Monday, August 29, 2016

Meatless Mondays, Oprah Winfrey, and the Humane Society of the United States

by David Balashinsky

Wayne Pacelle, the CEO of the Humane Society of the United States, recently announced on his organization's Facebook page that Oprah Winfrey has endorsed the Meatless Mondays movement.  In a post that also links to his appearance with Winfrey on SuperSoul Sunday, Pacelle writes, 
The big news coming out of my appearance with Oprah Winfrey on SuperSoul Sunday today is that she took the “Meatless Mondays” pledge and asked her 33.5 million Twitter followers to follow suit. Incredible, high impact, game-changing stuff. On today’s show, she showed such facility for the cause and a great shared passion for fighting for animals, in ways large and small. It’s great to have this amazing woman on our side. 
I write as a long-time and proud monthly financial supporter of the HSUS when I say that I am deeply disappointed to see it sully its reputation by associating itself with Oprah Winfrey.  Yes, Winfrey - to her credit - now endorses the Meatless Mondays movement.  Good for her.  But this is the same Oprah Winfrey who has gone on national television and shilled for SkinMedica, a company that manufactures anti-wrinkle face cream that is made from a line of fibroblasts harvested from the prepuce of an infant who was, in all likelihood, subjected to a non-therapeutic circumcision - a totally unnecessary genital modification surgery that causes infants excruciating pain, violates their right of bodily integrity, permanently removes a normal, sensitive and functional body part, kills over 100 of them and leaves over one million more scarred for life in the United States every year.  Of course, its use in the "beauty cream" industry may be only one of a number of uses to which the genetic material obtained from severed infant prepuces are put but it is easily the most ethically egregious.  How can one oppose an industry that exploits animals and causes them needless suffering while, at the same time, supporting an industry that exploits human infants and causes them needless suffering?  It strikes me as morally inconsistent and hypocritical to refrain from meat consumption on ethical grounds while smearing "beauty cream" made from a stolen human body part on one's face.  Yet this is exactly what Oprah Winfrey has now done.

Winfrey's hypocrisy has been noted by human rights advocates who have rhetorically questioned whether she would similarly endorse beauty products manufactured with the excised genital tissue of girls, given Winfrey's opposition to the practice of FGM.  Winfrey's double standard regarding the right to bodily integrity of boys is thrown into relief more generally by her robust advocacy on behalf of protecting children. But perhaps it is thrown into sharpest relief by her involvement in bringing the tragic story of Henrietta Lacks and the so-called HeLa cell line to the attention of a wide television audience.  Reporting for the Times on Winfrey's movie adaptation of Rebecca Skloot's The Immortal Life of Henrietta Lacks, Salamishah Tillet writes
HeLa emerged as one of the most widely used lines in medical research and helped establish the multibillion-dollar vaccine industry, cancer treatment and in vitro fertilization industry.  This was all done without the knowledge of, consent from or any compensation paid to Lacks's family as it struggled with racism and poverty in Baltimore. 
Winfrey not only stars in this adaptation but served as an executive producer.  What is striking here is that the ethical dimension of the  misappropriation of Lacks's cells - that is, harvesting them and profiting from them without her consent - is identical to that of SkinMedica's use of fibroblasts obtained from a neonate's amputated prepuce without his consent and without any compensation to him.  In response to the controversy regarding the source of fibroblasts for its "beauty products," the founder of SkinMedica, Dr. Richard Fitzpatrick, has pointed out (as paraphrased by Bruce Demara in The Star) that "the cells are grown from a single foreskin obtained more than 20 years ago."  This makes the theft of that individual's cellular material certainly no better ethically than the theft of Lacks's.  In fact, it was almost certainly much worse.  Lack's cells were harvested while she underwent potentially life-saving surgery (to remove her cervical cancer) and she consented to the surgery itself, if not the harvesting and use of her tissue sample for biomedical research.  In contrast, the infant from whom the tissue sample was harvested - and that ultimately was used to make SkinMedica's beauty cream - never consented to the surgical amputation of his prepuce, nor was the surgery, in all probability, medically indicated (since neonatal circumcision is virtually never medically indicated).

The HSUS, as well as many other animal-welfare and animal-rights organizations, has long deplored the use of animals in cosmetics testing not merely because the animals subjected to these tests experience horrific pain but because the tests themselves are absolutely unnecessary.  As unethical as such testing is to begin with, this routine exploitation of animals becomes even more conspicuously unethical when it is done for no more noble a purpose than to gratify human vanity.  Yet how is shearing off part of an infant's penis - without his consent, with insufficient or no anesthesia and resulting in permanent disfigurement and loss of sexual sensation and function - morally any better than painful and inhumane animal testing?  How is exploiting a human infant in the process of manufacturing and selling "beauty cream" (or any other product) morally any better than exploiting an animal in the process of manufacturing and selling cosmetics (or any other product)? 

