Digital Naivete

I suppose it was inevitable; I suppose I should have guessed… When you are charged with consulting on a generation that seeks its information online, there are issues that are only apparent in that venue. And treatment algorithms which don’t take that into consideration are woefully naïve. Doomed to fail.

There are smartphone apps for everything I guess, but in an Ob/Gyne practice like mine, there are only two that my patients seem willing to share with me: obstetrical dating apps that disclose the expected date of baby’s arrival, and period tracking apps. In an age of constant immersion in information sharing and with an understandable need for inclusion in any decision making, I think that both of these programs -especially the menstrual tracker- would be considered especially useful to any women at risk of pregnancy, particularly so if they also suffered from irregular periods. A natural extension of that, then, might be to extend its use. To adapt it for another purpose for which it was not originally intended -a technological exaptation.

But an article a while ago in the BBC news (also an app, by the way) looked at some of the pros and cons of menstrual tracking apps: http://www.bbc.com/news/health-37013217 that raise some serious concerns.

The idea of being able to follow one’s periods without the need to carry a marked calendar around is appealing, to say the least. It might also allow the recognition of a pattern in an otherwise seemingly random sequence. And even with a predictable cycle, other discernibly helpful patterns may become obvious. As one English singer put it: “When you are starting your period or you’re pre-menstrual, the hormones that rush around your body affect your larynx in ways that are detrimental to your singing voice. I use the app to avoid auditions, premieres or really important performances on those days if I can.” And, ‘The app also helps her identify connections with changes in her emotions, eating habits and headaches’.

So far, so good. As that English singer put it: “Being able to chart what happens to you and how you uniquely respond to your cycle is a great way of taking ownership of something that really sucks – but is completely necessary.” Perhaps the more you know about how unique you are (or aren’t) the more likely you are to feel in control –not simply a table of random numbers, a caster of dice… But there is a danger in relying too heavily on a reading and analysis of an app that merely calendarizes a menstrual cycle –especially an irregular one.

Yes, it is generally true that one usually ovulates about two weeks (or so) before the period starts, but each cycle has been exposed to a different set of conditions –stress, exercise, illness, and so on- so the rule is not reliable. Especially for contraception. The time period before ovulation (the follicular phase) while the egg is being readied in the follicle can be quite variable. If not using serial blood tests, or the like, one needs at least temperature charting and/or mucous testing to discover more reliably when ovulation has occurred… and then, of course, it’s probably too late to take precautions to avoid pregnancy.

The phase after ovulation (secretory phase) is also variable –although often less so- for a variety of reasons, so it won’t reliably predict the exact timing of an oncoming and expected period either.

The whole tracker app thing can be thought of as a digital rhythm method. And if you subscribe to that philosophy, a period tracker app may help you to remember when your last period started, so you can practice periodic abstinence. The Mayo Clinic suggests that with dedicated and consistent observance of this method, one might expect a failure rate of perhaps 13%. Although we all must decide what risk is acceptable given our circumstances, it does seem high in comparison with most other forms of contraception. And, ‘[…] the Royal College of Obstetricians and Gynaecologists has warned they [period tracking apps] should not be used as a form of contraception.’

Another thing that worries me about many of these apps –especially the downloadable free ones- is security of the information that you need to submit. As a privacy campaigner for medConfidential –a British privacy advocacy group- points out: ‘[…] if an app is free, consider whether you are paying for it in effect by giving away your data – and investigate where it might be going.’

With the blooming crop of digital savants, I suppose the posting of a cautionary list is merely an annoying Jeremiad from an older, and more naïve generation. And yet, there is more than a tittle of necessity to the reminders. Sometimes even the young need to step back and critically examine what they have come to believe is commonly accepted and practiced amongst their peers. The wisdom of the crowd differs markedly from the wisdom of the individual and although we may wish something to be so, as Plato observed: ‘Real knowledge is to know the extent of one’s ignorance.’

Or, put another way, with all due deference to the digital generation, Shakespeare’s immortal line in Julius Caesar: ‘Your wisdom is consumed in confidence’. Don’t let it be so…

 

 

 

 

 

 

The Grief that does not Speak

How weary, stale, flat, and unprofitable seem to me all the uses of this world!

Like Hamlet, we all recognize this mood: the black dog lying in the noonday sun, the cloud that even hides the moon. It is the tear that defeats the wavering smile –and yet… And yet, there is often something more behind the grief, something that is hidden beneath the first impression. Shakespeare, again, understood this over four hundred years ago: ‘Give sorrow words. The grief that does not speak whispers the o’erfraught heart and bids it break.’

I suppose we all impose our own reality; we all see the world through our own experience. But, sometimes we see through that glass darkly. Things are not always what they seem.

