Monday, January 30, 2012

Mothers View Of Preterm Babies

       I think the authors’ choice to study the relationship between genetics and environment and its long term consequences using birth weight was an interesting one. Their explanation was rich with other research to back up their claims. I was very intrigued by the point they brought up about how being labeled “fragile, delicate, or sickly” could be part of the cause of the psychological or physical problems of low birth weight babies. I looked at the study they cited in the Journal of Pediatric Psychology from 1995 where they compared preterm- born 4½ year olds to a comparison group of 4½ year olds born a normal birth. To get around the variable of how the type of environment affects the children, both groups lived in environments free from socioeconomic disadvantages often associated with deleterious outcomes. One of the items on one of the tests given to the mothers of both groups of children stated that preterm babies would have more problems later on. An analysis of this item showed that the mothers of preterm children disagreed on this point more strongly than mothers of the comparison children. I found this interesting because the way the book quoted this study made me think that the parents of these preterm children would treat them as “fragile” children possibly causing problems later on. However, from the study it seems that maybe it is the other parents and the other children that view these preterm children as sickly which as a result, causes them to be just that. Both groups of mothers had high expectations about their children. Mothers of preterm children also believed somewhat more strongly in the power of the environment to produce positive outcomes. This point makes sense since these mothers would believe more in the “nurture” effect on their child’s future, despite their “nature” of being a preterm baby. 

Angela's Response

The first few chapters of The Starting Gate discusses a lot of statistics and research dealing with health issues, in particular low birth weights. Conley states how black people are twice as likely to be born with a low birth weight than whites, and how low income parents are two to three times more likely to have a low birth weight baby (11). The studies that are cited look at social, biological, and/or genetic factors to try to explain these differences, and what causes low birth weights.  However, it seems that study after study cannot give an adequate explanation to the cause of low birth weights since they cannot control every possible factor.  For instance, Conley gives the example that black women above the age of 15 are at a higher risk to have a child of a low birth weight (40).  The reasoning behind this, according to Arline Geronimus, is that these women have been more affected from social inequality.  Because of the stresses resulting from inequality, these women are more likely to have a low birth weight child.  Geronimus gives a social explanation to this issue.  On the other hand, Conley says it may be due to other factors, such as exposure to toxins (40).   It remains unclear to what may cause low birth weights.  Conley tries to answer this problem of race and low birth weight by studying cousins with the same maternal grandparents (50).  The last bar in Figure 2.2 factors out the respondents' characteristics, socioeconomic variables and parental birth weight to see the effect race may have (55).  It seems to me that there are other significant factors that are not accounted for that can be causing the low birth weight.  From what I understand, the study does not examine factors such as diet, prenatal care, exercise, and environment.  The statistics stating the likelihood for certain races and social groups to have a low birth weight is alarming. Researchers, policy makers, and the general public should be concerned on how we should deal with these differences.  However, it seems to be very difficult to figure out solutions to the problem, when there does not seem to be a clear explanation to what is causing low birth weights in the first place. 

Biological and Social Explanations of Race

As stated in The Starting Gate, up to 77% of race differences in premature births could be explained by socioeconomic status (34). However, blacks still face more than twice the risk of whites of low birth weight. Despite varying levels of the effects of class shown through several studies, the question remains: How can we explain race differences as they relate to health? When attempting to answer this question, the issue of approaching race in genetic or societal terms appears. Can race be defined as a biological entity, or should it be viewed as social construct with possible biological connections?

A work that relates to this idea is Michael Omi and Howard Winant’s Racial Formation in the United States. Omi and Winant believe that race is not concrete, but it is also not simply ideological. They define race as "…a concept which signifies and symbolizes social conflicts and interests by referring to different types of human bodies" (Omi and Winant 55). They believe that racial divisions have no biological basis and that the categories used to signify different races are arbitrary and inaccurate (55). Omi and Winant define racial formation as "the sociohistorical process by which racial categories are created, inhabited, transformed, and destroyed" (55). This theory about the social construction of race is mentioned in The Starting Gate, as many scholars have come to the conclusion that categorically defining races has become genetically meaningless in today’s society due to the vast amount of diversity (47).

Conley states, "Given the complicated social context in which research on race and health is carried out, in addition to the trouble legacy of research on race and genetics, considering race and biology can be problematic" (47). I agree with Troy Duster’s statement that, "…when such social-genetic categories influence public health policy, eugenic tendencies develop" (47). In the nineteenth and twentieth centuries, scientific racial hegemonies often used their research to provide what they believed was evidence of biologically based racial inferiority. No matter how well intentioned such studies may be, I believe that it is difficult for the research to remain impartial, due to the history of racial relations in American society. I believe that to explain the connection between race and health, we must take into account the influence of both society and biology.

Social Standing vs Biological Predisposition

The Starting Gate provides a thorough and interesting analysis of the relationship between birth weight and health outcomes. Since low birth rate often occurs alongside social stresses, such as minority racial status, low education, young maternal age, low income, etc, it is difficult to identify whether it is biological versus social determinants which lead to the later challenges confronted by low weight babies. Such infants not only experience increased infant mortality rates, but health risks into adulthood. Dalton et al follow the relationship across generations and among social groups that are prone to low birth rates, specifically african americans. One deduction I found interesting (page 86) was when looking at two groups - one high income, the other low - each with a 20% biological predisposition for having low birth weight babies, the wealthier couples had resources to counteract biological odds. With the resources to provide better nutrition and prenatal care, these families managed to shrink the odds of having low weight babies to 4%, compared to the babies of the low income families, who experienced 17% low birth weight.