As Pacelle himself has written, "As harsh as nature is for animals, cruelty comes only from human hands.  We are the creature of conscience, aware of the wrongs we do and fully capable of making things right.  Our best instincts will always tend in that direction. . . ." (The Bond: Our Kinship With Animals, Our Call to Defend Them by Wayne Pacelle; published by William-Morrow/Harper-Collins; 2011; the quotations included here are all taken from excerpts from Pacelle's book that appear on the HSUS website.)  As I understand him, Pacelle is arguing here from the morally unambiguous (if overly optimistic) position that, because human beings have the capacity to entertain the notion of ethics, we have not merely a duty but even an innate impulse to act ethically. The focus of Pacelle's mission is to call humanity to a better version of itself and to apply the standards of integrity, rectitude and compassion to animals that we would like to believe we apply to ourselves - or, as Pacelle puts it, to uphold "the decent and honorable code that makes us care for creatures who are entirely at our mercy."  

Doesn't it go without saying that we have no less a duty to apply these same standards to our fellow human beings?  Doesn't "the decent and honorable code that makes us care for creatures who are entirely at our mercy" apply no less to infant boys than to our fellow living creatures?  Pacelle continues:
Especially within the last 200 years, we've come to apply an industrial mindset to the use of animals, too often viewing them as if they were nothing but articles of commerce, the raw material of science, or mere obstacles in the path of our own progress.  Here, as in other pursuits, human ingenuity has a way of outrunning human conscience, and some things we do only because we can - forgetting to ask whether we should.
Exactly these observations, criticisms, and questions are at the very heart of the genital autonomy movement: a movement that seeks to end the medically unwarranted but culturally normalized practices of involuntary male circumcision, female genital mutilation and the non-therapeutic sex-assignment surgery on the genitals of intersex children.   Indeed, with respect to involuntary male circumcision and the for-profit use of the genital tissue obtained by it, I can think of no more fitting a description than Pacelle's trenchant observation that "as in other pursuits, human ingenuity has a way of outrunning human conscience, and some things we do only because we can - forgetting to ask whether we should." 

Subjecting an infant to a medically unnecessary and irreversible amputation of part of his body is unethical.  To then profit from the use of that infant's excised body part in the manufacture of "beauty cream" as SkinMedica does is, by orders of magnitude, even more unethical: it is a moral abomination.  Oprah Winfrey has enthusiastically promoted this practice and this product.  I cannot think of a poorer choice as a spokesperson for the Meatless Mondays movement, much less everything else that the HSUS stands for, than Oprah Winfrey.

Postscripts: When this essay was originally published, Wayne Pacelle was the CEO of the Humane Society of the United States.  He has since resigned from that position.  After initially voting to retain Pacelle - a vote that prompted seven of its members to resign in protest - the HSUS's board of directors issued a statement implicitly condemning Pacelle for having violated the organization's sexual harassment policy and naming Kitty Block, a longtime HSUS staff attorney, as acting President and CEO.

Note also that this essay has been revised (on 6 May 2018) in order to address the circumstance of Winfrey's subsequent involvement in bringing the saga of Henrietta Lacks's stolen genetic material to the screen.

Sunday, August 28, 2016

Where They Stand: Straddling the Great Divide Between Non-Therapeutic Circumcision and Pain-Prevention in Neonates

by David Balashinsky

Earlier this year, the AAP published a revised policy statement regarding procedural pain in neonates.  The very first recommendation, as it appears in the Abstract section of the new policy statement (AAP Gateway, Pediatrics; February 2016, Volume 137 / Issue 2) is that "The prevention of pain in neonates should be the goal of all pediatricians and health care professionals who work with neonates. . . ."  In the Background section, the revised policy also states, in part, "The prevention and alleviation of pain in neonates . . . is important not only because it is ethical but also because exposure to repeated painful stimuli early in life is known to have short- and long-term adverse sequelae."  The AAP's policy also states (again, returning to the Abstract): "every health care facility caring for neonates should implement . . . a pain-prevention program that includes strategies for minimizing the number of painful procedures performed. . . ."  

I take it as axiomatic that the starting point for "preventing or minimizing pain" is avoiding unnecessary pain in the first place.  That being the case, one wonders how the AAP reconciles these humane and common-sense recommendations with its continued support for  nontherapeutic infant circumcision.