Alethea looked calm and happy as she sat in my waiting room. In fact, she was smiling and talking with a little child who’d toddled over to her in his diapers with a toy. She was bending over in her seat, her long black hair almost reaching the little boy, as she tried to make him laugh. Her full-length black, cotton skirt and her blue silk blouse contrasted sharply with his bulky white diapers –a chiaroscuro worthy of a picture, but he waddled off to another woman as quickly as he’d arrived. The waiting room is like that here: a work in progress; an evanescent scene of fleeting beauty.

Alethea smiled again when I greeted her, and examined me with friendly eyes. I had anticipated avoidance, or at least timidity from a woman referred to me with recalcitrant depression. A woman, according to a rather extensive explanatory note, who seemed refractory to multiple attempts at treatment. But I’m a gynaecologist, and although we’re sometimes involved on the edges of depressive illnesses, most of us lay no claim to the territory. We’re adjuncts –often last-minute guests- invited to the therapy just in case; we’re seldom primaries.

But in my office, she seemed less at ease, her eyes flitting from the plants in their pots to the eclectic pictures hanging on the walls. They spent some time inspecting a terra cotta sculpture of a woman begging with a bowl that I’d positioned on a little oak table.

“You certainly have wide-ranging tastes, doctor.” I don’t think she meant it as a criticism, so I took it as the long missing compliment I have yet to hear from my staff.

I smiled, and opened up the computer.

“I’m afraid my GP wrote a rather long note justifying the referral to you; she seems quite worried –or maybe frustrated with me.” Alethea rested her eyes on me for a few seconds. “I asked to see you rather than a psychiatrist.” And then she chuckled. “She was not happy about that, I’m afraid.”

I pushed the computer to one side and sat back in my chair. “Do you mind if I hear your version, first?” I asked.

“Thought you’d never ask,” she said as she made herself more comfortable in the sturdy, old wooden captain’s chair that I insisted on keeping across from my desk, her eyes twinkling with amusement at my suggestion, but still cautious.

“Well,” she started, obviously trying to place the events in their proper order, “A few months ago, I went to see my GP because of some problems I was having –you know, coping stuff,” she added when I wrinkled my forehead. “Anyway, I was in tears when I sat down in her office and had trouble even talking to her without crying.

“She got very clinical and I could tell she was trying to remain an objective observer.” Alethea rolled her eyes and sighed. “She does that sometimes when all I need is a hug or something.” She risked a quick glance at my expression. “But I realize that’s not what doctors are supposed to do…

“Anyway, she asked me all the usual questions about my work, and my home life…” Alethea blinked and looked away. “I think she felt a bit uncomfortable with that part because my partner also used to go to her.” Suddenly she stared at me and I could feel the anger in her eyes. “I really don’t know why that would matter…”

She quickly snatched a tissue from my desk and wiped her eyes. “I’m sorry, doctor, I guess my GP is not the only one who gets frustrated.” She took a long, deep breath and exhaled it slowly. “She said she’d never seen me like that before, and that whatever might be going on, I was seeing it through the lens of depression.” She glared at the begging lady statue for a moment. “She actually said ‘lens of depression’ for god’s sake! Like no matter what I said, or experienced, it was somehow misinterpreted through that bloody lens, or whatever.”

Alethea seemed uncomfortable and kept readjusting her body on the hard chair so I pointed to a more comfortable one nearby. That got her smiling again, but I could tell she was still angry.

“She insisted I go on one of those new antidepressant medications –you know, the ones that aren’t supposed to make you tired. The ‘no side-effects pill’ she called it. ‘Just try It for a few weeks and let me know if it helps,’ she said and escorted me to the door, all buddy-buddy.”

She brought the comfortable chair close to the desk and helped herself to a handful of tissues. “But it only made things… worse.”

I leaned forward on my chair, detecting something she was implying in the way she said that word. “How do you mean, Alethea?”

A tear rolled down her cheek and she dabbed it with the tissue. “I didn’t feel at all like sex, when I was taking it and…” She hesitated for a moment. “And that really made her mad.”

I was confused. “Made who mad?”

She was staring at her lap, but her eyes wandered up to my face for a brief look before she called them back. “My partner.” She sighed again. “So I decided to go off the antidepressants after a while and went back to the GP. She seemed upset that I had only given them a month, and said I was still acting depressed. At that point she said I needed to see a psychiatrist, but I refused. ‘You have a chemical imbalance,’ she almost screamed at me, and implied that if I didn’t get help soon, there might be dire consequences.” Alethea glanced at me again. “I suppose she thought I might try to off myself or something.” She giggled at the thought and when I looked puzzled, she smiled and continued. “Maybe it’s your birth control pill, Alethea. I don’t know why you insist on taking them anyway.’” Alethea’s face turned mischievous and her eyes twinkled like when she first came in. “Because I’m Bi, you stupid woman!” she said and laughed. “Well, I didn’t actually say that to her, but I felt like it…

“Anyway, I convinced my GP to send me to you.”

