babies born with low birth weight. It is a vicious cycle where the baby's mother was also born with a low birth weight because her mother might have live in poor socioeconomic conditions. Hence, while the baby's mother might not be exposed to poor socioeconomic conditions when she is pregnant, the fact that she was a low birth weight baby causes her to be more likely to give birth to a low birth weight baby. Thus this is why it might seem to be a genetic factor to those of the African American race but actually they are more prone to give birth to low weight babies is due to their forefathers. I wonder if it is possible to reverse this trend. I feel that the first thing that must happen is to change the environment. It was mentioned that even though a pregnant woman may not be poor but lives in a poor neighborhood, her baby has a higher risk to be a low birth weight baby. It is not clear whether or not this is due to poor housing conditions or if they do not easily have access to learn about good pregnancy practices. Nevertheless, if we are able to try to fix this problem then those from a poorer socioeconomic background will have a lesser chance to give birth to a low birth weight baby. Then this vicious cycle of mothers who were born with low birth weight giving birth to low birth weight babies will end.

Race and Medicine

I thought I would begin by sharing this XKCD comic. It is amusing and brings up one of the big issues that I think about whenever I read medical or public health research: correlation does not imply causation. This makes some of the book slightly more difficult to read because it contains these long lists of possible factors and possibilities and very little in the way of concrete findings. Instead having numerous examples of statements similar to, “Birth weight is indeed a case in which genetics, biology, and society become intimately linked.” (15).


One of these numerous factors evaluated brings up something I find particularly interesting, the issue of race and health. Conley when discussing the problems of race based science brings up eugenics briefly a few times, yet not by name. He discusses the, “dubious linkages drawn in the nineteenth century between genetics and inequality--and race was a favored topic of this work. Correctly fearing a return to such so-called science, many researchers (both biologists and social scientists) have avoided considering genetic explanations of racial differences in health.” (44) However, the only time he mentions eugenics by name (that I have yet to find in the book) is in referring to the work of Troy Duster who has written extensively on genetics as a modern-day eugenics movement.


Another criticism of race-based medicine Conley raises is that of Jacqueiline Stevens who, “points out that racism stems from views about innate differences, and medical research now emphasizing such innate differences with genetic research may be hardening the very theoretical basis of racism.” (47) This quote immediately reminded me of an episode of House M.D. (entitled “Humpty Dumpty”) in which a patient in the clinic refuses to take the pill “targeted to African-Americans” and refers to it as a “racist drug”. There has been some skepticism by African-Americans about these types of drugs in large part due to the historical instances of race-based medicine. This is seen in this Keith Knight comic from “The K Chronicles”.

For more information about the race-based medication, BiDil, you can check out the Scientific American article, “Race in a Bottle”.



Immigration as an Indicator: Low Birth Weight Not Just Genetic

Probably the thing that struck me most about The Starting Gate was the section on migration, specifically among Mexican Americans.  Apparently Mexicans who had recently immigrated to America have staggeringly lower rates of low birth weight than Mexicans who had been in the country for some time.  It was posited that this was because Mexicans have a sort of cultural protection in Mexico against substance abuse because of strong family ties and a life that is more suited to lower income areas.  However when they settle in America they resort to our vices, substance abuse and smoking as their lives become more stressful.  I was interested at how disparate the cost of living was between Mexico and America, and I found this interesting map.  As you can see, the cost of living in Mexico is among the lowest in the world, but when Mexicans migrate into areas like California and Texas, they see their cost of living jump.  If you add to this the wildly competitive labor market in these areas, you get a recipe for disaster for people coming to this country looking for their promised land of opportunity as immigrants struggle to cope with the increasing costs of living in America.

Another interesting aspect of the immigration discussion is that it gives us an almost real time look at what it is that might create problems like low birth weight in our society.  Even though the text basically proves that having a low birth weight parent or grandparent leads to a greater chance of an infant being born low birth weight, the problem is clearly much more than genetic.  With the sharp rise in low birth weight among Mexican Americans who have been in the country for some time compared to recent immigrants, we see that the problem is also sociological and environmentally related.  The text tells us that substance abuse and smoking are more likely among the lower class, so it is easy to see how the labor class of immigrants would have health problems like low birth weight as pregnant women become more likely to smoke during pregnancy.