Nontherapeutic infant circumcision, which is still routinely practiced in the United Sates, in contrast to most of the developed world, and which is overwhelmingly practiced here for reasons of custom or cosmesis, is a medically unnecessary surgery that violates the four most basic and important principles of medical ethics.  First, not to do harm.  Second, not to provide a treatment in the absence of a medical problem (such as a disease or harmful congenital deformity). Third, to opt for the least invasive or aggressive treatment available when there is a disease or other medical problem.  And, fourth, to obtain consent from the patient before rendering care unless the patient is incapable of providing consent and the treatment is required urgently to save life or limb. Nontherapeutic infant circumcision violates every one of these principles.  Every one of the "health benefits" on the basis of which  infant circumcision is rationalized can be achieved through the use of non-painful and non-invasive means, such as the practice  of basic hygiene, the administration of the HPV vaccine, the use of a condom in order to prevent the spread of STIs, or the use of antibiotics or other non-painful and minimally invasive treatments when a pathological condition, such as a UTI for example, does occur - in other words, exactly the same prophylactic and remedial approach to genitourinary health as is employed with girls.   Even something as simple as not smoking has been proven to have a greater effect upon reducing a man's chances of developing penile cancer than circumcision has.  

Above and beyond all this, circumcision causes extreme pain and distress to the neonate who is subjected to it.  For generations, circumcision was routinely performed without any pain-relief whatsoever in the absurd belief that infants are incapable of experiencing pain. Today, with over one million circumcisions still performed annually in the United States, the application of adequate or even any pain relief is by no means universal nor is it mandated by law.  By some estimates, even now, only 25% of children who are subjected to circumcision receive adequate anesthesia.

The AAP concedes that "existing scientific evidence is not sufficient to recommend routine circumcision."  And yet, lacking sufficient evidence-based medical justification for nontherapeutic circumcision, the position of the AAP, as articulated in its most recent policy statement (2012) is that "the final decision should still be left to parents to make in the context of their religious, ethical and cultural beliefs."  Why does the AAP, an organization of medical professionals that professes to be "dedicated to the health, safety, and well being of infants," continue to defend a painful and medically unnecessary surgery on the basis of "religious, ethical, and cultural beliefs"?  How is subjecting male infants to circumcision for cultural or religious reasons ethically any different from subjecting girls to "female circumcision," which is also performed for cultural and religious reasons?  Defenders of infant male circumcision in the United States are quick to claim that male genital cutting and female genital cutting are fundamentally dissimilar - but isn't this just a form of cultural arrogance?   It amounts to claiming "It's okay when we do it."  But it is merely the distorting lens of one's own cultural context that makes these two practices appear to be fundamentally different.  In a culture in which male circumcision has been normalized but female circumcision has not, the two practices are simply judged by different yardsticks.  Yet there is no rational scientific or medical basis for hypothesizing and studying the potential health benefits of surgical modification to male genitalia while denying a priori any comparable health benefits of surgical modification to female genitalia.  

This raises an important question:  If studies were to suggest that the "benefits" of female genital cutting outweigh the "risks," would the AAP likewise endorse "access to this procedure for families who choose it" (to use the AAP's parlance)?  That is not a farfetched hypothetical question.  In Egypt, where female genital cutting remains common, its defenders include physicians who claim, just as the AAP does on behalf of male circumcision, that female circumcision is medically justified.  It is probably not a coincidence that female circumcision is now, in the 21st century, increasingly becoming "medicalized" (that is, performed in hospitals under aseptic conditions and justified on medical grounds) just as male circumcision became medicalized in Great Britain and North America in the 19th century and is now becoming medicalized in Africa. (Indeed, one might reasonably speculate that the defenders of female circumcision have now taken a page from the AAP's book.)   Nor is it a coincidence that the "benefits" of female circumcision closely parallel the myriad claims that are routinely made in defense of male circumcision, including "improved aesthetics and hygiene."  The inescapable conclusion of all this is that the AAP endorses what is essentially a cultural practice that harms infants and causes them excruciating pain needlessly even as it acknowledges that there is insufficient medical evidence to support routine infant circumcision (RIC) and even though, as the AAP now acknowledges in its latest policy statement on neonate pain management, "there are significant research gaps regarding the assessment, management, and outcomes of neonatal pain; and there is a continuing need for studies evaluating the effects of neonatal pain and pain-prevention strategies on long-term neurodevelopmental, behavioral, and cognitive outcomes."