I squirmed a little uncomfortably in my own, soft chair. “Why me?”

A playful smile emerged. “My aunt and cousin see you… They said maybe you’d listen.”

I think I blushed. “And what about your partner? Did she think you were… depressed?” I hesitated before using that word. “Did she listen?”

Alethea’s face suddenly tensed. “She was abusive,” she said between gritted teeth, and sent her eyes to scout my face again. “She used to scream at me and throw things around. I hated going home after work.”

“Did you tell that to your GP?”

She shrugged. “I told you, she felt uncomfortable about it. And anyway, she had a diagnosis –and a treatment,” she added, with a wry smile. “That’s what medicine is about nowadays, isn’t it?” The smile disappeared, to be replaced by a sweet grin. “And once you have a treatment, it’s… Next!” she said, rolling her eyes, and we both laughed.

“And so what’s happening now? Are you still with your partner?”

Her face beamed and her eyes sparkled. “Now, I’m back with my old boyfriend -it takes a long time to get in to see you,” she explained with a chuckle. “We’re even planning to have a child soon, maybe.” Her eyes hovered under the ceiling for a second or two. “I guess I wasted your time, doctor, but my aunt was right -it does help to talk about it… And I thought I should meet you anyway,” she added, and decided to make eye contact again. “You delivered my cousin last year…” The twinkle returned. “Care to see me again –in a while?”

I think my smile told her I’d love to see her again.

And as she left, I couldn’t help but think of that wonderful metaphor of Khalil Gibran: ‘Sadness’, he said, ‘is but a wall between two gardens.’

It certainly is.

Is Beauty really skin deep?

Although love looks not with the eyes but with the mind, as Shakespeare reminds us, there is a redness of the cheek that is not as kind as a simple blush. So may the outward shows be least themselves, he also says. The world is still deceived with ornament.

Acne arrives at the wrong time of life; it usually declares itself around the same time a teenager is trying to establish her identity; trying to acquire independence; experimenting with relationships outside the family. It is a time of uncertainty when self-esteem and confidence may be suspended, like the Sword of Damocles, on that single hair of outward appearance.

Acne is nothing new; it has probably been around as long as there has been skin with hair follicles to get blocked. Oil from glands is one of the culprits and these are more common on the face and upper body. The hormonal changes of puberty may result in changes in activity of these glands -that, plus genetics, and excessive growth of the bacterium Propionibacterium acnes, all contribute to the unfortunate timing.

An article last summer in the BBC News reminded me of the consequences that affected a patient I once saw in my office for gynaecological consultation.  http://www.bbc.co.uk/newsbeat/article/36712810/doctors-warn-acne-could-become-resistant-to-antibiotics

The waiting room was full that day and I saw Janice sitting quietly in the corner, her face almost buried in a magazine. She was a tall, thin, sixteen-year-old wearing tight designer jeans with a cream-coloured baggy sweater and beautiful deep blue hijab that she wore sufficiently loosely around her head that, even when she looked up, seemed to cover most of her face.

At first I wasn’t sure what to make of this. I wondered if it might be a cultural, or religious requirement for seeing a male gynaecologist -or merely a teenage affectation. But apart from her continuing reluctance to expose her face, she seemed more at ease once she was seated in my office.

The consultation note from her GP was one word: Contraception!! -with two exclamation marks. I took that as a sign.

“So, what can I do for you, Janice?” I usually like to let the patient tell me why they were referred; it’s sometimes different than what the family doctor thinks.

She shrugged. “Birth control, I guess…” But she seemed rather unsure.

I smiled and tried to make eye contact, but she continued to look away, first to a painting on the wall beside her, and then to the other wall where I had placed a terra cotta statue of begging woman on an oak stand. Janice seemed to favour the statue.

“Is that for tips?” she said, indicating the bowl the woman was holding in front of her. It was filled to overflowing with coins.

I laughed and shook my head. Everybody seems to ask the same question, and then puts a coin on the pile. “I’m not sure why some people do that, but I empty it from time to time and give it to real people begging on the street. I like to think that’s what my patients want me to do with it.”

She turned her head to look at me and I could see a smile peeking from the shadows inside the hijab. “I didn’t bring any change…”

My smile broadened. “That’s okay, I’ll put a coin in the bowl later for you if you like.”