While I found the book to be a little difficult to digest because a significant portion of the analysis is devoted to picking apart the complex interplay of variables, it does provide some interesting fodder for addressing the issue, especially among populations that are at risk. This is especially significant since the book demonstrates how low birth weight can have far-reaching implications, into the classroom and adulthood. If hospitals and primary health providers carefully educate pregnant women who have predisposition to low weight babies (especially those of low income), it may have very real and positive future outcomes for those babies. Perhaps investing in ensuring that those children do not end up in the 17% low weight statistic listed above will save tax payers down the line in healthcare and other costs.

Another theme I found interesting on pages 74-76 was the implications of stress on social groups, and how pregnant women with elevated stress levels were susceptible to low weight babies. There have been theories that peoples of racial minorities have some sort of discrimination stress. Perhaps a historical decline in low weight babies among women of social minorities may indicate a decrease in social racial discrimination, in a similar manner as trends of interracial marriages?

Race and birth weight

There have been many debates on whether or not your race determines your life. Starting as early as when you are conceived, and later affecting your entire life span. Although it is an ambiguous and controversial topic, studies have shown that infant mortality has been higher in African American babies compared to white babies. The question is why? Both social and biological factors are looked upon when studying these two race groups yet it is neither a social or biological factor which will determine your child's survival rate, birth weight, and health risks during their life span. It is a mixture of bits and pieces of your culture as well as your biological structure and race. On page 37 of The Starting Gate it states that, “Women living in highly segregated areas are more likely to have low incomes, be unmarried, and be less educated than those living in less segregated areas and these characteristics have all been shown to increase the risk of unhealthy birth outcomes.” The environment in which the mother resides while she is pregnant has an impact on her baby because if she is uneducated and isn’t around needed resources she has a greater chance of being exposed to harmful activities such as drinking or smoking. Also being without the support of a husband she may be more stressed and not mentally prepared for raising a child alone. On page 45 it states that, “… infants of different races may ‘naturally’ come in different sizes due to genetic variations between two populations.” I think that the comparison between the two races is unfair, being that there are biological differences and what is considered normal for one race might be considered abnormal or in this case under weight for the other. “If black babies are ‘naturally’ smaller than white babies, low birth weight for a black baby may not indicate the same level of physiological immaturity, and hence health risk, that it does for a white baby.”(p45) I think this is crucial to the studies because if African American babies tend to be birth, then they were born at a normal weight and there might be no difference in low birth weight when looking at these 2 races after all.

*edited citation page

Sunday, January 29, 2012

Genetic Testing and Abortion: Is It Ethical?

Open the New York Times or peruse any of the nation’s most prominent news publications and you’ll almost certainly cross a headline reporting on the ever-debated topic of abortion in the United States. As we narrow in on the 2012 presidential elections, those on the frontline have become even more impassioned—there’s an incredible push from the left to protect a women’s right to choose, and an equally fiery force from the right with a “right to life” belief, a stance often muddled with the anti-abortion views of the Church.

Being the Massachusetts liberal that I am, I’m the first one to defend a woman’s (and family’s) options around family planning. What if, however, a woman chooses to keep her baby, only to make it approximately 20 weeks into the 40-week gestation period and be read the abnormal results of an amniocentesis (and other genetic tests)…and then decide to abort the fetus? The marvels of modern science have made is possible for man to intervene in arenas he was formerly unable to penetrate: surrogacy, conceiving without a father, pre-implantation gender selection, reduction….and now, advanced and accurate genetic testing. But, is it ethical to terminate a pregnancy on the grounds of developmental challenges? Is it okay to say I want a child, but only a neurotypical one?

On page 47 of The Starting Gate, Troy Duster, author of Back Door to Eugenics, says: “It is no coincidence…that genetically “at risk” populations overlap with social categories of race, ethnicity, and sex. Further, Duster suggests that, when such social-genetic categories influence public health policy, eugenic tendencies develop. Referring specifically to prenatal screening, Duster writes: “This kind of screen heavily implies that if one finds what one is looking for, then termination of the pregnancy is high on the list of potential intervention strategies…””

In 2007 The New York Times published an article called “Genetic Testing + Abortion = ???.” The article addressed the ethics of aborting a genetically abnormal fetus. Where many abortion rights supporters find it morally reprehensible to use abortion to obtain a “particular baby,” 70% of Americans in a National Opinion poll voted in favor of a legal abortion where a genetic defect is known. Some hold that it is exclusively a family matter, one that the government should stay out of.

“The Problem With an Almost-Perfect Genetic World” takes a decidedly different stance. Also a New York Times article, this one published in 2005, talks to the chief of self-advocacy for the National Down Syndrome Society. Ms. Peterson has Down syndrome, and starkly opposes inutero genetic testing for the judgment that it creates. There is an expectation of a “perfect” healthy child, and it’s an image that a baby with developmental delays would not fill for most families. Since about 90% of those carrying genetically abnormal fetuses choose to abort, the communities for all sorts of mental and physical disabilities are shrinking. Andrew Imparato, the president of the American Association of People With Disabilities says, “We’re trying to make a place for ourselves in society at a time when science is trying to remove at least some of us.” Fewer children with disabilities being born certainly lessens the imperative for funding research, and schools may not feel a responsibility to provide strong academic supports and take a stance of inclusion. Is it, perhaps, a woman’s moral obligation to birth these children to maintain community and promote awareness? Is this making a martyr out of a fetus?

Personally, the only reason I see to accept genetic screening is to prepare early-intervention tactics to increase cognitive skills as an infant in the event of genetic abnormalities, perhaps even limited to the over-40 set, as risk is higher with age. I see a big difference between aborting a fetus after a rape or as a teen, and aborting a baby on the grounds that it’s not “normal,” the latter an act I find disgraceful.

Friday, January 27, 2012

On psychedelics and health

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

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


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