As controversial as nontherapeutic circumcision is, there remains one fact about it that is not in dispute that, to my knowledge, the AAP has never addressed.  This is that no infant ever consents to his own circumcision.  Consider again the AAP's position statement that "the procedure's benefits justify access to this procedure for families who choose it."  But, of course, it is not "families" who choose circumcision but parents.  The individual himself  - the one who is actually being circumcised and, therefore, the only person whose opinion should actually matter - has no say at all.  But by what right of parental authority is it ethical or appropriate for a parent to order the medically unnecessary amputation of a part of his or her child's body?  And by what principle of medical ethics does the AAP endorse such a parental prerogative?  Throughout the AAP's deliberations regarding its official stance on circumcision, how much weight was given to the right of the individual himself not to have part of his penis amputated without his consent?  Where is the AAP's recognition that every human being is born with an innate and sacrosanct right to ownership and control of his own body?   Infants, after all, do not remain infants forever. Circumcision, on the other hand, is permanent.  (And, of course, there is absolutely nothing to prevent an intact adult male from choosing for himself  to undergo a circumcision once he is old enough to weigh for himself the costs and potential benefits of circumcision.)  Where is there any acknowledgement by the AAP that the man the circumcised infant will one day become may object to having had a functional and erogenous part of his penis amputated on the basis of nothing more substantial than an amalgamation of superstition, cultural norms, religious beliefs, and tenuous medical justifications?  Was there ever even a passing consideration by the AAP's task force on circumcision  that that man may prefer to have experienced life with his body whole and his penis intact?   The AAP equivocates about the "risks" of circumcision (while conceding that no one actually knows for certain what those risks are) yet refuses to acknowledge even now that circumcision is a harm in and of itself.   If the AAP's refusal to recognize this fact is predicated on its dismissal of the functions and importance of the male prepuce, including its role in sexual sensation for both male and female and its functional role during coitus, it is predicated even more fundamentally on the AAP's apparent disdain for the right of the individual to decide for himself which parts of his body are important to him -  and to decide for himself which parts of his body he gets to keep and which parts get cut off. 

It's time for the AAP to live up to the lofty ideals of its professed mission "to attain optimal physical, mental, and social health and well-being for all infants, children, adolescents and young adults."  The AAP has an ethical duty to protect children; that ethical duty is incumbent upon each of its members, as well.  That duty includes refraining from subjecting neonates to painful and unnecessary surgeries, especially a surgery that results in the permanent loss of a functional and sensitive body part that every neonate, every infant, every child, every adolescent, and every man has a right to retain and to have retained into adulthood.  Revising its policy on circumcision so as to bring it into conformity with the AAP's recent policy statement on neonate pain-prevention - to say nothing of bringing it into conformity with the principles of medical ethics and into conformity with a basic respect for infants' and men's fundamental human right to physical integrity - would bring the AAP a long way toward realizing its stated goal of "preventing or minimizing pain in neonates."

Thursday, August 11, 2016

A Short Critique of the Women's Gymnastics Floor Routine

by David Balashinsky

I have long been bothered by the women's gymnastics floor routine and this, the quadrennial Olympics season, offers a suitable opportunity to explain why.  What bothers me is the sexism and the conspicuous gender-construction of it.  The cloying mincing and prancing and the striking of quasi-sexy poses makes the event unbearably awkward and embarrassing to watch.  These turn what ought to be a demonstration of athletic prowess into something akin to a latter-day Dance of the Seven Veils.  Could you imagine male gymnasts performing like this?  Gymnastics is gymnastics.  A sumersault is a sumersault.  Why is it necessary for gymnastics pyrotechnics to be punctuated by the gymnast's arching her back and sticking out her buttocks when the gymnast is a woman but not when the gymnast is a man?  Why is it  necessary for the routines to be accompanied by music and the tumbling interspersed with dance steps when performed by women but not when performed by men?  What do any of these absurd and uncomfortably sexualizing embellishments have to do with gymnastics, anyway?  Why is it not enough for women gymnasts to excel at gymnastics without having to overlay their floor routines with wheedling smiles, constructed and exaggerated femininity, and the overt sexualization of their bodies?

Consider the numerous other sports that female and male athletes both compete in: weight lifting, boxing, equestrian events, track and field - the list is long.  Yet in none of these other events are women expected to perform the sport in a manner that is so thoroughly permeated with gender that it alters the character of the sport itself and results in such a marked difference between the way women and men perform it.  Take the heptathlon, for example.  Could you imagine the women athletes having to perform one of the seven sports that comprise this event to music, and interspersing the activities - say, the shot put or the javelin throw - with mincing, prancing, and dancing around?  Why is the women's gymnastics floor routine treated differently?