The hijab nodded.

I settled back in my chair. “So you want to discuss contraception, Janice?” Another nod. “What have you been using so far?”

She shrugged. “Condoms at first…” She hesitated and then sighed. “Then when we got to know each other better, I went on the pill.”

“Is that what you’re on now?”

She shook her head. “They didn’t work. Well…” She lowered her head, so all I could see was the top of her hijab. “Actually, I kept forgetting to start them again after my period…” Two eyes peeked timidly from the shadows on her face. “So I had a couple of… accidents.”

She said the last word in a whisper I could hardly hear as she lowered her head to look at her lap. Suddenly, her head jerked upwards to face me and she pulled the hijab back so I could finally see her face. Both her cheeks were rough and jagged seas of red nodules, some weeping and moist, some merely little cysts about to burst. I could understand why she had chosen to wear her hijab as she did.

“My GP tried me on several kinds of treatments for the condition, but none of them helped. In fact, it was getting worse, so she sent me to a dermatologist. And she just put me back on higher doses of some antibiotic I’d already been on: mino-something.

“Minocycline?”

She nodded, and her eyes filled with tears, so I handed her a tissue from the desk. “But she said it was dangerous for a developing baby, so I had to stay on the birth control pill.” She looked up at the ceiling for a moment, shaking her head. “I told her I kept forgetting to take them, but the doctor just shrugged and told me to write little notes for myself… Stupid woman!

“After the second abortion, my boyfriend and I decided the birth control pills didn’t work so I stopped them. When I told my GP about it, she took me off the antibiotics, too… I guess because she thought I might get pregnant again…” She wiped her eyes and grabbed another tissue from the box I kept on the desk. “And now look at me!”

Her eyes flitted around my face for a moment, and then she summoned them back. “They wanted to put an IUD in me at the time of the second… procedure, but I wouldn’t let them.” Her eyes found mine again. “They recommended the hormonal one.” She seemed on the verge of tears again. “But they told me it might worsen the acne.”

All of a sudden, she leaned over the desk towards me –as if she wanted me to really see what she had to deal with. “I can’t stand my face like this!” She sat back in her seat again. “My boyfriend has already left me; my friends whisper behind my back. Everybody is afraid to look me in the face…” She grabbed a handful of tissues this time and dabbed her cheeks when she’d dried her eyes. “I’m really confused, doctor. Nobody seems to know what they’re doing; they keep changing their minds…

“I can’t go on like this! I can’t…” She took a deep ragged breath. “I need somebody to tell me what to do before I fall off the edge… Or jump,” I heard her whisper into the folds of her hijab.

And then her eyes almost bored into my skull. “Can you help me, doctor?”

Her expression worried me; she was desperate and clearly in crisis -obviously at that edge. I had to do something.

“Tell me, Janice, when you were on both the pill and the antibiotics that last time, was your acne improving?”

She nodded vigorously. “The doctor told me the hormones in the pill sometimes help.”

I smiled in agreement, although I didn’t feel comfortable dealing with acne; I suspected she needed to go back on the antibiotics and her GP was right, she needed absolute protection against pregnancy while she was on them. Minocycline is a class D drug –meaning there is positive evidence of human fetal risk.

And then something occurred to me. “Was it only when you were restarting the birth control pill after your period finished that you forgot to take them?”

She nodded, obviously embarrassed. “There was a lot going on in those days…”

“But you were happy with the pill? I mean it wasn’t giving you any problems?”

“No… except for the pregnancies.”

“So, if you didn’t have to stop the pill for a period, would that work for you?” I watched her closely. “I mean, do you think you would remember to take them?”

She nodded carefully, and stared at me. “Yes… But you mean I wouldn’t have any periods?”

I nodded. “You can take the birth control pill every day for three or four months at time –or even more- then stop and have a period.” Sometimes the simplest solutions work the best.

She thought about it for a moment. “Uhmm… But if I didn’t get my period, how would I know I wasn’t pregnant?”

A good question. I smiled what I hoped was a reassuring smile. “Well, it’s true that Minocycline can interfere with the absorption of the pill, but the risk of pregnancy is still low. And you should supplement the pill with a condom.” I waited till she made eye contact again. “In fact, if you’re starting a new relationship, wouldn’t condoms be a reasonable precaution anyway?”

The acne made way for a face-swallowing smile. “I’ve sworn off sex… Well, at least until I get my face back.” I could tell she was blushing, even under the hijab. Even under the acne.