In terms of fixing the problem, I believe that a large amount of this issue is a lack of awareness among the general population with respect to the effects of substance abuse, alcohol, and smoking during pregnancy.  The reason that low birth weight is more common among the lower class and underprivileged groups is because these groups are less likely to have gotten the education they need to be aware of the effects of drugs and alcohol during pregnancy.  Hopefully this problem will be observed more closely when more research about the effects of low birth weight on life chances emerges and programs will be created to educate the public further about the issue of low birth weight and what causes it.

Gapminder World Makes Data Fun

Brilliant statistician and professor of global health at Sweden's Karolinska Institute, Hans Rosling, has developed a software program that configures interactive graphs for nearly all variables of international data.  Rosling works with the aim to eliminate our predetermined perceptions of what differentiates the Western world from the developing world.

Gapminder World, developed in 2006, is a nonprofit internet-accessible software program that allows its users to actively compare various patterns on an international level.  For example, you can compare children per woman with child mortality to examine the trends that ensue. Here, you can see the specificity by which you can adjust the axis to represent different relationships:


Perhaps the most fascinating feature of this software is its ability to "play" these datas over time.  Once you select the factors to be represented on each axis, press "play," and you see how these factors have changed since 1800.  Specific countries can be tracked by selecting them on the right-hand toolbar; in viewing all countries the size each geographically-color-coded circle reflects the population of that nation.  Watching a graph come to life brings about a "horse-race" like quality, as you track the highs and lows of each nation as it faces social, economic and health changes.

For those on the pursuit of understanding how social trends influence health, Gapminder World provides an invaluable tool for both aesthetically pleasing and stimulating research.  By publicizing and animating international UN data, Rosling has eliminated the need to scour old record books with lifeless table sets while providing a more enjoyable and comprehensive alternative.


Is this interesting to you?  Here are some additional links...
I highly suggest that everyone dabble on the Gapminder World website - it is actually really fun: GAPMINDER 
  • There are several pre-made graphs that are useful to explore, but to create your own Gapminder experience, click on the "Open Graph Menu" key and the software will load.
I also recommend watching Hans Rosling's TED talks on Gapminder World, where he shares the effort put behind the creation of this software and explains the data presented by his animated graphs.  His demonstrations can be viewed on ted.com.  Here are a few links to his videos; I found them to be extraordinarily eye-opening and inspiring:


I Mean Isn't Everyone Stressed?


The Starting Gate: Birth Weight and Life Chances addressed many generalizations about how race and class affect health, from pre-birth until late adulthood. Something that grabbed my attention was the idea that social classes come with their own predetermined level of stress which can directly affect someone's health. For example, some authors suggest that "being at the bottom of a social hierarchy is inherently more stressful." These authors therefore believe that people in a lower social class will naturally have worse health than someone being at the top of the social hierarchy, because living at the top is "inherently less stressful." While this assumption is somewhat understandable, I would ask the authors to look at some of the businessmen, CEOs, and lawyers walking around with bags under their eyes from exhaustion and an extra layer of fat strategically placed around the center to yell out to people "hey, i'm stressed." My father and a handful of my uncles can fit into this category because part of their job description is to make decisions that affect entire companies, everyone it employs, and the families of the employers. Anyone would argue that is a tremendous amount of stress to put on an individual. Also, currently in this country, the more you make, the more you pay. Even though, my father has five children to support and eventually put through college, because of his income, he pays more through taxes than other families. I would never say that the lower class still does not have more stress than the upper class, however to suggest that the same health deterioration brought on by stress is not as prevalent in the upper class in unfair, I think they are just better equipped to take care of it after it takes hold.

Friday, January 27, 2012

On psychedelics and health

I thought this relevant to the conversation we were having, about how society mediates health.

http://healthland.time.com/2012/01/24/magic-mushrooms-expand-the-mind-by-dampening-brain-activity/

DRUGS
Magic Mushrooms Expand the Mind By Dampening Brain Activity
A new brain-scan study helps explain how psilocybin works — and why it holds promise as a treatment for depression, addiction and post-traumatic stress.
By MAIA SZALAVITZ | @maiasz | January 24, 2012 |


(UPDATED) More than half a century ago, author Aldous Huxley titled his book on his experience with hallucinogens The Doors of Perception, borrowing a phrase from a 1790 William Blake poem (which, yes, also lent Jim Morrison’s band its moniker).

