Inclusion is the Core of My “Radical” Feminist Agenda

I’m tall, I’m a natural blonde, and I have green eyes. I’m also anywhere from “pleasantly plump” to “obese whale” depending on your scale of things, and I’m invisibly disabled. Needless to say, I receive a lot of comments about my body, both directly and indirectly, on a daily basis, and am frequently reminded of how I am–or am not–valued on the basis of what my body looks like and what it can or cannot do. I “should” be thinner, healthier, ignore the people who think I should be thinner, healthier; I “should” embrace who I am, change who I am, be a ‘better’ version of who I am, achieve health at any size-the list goes on, and on, and it often seems and feels like everyone has, and feels comfortable, voicing their opinion on what my body should look like and be capable of.

Would there be any less pressure if I wasn’t fat? After all, some people might want to argue that the comments come because of my weight, and the fact that I am so close to “the ideal” for a woman (tall, blonde, fair) that if I could get get thin, it’d all be fine.

Well, Cassey Ho’s recent “The ‘Perfect’ Body” video should put that idea to rest:

And if I were thin, I think it’s safe to say that the so-called “radical feminists” would simply say that being a thin, tall, blonde, fair woman is merely contorting myself to a body approved by a patriarchal/porn culture, and criticize me for that, as well. I suppose I might get “points back” for being disabled, but who knows.

Are you getting the idea that I can’t win? Because if I can’t win–if I can’t be my normal hair colour, my normal eye colour, my normal skin colour, all of which are considered damned near ideal for way too much of the world, and thin or fat or anywhere in between-then how is anyone else supposed to win?

Playboy (yes, really) takes this on in their post on Laverne Cox’s nude photo for Allure and the frankly ugly response from “radical feminist” Megan Murphy. To quote Noah Berlatsky, author of the Playboy piece,

Murphy reacted to the photo just as Cox suggests that people often react to black and trans women — with disgust, prejudice and horror. In a short but impressively cruel post, Murphy sneers at Cox for attempting to achieve a “‘perfect’ body as defined by a patriarchal/porn culture, through plastic surgery, and then presenting it as a sexualized object for public consumption.”

She scoffs at the idea that trans women who take hormones or have surgery are accepting themselves. Murphy suggests that trans women are “spending thousands and thousands of dollars sculpting their bodies in order to look like some cartoonish version of ‘woman,’ as defined by the porn industry and pop culture.

My first thought, reading both Berlatsky and Murphy, is that this comes down to a question of how we define self. Berlatsky, along with most who support trans folks, seems to accept the idea that “who we are” can be a mismatch; your internal notion of self doesn’t match your external representation. For Murphy, it appears that you’re supposed to merely integrate the internal and external, and that if your internal notion of self doesn’t match your external being, that’s the fault of society for placing unrealistic notions on the external being.

Now, this notion of social expectation shaping external being is definitely accurate–if the mismatch you experience is what society tells you your external self should be and what your external self actually is. But where Murphy and most “radical feminists” seem to fall down is comprehending that there’s another option here, the one that trans folk fall in to, where your internal notion of self doesn’t match the assigned external self. When that happens, it’s not enough to say “ignore society” because the dissonance isn’t coming from society; there can, after all, be strong, physical differences between genders that have nothing to do with society and everything to do with biology.1 emp_v_obj-finalSociety might embrace fashion that emphasizes child-bearing hips, for example, but society doesn’t create those child-bearing hips. That’s biology.

But my first thought was a bit too shallow, on reflection. While this is all certainly true-Murphy and her ilk are simply not capable of dealing with the nuance of what it means on a base level to be trans-what it actually comes down to isn’t that, at all. What it comes down to is “radical feminists” not understanding the difference between sexual empowerment and sexual objectification. Which, to be fair, is a difficult concept to understand–but I don’t think I’m totally out of line to say “if you’re going to write critiques about bodies and empowerment, you’d best know what you’re talking about, first.”

I find that the cartoon by Ronnie Ritchie, posted by Everyday Feminism, really nicely captures the necessary nuance of power dichotomies (see right).

My problem with the “radical feminists” is pretty simple, and it’s neatly illustrated by the above response to Cox and a lack of understanding agency and consent: they’re drawing such a tiny, tight boundary around what it means to be feminist, that most people fail. Perhaps even more damning, that tight boundary contains body policing–something that most feminists, one hopes, would tell you is decidedly anti-feminist.

I place “radical feminist” in quotation marks because I don’t actually think they’re radical or feminist. I think that, for the most part, they’re scared women who are trying to define themselves in a way that maximizes their own power, and they do that by trying to keep it to themselves rather than share it liberally–another hallmark of what I think feminism should be about. In fact, I think that along with trusting adults to their own agency, about the most radical thing any feminist can do is include everyone.


CRISPR and the Amoral Othering of Chinese Researchers

I’ve been under a rock for the last week or so, first at a conference in San Diego, and then fighting off a nasty combination of strep throat, laryngitis, and double ear infections. (So when I say “under a rock,” I mean hiding under the blankets in my bed, spending most of my time sleeping.) So while bits and pieces of the “CRISPR/Cas9-mediated gene editing in human tripronuclear zygotes” paper published in Protein & Cell by researchers from Sun Yat-sen University in Guangzhou, China, made its way to me, it wasn’t until today I felt well enough to say anything about it–mostly because I don’t expect what I have to say will be very popular. So without further adieu, a few unpopular thoughts on Zhou, Huang, et al’s paper.