But I could finally hear some hope in her voice, and I was reminded of another verse from Shakespeare: ‘I will go wash; and when my face is fair, you shall perceive whether I blush or no.’ It seemed fitting, somehow…

 

Earthing Unearthed

Sometimes I feel disconnected. It’s almost as if I have been traveling on a highway all my life, largely unaware of the myriad roads that emanate from it. Unaware of the different coloured horizons that have been hiding out there all along. Or is skulking sometimes a better descriptor? Every so often I come across a concept so… bizarre, that I wonder how it even survived long enough to acquire a name. ‘Earthing’ caught my attention immediately.

I feel I have to explain that I don’t go looking for these things, but in the spirit of full disclosure I will confess to being a one-time member of the Skeptics Society –one time, I suppose, because the time constraints of a busy medical practice required that I relinquish at least some of my addenda. Now, retired and awash in compensatory time, I dabble once again.

‘Earthing’, for those of you as naïve as myself, is the act of walking barefoot –not just on the beach or over the soft grass of a lawn, however. It is to soak up earth’s energy fields previously denied to you –blocked, in effect- by your shoes. These energy fields apparently supply free electrons replete with many health benefits. Shoes, as disruptors, ‘[…] allegedly cause inflammation and autoimmune diseases, circadian rhythm disruptions, hormonal disorders, cortisol disorders, heart rate variability problems, arthritis, herpes, hepatitis, insomnia, chronic pain, exhaustion, stress, anxiety, premature aging […].’ http://www.skeptic.com/reading_room/bogus-claims-grounding-bare-feet-to-earth/ Uhmm…

How could I have journeyed so far along the trail of years and not heard this coming up behind me? Call me old fashioned, if you will –or just ‘old’, perhaps- but I would still feel more comfortable if there were credible, corroborative and objective evidence to substantiate assertions before I even decide to consider them -let alone examine them seriously… Anybody can claim things, but as Carl Sagan once declared: ‘extraordinary claims, require extraordinary evidence’.

Now I have to say that just because something seems counterintuitive, I don’t think it should be simply dismissed out of hand. Paradigms do shift, after all. But they still require critical analysis; it is not enough to suggest that, as in the case of homeopathy, for example, any attempt to verify it destroys the field in which it exists. Nor are statements like, ‘It may be that our connection with the earth carries information, helping align us with the greater network of intelligence of our planet.’ either provable, or refutable –the famous philosopher of Science, Karl Popper’s belief that what distinguishes science from pseudoscience is its potential for refutation. For example, to say that all swans are white, only holds until a black one is found. The assertion –if properly attested by observations- is scientific in that the demonstration of even one black swan is able to refute it.

But, academic considerations aside, there is something troubling about ‘Earthing’ and its ilk. That something like this arose at all is, I suppose, a function of the random accretion of isolated and misunderstood bits and pieces of our complex modern world that are only describable in metaphor –as in, say, electrons are the carriers of electricity. True, as far as it goes, I guess, but misleading if taken as literal. Maybe some shoes –all shoes?- may block electrons… But so what?

Just try and understand the electric fields on the earth and in the atmosphere. As an example, a description from (shudder) Wikiversity: ‘The Earth is negatively charged, carrying 500,000 Coulombs (C) of electric charge (500 kC), and is at 300,000 volts (V), 300 kV, relative to the positively charged ionosphere. There is a constant flow of electricity, at around 1350 amperes (A) [approximately 1100 A], and resistance of the Earth’s atmosphere is around 220 Ohms. This gives a power output of around 400 megawatts (MW), which is ultimately regenerated by the power of the Sun that affects the ionosphere, as well as the troposphere, causing thunderstorms. The electrical energy stored in the Earth’s atmosphere is around 150 gigajoules (GJ). The Earth-ionosphere system acts as a giant capacitor, of capacity 1.8 Farads. The Earth’s surface carries around -1 nC of electric charge per square meter’. Do you see why most of us non-experts are dependant on metaphor? And why explanations such as this about ‘constant flow of electricity’ unaccompanied by suitable annotations may lead to some unfortunate and perhaps misguided applications?

On the other hand, I think that trying to dissuade gullible adherents requires some tact. Attempts to ridicule them by referring to the authors of a book on the subject: Earthing. The most important health discovery ever? and saying ‘None of the book’s authors is a physicist— it shows.’ is just ad hominem. Or suggesting that scientific credentials are not available: ‘The studies were not published in mainstream journals. They involved small numbers of subjects and usually failed to use any controls.’ While true -and to those of us with any acquaintance with how science works, compellingly obvious- it likely fails to convince those who mistrust the scientific paradigm and its lack of certainty to start with. And it may antagonize them to the point of utter rejection of any meaningful dialogue. It becomes another us-and-them standoff.

So, what to do? Tolerate or proselytize? Divide and conquer? Provoke and legislate…?