Blake wrote:

If the doors of perception were cleansed, every thing would appear to man as it is, infinite. For man has closed himself up, till he sees all things through narrow chinks of his cavern.
Based on this idea, Huxley posited that ordinary consciousness represents only a fraction of what the mind can take in. In order to keep us focused on survival, Huxley claimed, the brain must act as a “reducing valve” on the flood of potentially overwhelming sights, sounds and sensations. What remains, Huxley wrote, is a “measly trickle of the kind of consciousness” necessary to “help us to stay alive.”

A new study by British researchers supports this theory. It shows for the first time how psilocybin — the drug contained in magic mushrooms — affects the connectivity of the brain. Researchers found that the psychedelic chemical, which is known to trigger feelings of oneness with the universe and a trippy hyperconsciousness, does not work by ramping up the brain’s activity as they’d expected. Instead, it reduces it.

Under the influence of mushrooms, overall brain activity drops, particularly in certain regions that are densely connected to sensory areas of the brain. When functioning normally, these connective “hubs” appear to help constrain the way we see, hear and experience the world, grounding us in reality. They are also the key nodes of a brain network linked to self-consciousness and depression. Psilocybin cuts activity in these nodes and severs their connection to other brain areas, allowing the senses to run free.

“The results seem to imply that a lot of brain activity is actually dedicated to keeping the world very stable and ordinary and familiar and unsurprising,” says Robin Carhart-Harris, a postdoctoral student at Imperial College London and lead author of the study published in Proceedings of the National Academy of Sciences.

Indeed, Huxley and Blake had predicted what turns out to be a key finding of modern neuroscience: many of the human brain’s highest achievements involve preventing actions instead of initiating them, and sifting out useless information rather than collecting and presenting it for conscious consideration.

For the study, the authors recruited 15 brave volunteers to receive injections of psilocybin or placebo, in alternate sessions, while being scanned in an fMRI machine. Taken intravenously, psilocybin alters consciousness in a mere 60 seconds, as opposed to the 40 minutes it normally takes when administered orally. And the high lasts a half an hour, not the five hours that typical users experience.

Provisions were made for the possibility that the participants might panic while high in the noisy, claustrophic setting of the scanner, but none of the volunteers did so. In fact, once they’d become accustomed to the noise and small space, “they quite liked being enclosed and felt secure,” Carhart-Harris says. All of the participants had previously been, as Jimi Hendrix put it, “experienced.”

Researchers had assumed that the hallucinations and bizarre sensations caused by psilocybin would have at least one part of the brain working overtime. But instead they found the opposite.

“The decline in activity was the most surprising finding,” says Carhart-Harris, “and anything that’s of surprise is usually important.”

Reducing the brain’s activity interfered with its normal ability to filter out stimuli, allowing participants to see afresh what would ordinarily have been dismissed as irrelevant or as background noise. They described having wandering thoughts, dreamlike perceptions, geometric visual hallucinations and other unusual changes in their sensory experiences, like sounds triggering visual images.

Indeed, if we always paid attention to every perceptible sensation or impulse like this, we’d be incapable of focusing at all. This is why it’s difficult to sit still and try to tune in all the feelings and perceptions we normally tune out, but why also, like psychedelic drugs, meditation can make the world seem strange and new.

The particular brain regions that were silenced or disconnected from each other by the drug also provided insight on the nature of psychedelic experience and the therapeutic potential of psilocybin. Two regions that showed the greatest decline in activity were the medial prefrontal cortex (mPFC) and the posterior cingulate cortex (PCC).

The mPFC is an area that, when dysfunctional, is linked with rumination and obsessive thinking. “Probably the most reliable finding in depression is that the mPFC is overactive,” says Carhart-Harris.

All antidepressant treatments studied so far — from Prozac, ketamine, electroconvulsive therapy and talk therapy to placebo — reduce activity in the mPFC when they are effective. Since psilocybin does the same, Carhart-Harris and his colleagues plan to study it as a treatment for depression. “It shuts off this ruminating area and allows the mind to work more freely,” he says. “That’s a strong indication of the potential of psilocybin as a treatment for depression.”