Of course, sexism has always determined which events women and men are permitted to compete in.  Nor is the gymnastics floor routine the only Olympic event in which an artificial and socially constructed gender difference is rigidly enforced.  But in the only other two notable Olympic events that I can think of in which it is - synchronized swimming and rhythmic gymnastics - the differentiation between female and male is so complete that males do not even get to participate in them.  In contrast, I am speaking here of precisely how the gymnastics floor routines - which both women and men do perform - are performed so differently when performed by each.  (And there is, of course, no rational, non-sexist reason why men should not compete in either synchronized swimming or rhythmic gymnastics.)

A useful test for sexism consists in the simple thought experiment in which a man replaces the woman (or a boy the girl) in any social context or artistic rendering; everything else remains unchanged: only the sex of the participant is different.  Watch any modern women's floor routine but imagine that it is a man performing.  I'm sure what you are seeing in your mind's eye will make you squirm (and if it doesn't, it should).  The male gymnast performing exactly those steps and striking exactly those poses would look foolish and ridiculous.  You'd likely consider it absurd and degrading (and if you didn't, you should).  What does it say about our culture that movements and poses that are considered cute and sexy when performed by women are considered absurd and degrading when performed by men? That we take it for granted that women gymnasts should perform their floor routines in a manner that would look degrading, foolish, and ridiculous when performed in exactly the same way by men demonstrates not only how thoroughly our concepts of male, female, and gender are shaped (and warped) by our culture but how the constructs of masculinity and femininity empower men while disempowering women, respectively.  At the same time, it demonstrates how thoroughly the sport of gymnastics has been perverted by sexism.  For when you watch a women's gymnastics floor routine, what you are really witnessing is a sexual double standard: the incessant and ubiquitous sexualization of women's bodies that is demanded of women when they are the focus of attention in the public sphere.

Let me anticipate a criticism of my thesis: that the women's floor routine is an anomaly, as suggested by the fact that there are so many other events - including certain women's gymnastic events, such as the uneven parallel bars and the vault - where there is little or no differentiation between female and male based on the social construct of gender.  To make a general statement about this, the disparate treatment of female and male in the gymnastics floor routine itself, it seems to me, is an argument rather for doing away with the convention than maintaining it.  If overt gender construction is not needed in all the other events, it's hard to see why it should be needed in this one.

Why then does the convention of music, dancing and often lewd posing in the women's floor routine exist?  I attribute this to two factors.

First, undoubtedly, the women's floor routine lends itself to being turned into a sort of dance routine simply because it is performed on a flat surface and involves movement that has  an essentially aesthetic component, as opposed to an objective component, such as hitting a bullseye or jumping higher, as measured in millimeters, than one's adversaries.  Gymnastics, after all, is judged largely by subjective rather than objective standards.  And where subjectivity prevails, cultural norms will tend to predominate.  But the men's floor routine is also performed on a large flat surface and incorporates movements that are judged largely by aesthetic criteria.  But whereas the men's floor routine tends to incorporate socially constructed notions of masculinity, the women's floor routine tends to incorporate socially constructed notions of femininity.  It goes without saying that, in the case of the men's floor routine, masculinity consists in strength, power, agility, determination, and seriousness (when is the last time you saw a male gymnast smile ingratiatingly at the audience during the performance of his routine?).  And in the case of the women's floor routine, femininity (as specifically tailored for this event - it is gymnastics, after all) incorporates, in addition to the strength, power, agility, determination, and seriousness of the gymnast herself, the additional obligatory characteristics of daintiness, cuteness, sexuality, and submissiveness.  (Striking poses such as those that women gymnasts typically assume throughout the performance of their floor routines is analogous to a display of submissiveness in the animal kingdom so as to forestall an act of aggression when a threat is perceived: thus are women expected in our culture to forestall aggression with overt displays of ingratiation and subservience.  Surely many men come to expect this sort display of submission as their due, and surely this is why men not infrequently exhort women - perfect strangers - when they pass them in the street, to "Smile, Honey.")

The second factor is simply this.  The failure of sexism to permeate the other events that women athletes engage in should not be interpreted as evidence that it is not sexism that has distorted the women's gymnastics floor routine.  Sexism in sports, because it reflects sexism in our culture, tends to manifest itself in different ways depending on the context.  It is not that sexism does not tend to push its tentacles into everything that it can.  It just tends to succeed better in some contexts than in others, in the way that a fungus or parasite will thrive on some hosts and in some environments better than others.  Alas, such is the case with the women's gymnastics floor routine.