Perhaps it’s my age, but I’ve seen many fads arise and then dissipate like waves on a beach, with any one of them having about as much individual significance. Think of alien abduction, recovered memory therapy, pet rocks… Each seems to have a brief super nova-like appearance, and is intriguing for a while, and then, when a new star is born, interest flags. Social media may extend the lifespan, perhaps, but novelty is usually trump for those attracted to the fringe belief realms. I’ve learned not to obsess on what I consider the irrational; I will attempt to educate, but not to the point of taking arms against a sea of trouble and by opposing, ending them –as Hamlet would have us decide. If they are not harmful, then they will, as certain as the tide, recede.

In the turmoil of this uncertain world I think we all try to find secure and novel refuge, and when the storm has passed, set out again. It’s what we do –Shakespeare again: ‘Wise men ne’er sit and wail their loss, but cheerily seek how to redress their harms.

Earthing, with benign neglect, may itself be unearthed…

 

Statistics and Gender

Statistics, the collation, analysis and ultimately, the interpretation of data, have never been easy – at least for me. They have never reached the level of intuitive and, indeed, have barely climbed past manipulative in my head. And I readily admit to occasional cognitive dissonance even when they are used to support what I already believe. Or, rather, want to believe… I wonder if the sources from which I have accessed the numbers might be those that already pander to my own biases. In the cloud of assertions that cover me, everything is obscure and up for grabs.

I suppose it’s like that for us all, though –we hear what seems important to us and sift clumsily through the rest, filing most of it somewhere else, if at all. Especially if what has been measured is not crystal clear –or at least what has been reported is not. A classic example was that of a survey of shared parental leave in the UK. It was initially reported that only 1% of men were opting for this –much less than the rest of Europe. In fact, however, the figure reported was 1% of all men, not 1% of men who had just had a baby.

We have to examine what we read before we arrive at our conclusions; most of us don’t. Most of us have neither the interest, nor the tools to know if what is presented to us is reasonable, or at least free of bias – especially our own confirmation biases. A lot slips through the net.

A good example of this are the statistics on women and girls: http://www.bbc.com/news/magazine-36314061

‘There is a black hole in our knowledge of women and girls around the world. They are often missing from official statistics, and areas of their lives are ignored completely.’ For example, a record of their participation in the labour force in various countries. The data are often biased towards employment in the formal sector, which in those countries, is where men work. ‘Buvinic [an expert from the Center for Global Development, a think tank] argues that many women get missed out because they consider themselves primarily as housewives, when in reality they work on farms, do part-time jobs and seasonal work or run their own businesses.’

‘There are other problems too, Buvinic says. Not all countries collect statistics on other aspects of women’s lives, such as domestic violence or maternal mortality rates, and when they do collect this data they often do it in different ways, making international comparisons difficult.’ And, ‘There are many statistics that are collected without being broken down by sex, which makes it hard to tell when women are not being treated equally.’ For example, “Until recently, very few banks disaggregated their customer data by sex, leading to difficulties in understanding reasons behind the persistent gender gap in access to and use of financial services,” says Megan O’Donnell, one of Buvinic’s colleagues at the Center for Global Development.’

That I find all of this surprising speaks to my naïveté, I suppose, and yet I have my doubts that many of us would take the time from our busy lives to consider what this neglect might mean. David McNair – Director of Transparency at the One Campaign, a group that fights poverty- even uses the weighted ‘sexist’ epithet and summarizes the problem succinctly: “The reason why it is sexist is that women and girls are disproportionately left out of data collection. They are uncounted, therefore they don’t matter.”

Roughly half the population on the planet doesn’t matter? And it’s the half that has gestated and succoured that other half -the only half that is counted? Even if I try my best not to be an historical revisionist, it does not make sense to me.  Perhaps McNair, again, had the best explanation: “If you have robust data then you can be held to account for your decisions. There are people who have a vested interest in not having that information in the public domain.”

But I suppose we have to look for any encouraging little cracks in the imposing male edifice: ‘Recently the UN’s International Labour Organisation (or ILO) held a conference, where labour statisticians agreed how to start collecting data on unpaid and domestic work, for example time spent cleaning your house. Ten countries have volunteered to take part in a pilot to use this new framework to measure unpaid work.’

Whoa, ten countries have decided to put their toes in the water…? Or rather, their statisticians in the water? How brave. Maybe Macbeth was on to something when he said that ‘tomorrow creeps in this petty pace from day to day.’ It’s the end of his soliloquy that has me worried though: ‘It is a tale told by an idiot, full of sound and fury, signifying nothing.’