The PCC is thought to play a key role in consciousness and self-identity. “The most intriguing aspect was that the decreases in activity were in specific regions that belong to a network in the brain known as the default network,” notes Carhart-Harris. “There’s a lot of evidence that it’s associated with our sense of self — our ego or personality, who we are.”

“What’s often said about psychedelic experience is that people experience a temporary dissolution of their ego or sense of being an independent agent with a particular personality,” he says. “Something seems to happen where the sense of self dissolves, and that overlaps with ideas in Eastern philosophy and Buddhism.” This sense of being at one with the universe, losing one’s “selfish” sense and vantage point, and feeling the connectedness of all beings often brings profound peace.

The researchers also looked for an effect on the language-processing areas of the brain, since users so often report that their experience is difficult to put into words. “There wasn’t any correlation between people saying that the experience was ineffable and any change in brain activity,” Carhart-Harris says. “It may just be because the way we symbolize the world with language is a constrained function. It has a degree of precision to it, really, and these drug experiences are so unusual we don’t have words to describe them.”

Carhart-Harris and his colleagues did find support for claims made by sufferers of painful cluster headaches that psilocybin reduces the frequency of their attacks. These headaches are known to involve overactivity of a brain area called the hypothalamus, and psilocybin calmed this region.

Interestingly, Nature‘s Mo Costandi reports that another study of the effects of psilocybin on the brain found the opposite effect of Carhart-Harris’ group:

“We have completed a number of similar studies and we always saw an activation of these same areas,” says Franz Vollenweider at the University of Zurich in Switzerland. “We gave the drug orally and waited an hour, but they administered it intravenously just before the scans, so one explanation is that [their] effects were not that strong.”*
Another neuroscientist told Nature that some studies find that lowered activation of the mPFC is associated with anticipatory anxiety rather than calmness or overall lack of depression. The researcher theorizes that the brain images in the current study picked up the participants’ fear, rather than their mystical experiences. But that conflicts with participants’ reports: they said their trips were mainly positive.

Carhart-Harris cautions against using psilocybin outside of a well-monitored therapeutic setting, however, particularly for patients with depression. “What we found was in healthy volunteers,” he says. “They liked the experience and didn’t have negative reactions, but during depression people are more sensitive to having a negative response to psychedelic drugs.”

In fact, that may help explain why psychedelic drugs are rarely addictive and why some of them may even have potential to treat other addictions. Unlike addictive drugs, which typically allow users to escape, psychedelic drugs have the opposite effect: instead of allowing users to avoid negative emotions, they magnify the painful feelings. Researchers believe this may help patients address their problems instead of fleeing them — in the context of an empathetic therapeutic setting — but it can also exacerbate distress. (Psilocybin is illegal in the U.S. and is considered a Schedule 1 drug, a class of substances that “have a high potential for abuse and serve no legitimate medical purpose in the United States,” according to the Department of Justice. Other Schedule 1 drugs include marijuana, heroin and LSD.)

Indeed, the new research bolsters the idea of “psychedelic” as an accurate label for these drugs. The word was originally coined by Huxley, from the Greek “psyche” for mind or soul and “delos” for manifest. A growing body of literature suggests that these drugs can indeed help scientists understand the workings of the mind and brain, by revealing some of the underpinnings of consciousness.

Some have argued, for example, that the geometric visual hallucinations commonly seen by people on psychedelics (and by some sufferers of migraines) help reveal the architecture of the brain’s visual processing mechanism. “One hypothesis is that what you’re actually seeing is the functional organization of the visual cortex itself. The visual cortex is organized in a sort of fractal way [it repeats the same patterns in different sizes]. It’s the same way that fractals are everywhere in nature. Like tree branches, the brain recapitulates [itself],” says Carhart-Harris. “You’re not seeing the cells themselves, but the way they’re organized — as if the brain is revealing itself to itself.”

*Updated to correct quote.

Monday, January 23, 2012

Welcome

Welcome to the class blog! Fresh and ready for you to post responses, comments, questions, and thoughts.