Oh, I hope not…

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Barbie in the Mirror

As an Ob/Gyn specialist I have been, I suppose, more than a passive observer of women over the years. But society has not been passive, either. Depending on where you live and in what cultural milieu, issues such as our sizes and shapes have become sources of real anxiety. Unrealistic expectations of morphology no doubt arise from multiple origins, but the end result is often the same -many of us don’t even come close to meeting them.

And as if that worry wasn’t enough, there has now been added the perhaps more troublesome issue of health. Despite the euphemism ‘plus-sized’ there is no disguising the stigma of the special term for many women –particularly when it comes wrapped with innuendoes of obesity and diminished well-being… not to mention beauty. Shakespeare would have us believe that ‘Love looks not with the eyes but with the mind.’ But does it? https://blogs.harvard.edu/marianabockarova/2014/05/29/the-science-of-beauty/ Once again, morphology rears its stilted head.

But we are a curious lot, we humans, influenced as we are by fashion and culture. Fickle in our choices, mercurial in our attitudes to those who fall outside the norms, we deride those who fail to satisfy the arbitrary boundaries –temporal though they may be.

Some have argued that one of the barometers of expectation is the shape of dolls –Barbie dolls in particular. They become, after all, the matrix of imaginary play and serve as proxies for the roles the children are trying to understand. http://www.bbc.com/news/magazine-35670446

A fuss seems to have been engendered by the release of three new types of Barbies: curvy, petite and tall. There are also skin colour differences, presumably to reflect the diversity in modern societies. But also, one could argue, to deflect the criticism of pandering to the thin, blond phenotype so prevalent in their models up to now. ‘Mattel [the makers of the doll] argues Barbie shouldn’t be expected to represent average proportions in the first place. “Barbie is a doll. She is not meant to reflect a real woman’s body,” says Sarah Allen from Mattel UK. “The purpose of introducing three new bodies into the range is variety and differentiation. When you look at the dolls collectively you can see the range in relationship between the dolls. “’ It’s a start, I suppose.

Therein lies the problem, of course, and it seems to me that it is hydra-headed. On the one hand to portray a doll that is truly representative of the reality that the child sees around her, would be to normalize –legitimize, really- the scourge of the 21st century: obesity and all of the health risks that entails: ‘[…]were Mattel required to accurately reflect the average British and American woman across all ages, the dolls would be overweight or obese.’ And yet, from a more modulated perspective, ‘Lenore Wright, from Baylor University, Texas, conducted a study in 2003 that explored the role of Barbie. She found Barbie’s shape didn’t really matter to children – her function was more important.’ Dolls, in other words, are just pretend –they’re substitutes that are merely assigned the role the child is exploring. The child knows they are not real.

But ‘Wright adds that Mattel’s new line has been criticized by some feminist scholars for reinforcing an old stereotype – that women are defined by their bodies.’ As I suggested, there are many divergent perspectives but remember that a Minotaur waits at the center of the labyrinth. We must be careful not to wander too far in our approach; we must not let our zeal mislead us.

It seems to me that children have always played with dolls and represented them according to their needs. To criticize a stick-doll, for example, or to confuse it with the reality the child apprehends is to stray dangerously far into revisionism. We are not children and we do not think as children. In a world where dolls are doctors, and dogs are patients, we are now strangers. Adults. Other… Forgive me for referencing Corinthians, but I think its advice was prescient: ‘When I was a child, I spake as a child, I understood as a child, I thought as a child: but when I became a man, I put away childish things.’

Amen to that.

 

 

 

 

 

Is there really Something in a Name?

What’s in a name? That which we call a rose, by any other name would smell as sweet.

So said Shakespeare’s Juliet. And yet even then –especially then- it mattered. Tribes have always mattered; we have always been known by our tribes: we are all either us or them aren’t we?” And little has changed despite the agglutination of the numberless tribes into tightly knit societies; there are still passwords.

I suspect I have lived in a bubble somewhere all these years; I really did think things were improving –that we were becoming less prejudiced- but I suspect it is just one more of those parochial shadows obscuring our vision here in Canada. Names, religions, skin colours, gender –appearance– all are code words for acceptance or rejection. We may fantasize that we live in a meritocratic land where Justice is blind and deaf, where we are all judged by our abilities and not our backgrounds, but alas we are deceived –or, rather, we deceive ourselves.

And so, more thoughtful societies have cast about for solutions to those biases so deeply ingrained, and often so hidden that we scarcely notice them anymore. The idea of ‘blind recruitment’ might offer one way to help resolve unconscious (or not) biases that plague many employers. Symphony orchestras were among the first to try it as the following CBC news article points out: http://www.cbc.ca/news/business/blind-recruitment-marketplace-1.3462061 -‘When the Toronto Symphony Orchestra began to audition musicians blindly in 1980, putting them behind a screen, the result was profound. While the hiring committee could hear an applicant’s performance, they not see what he or she looked like. They even put down a carpet so high heels couldn’t be heard. Now the orchestra — which was made up almost entirely of white men in the 1970s — is almost half female and much more diverse.’ Another news article, this time in the BBC News echoes this: http://www.bbc.com/news/magazine-34636464

Talent will out, if that is the sole criterion; but it isn’t. Unfortunately, our judgments are not entirely determined by merit; we sometimes are distracted by other, unrelated issues. Gender, seems an obvious one, but topping the list, is race. Foreign-sounding names seem to discourage interest in the further exploration of a CV: ‘Studies in the U.S. and Canada reveal that job applicants with ethnic-sounding names are less likely to get a response than more Anglo-Saxon names, despite having the same experience and credentials.’ So, unless ‘name blind’ applications are mandated, applicants with foreign-sounding names are at a distinct disadvantage in the job market. This is such a blatant waste of talent and opportunity that –at least anecdotally- some career advisers have suggested that their clients harmonize the names they use on job applications to more societally acceptable ones. Or more pronounceable: ‘Luxshiani Ganeshalingham says her friends automatically change their names when they’re looking for jobs. “We shorten our names to get a better response, or more responses.”’

Hiding things on the initial application may allow people the chance for an interview, but it is obviously far from the solution to racial, gender, or religious bias in hiring, however. ‘”… the reality is that people carrying out interviews, at the next stage on from applications, are humans,” says Azmat Mohammed, director general of the Institute of Recruiters. “The thing is for them to be able to analyze their own biases. Everybody has them and businesses are working to address this issue.”’

And nowadays in most Western countries, where discrimination is prohibited by law, or even discouraged by popular media, the biases have been driven underground. ‘”Modern prejudice is the transformation of our biased attitudes,” says the students’ professor Michael Inzlicht. “[About] 40, 50 years ago, one could express overt hostility or antipathy toward a group — ‘No, I’m not going to allow a black person into my golf club,'” he says. “You politically can’t say that any more.” Modern racism is less overt, Inzlicht says, but we see “very clear” biases. “It’s more dangerous … if you’re not aware of it,” he says.’

I can remember sitting on a rather crowded bus last year and feeling grateful that I had found the last unoccupied seat. A young woman with sparkling brown eyes in the adjacent seat seemed to be absorbed in reading and writing notes on some loose papers in a folder, and as she read I could see her sigh, or at times, chuckle at their contents.

Although I tried to be discreet, she obviously noticed my interest and turned to me with a smile. “Students nowadays are so funny,” she said, glancing first at my face, and then back at one of the papers. “They think they are inventing the wheel each time they answer… But, you know, sometimes they come to the question with such an innocent perspective, they really are… The world is different for them –new, exciting… They’re not muddied by the old methods we bring to questions -the old thoughts that channel us like pipes.”

I looked at her more closely when she said that. She was a young woman, in her late twenties perhaps, with dark hair, and a nut-brown complexion. She was actually excited by what she was reading. I smiled at her enthusiasm and, as strangers will, we began to talk of other things as the bus honked and jolted its way through rush-hour traffic. Just before the journey’s end, we exchanged names. Hers was Alice. I smiled at the name –it has always been one of my favourites and I told her so.

She returned the smile. “I have always liked it, too,” she said, almost wistfully. “Maybe it was Lewis Carroll’s influence –sorry, I mean Charles Dodgson’s,” she corrected herself academically with an embarrassed grin. “My mother always read to me in English at night when I was a little girl growing up in Tehran, and I used to ask for Alice in Wonderland all the time…”

“So you mean Alice was a name you chose for yourself? It’s not your birth-name?”

Again, she seemed embarrassed. “No, my real name is Aza; Alice is pretty close though, don’t you think?” The almost childish delight returned to her face and she smiled so brightly, her teeth seemed to sparkle in the sun coming through the window.

“But…” I was confused. “But Aza is such a beautiful name. Why would you want to change it?”

Her expression changed for a moment and she looked puzzled. She tried to disguise it, but her eyes inspected me to determine if I was patronizing her. As if I, of all people, should know why she’d changed her name. For that brief moment, I was one of her less gifted students. But it passed like a cloud and suddenly her smile returned.

Her stop was coming up so she reached up and pulled the cord. Then, in an effort to atone for her doubts about me perhaps, she touched my hand. It was a gesture of friendship at the very least. “Names, not credentials, get you interviews,” she said with a sad smile as she stood up to leave. “And I wanted to teach…”