Claim
The paper was rejected by Nature, Science, other top journals, for being unethical.

Hah. Ahem. Look, if Nature, Science, et al, want to make that sort of “it’s unethical we can’t publish it” claim, they might want to do so when the ethics-inclined folks who’ve been around a while are, I don’t know, busy, off tilting at other windmills, at a conference in Bermuda, or something. Because history here isn’t really kind to the so-called “top journals” when it comes to publishing unethical material; see, for just a really short course on it, the Fouchier and Kawaoka H5N1 gain-of-function debacle. “Top journals” were burned by the response to the H5N1 enhancement debacle, and were flat-out caught unaware that such a thing as “bioethics” had enough of a voice to be heard. They don’t want to be caught again, so they’re walking away from anything possibly controversial right now, and the debate over CRISPR/Cas9 has already been going up in the flames of controversy.

In short, any time any “Top Journal” says “we’re concerned about the ethics” you should actually read “we don’t want to be involved in any mainstream media controversy.”1 They learned this with H5N1 GOF issue to the point that these days, any debate over GOF/dual-use research of concern/potential pandemic pathogen research is met with a chorus of “la la la can’t hear you publish what?”

Claim
OH MY GOD THE CHINESE ARE MAKING GENETICALLY MODIFIED HUMAN BEINGS!

Fu_ManchuReally? Is it time for the great Bondsian bad guy freak-out? Do you suppose the folks who are making this claim picture Zhou, Huang, et al, twirling Fu-Manchu moustaches while wearing Zhongshan suit-inspired lab coats as they look upon an army of genetically modified super humans being incubated in chained women who were discarded as babies for being female? How many tropes do you suppose are shoved into this image of evil?

Again, take it from an old-timer: “we have to do it before the Chinese” has been a rallying cry for an awful lot of the science that falls at the intersection of bioethics and transhumanism. Why? Because “the Chinese” stands for “people who don’t have our values and belief systems-they’re DIFFERENT.” We’ve heard it with cloning humans, dual-use research of concern, with just about everything, and now we’re hearing it with CRISPR/Cas9: “we” have to do it before the big scary Not Western people do it!

Except some researchers from China do it and what–it’s suddenly “not ethical” because they’re Chinese? Pundits, scientists and otherwise, are freaking out not because “omg someone edited embryos with CRIPSR!” but because “the Chinese” have. (And do you note how most folks are just saying “the Chinese” as if the paper has no authors? See: creating a big bad menace in your mind.) And unfortunately, this excuse isn’t limited to Top Journals rejecting the paper for claims of it being unethical. The concern shows up in Paul Knoepfler’s blog, as well:

It is worth noting that the current study had institutional ethical approval according to a statement in the paper:

“This study conformed to ethical standards of Helsinki Declaration and national legislation and was approved by the Medical Ethical Committee of the First Affiliated Hospital, Sun Yat-sen University. The patients donated their tripronuclear (3PN) zygotes for research and signed informed consent forms.”

Would an institutional review board in another country such as the US have given the green light to making GM human embryos? I don’t know.

The emphasis there is mine, and it’s one I dislike making,2 since I do consider Paul a friend. But what this shows is just how pervasive the idea that “the Chinese aren’t moral like us” is: Zhou, Huang, et al, swore to the study conforming by ethical standards required by the Helsinki Declaration as well as their own national legislation, noted it was approved by a MEC–and people are still questioning whether it was ethical enough, because they’re Not Western.

Which ties into the third issue people seem to be having,…

Claim
OMG the Chinese did CRISPR/Cas9 editing this is so worrying aren’t you bothered YOU SHOULD BE BOTHERED!

Well, no, I’m not bothered by the paper. I am bothered that Protein & Cell did such a rapid turn-around on peer review for the paper, but I have that concern whenever any journal does such “rapid turn-around” (and you’re kidding yourself if you think this is an isolated event-it’s very much not). Nor am I bothered that “the Chinese” did this particular CRISPR/Cas9 experiment, just like I’m not bothered by human embryonic stem cell research. The researchers (and again, let’s think for a minute about the alienating and Othering going on by insisting on referring to the folks behind this research as “The Chinese”) answered some pretty important questions about the immediate applicable functionality of CRISPR/Cas9 editing–which is especially important given the recent moral panic going on about the technology as a whole.3 In short, they learned two major pieces of information that have direct implications for any conversation about future use in humans–and bans on the technology.

  1. CRISPR isn’t 100% accurate, and sometimes “missed,” inserting DNA in the wrong place. This is problematic, because instead of offering a cure for $Whatever, it can actually create a new problem. So, not a benign “oops.”
  2. Even the embryos that were edited correctly by CRISPR ended up as mosaics-in other words, it wasn’t a universal fix. This, as Carl Zimmer explains, means that it’s a lot harder to take a single cell from an embryo and “verify” that it’s been fixed, and it’s hard to know whether or not the fix will manifest, pass down in the germline, etc.

In other words, as Zhou, Huang, et al say themselves: their “study underscores the challenges facing clinical applications of CRISPR/Cas9.”

Claim
But what about the embryos?!

Zhou, Huang, et al used tripronuclear (3PN) zygotes for their research. These zygotes occur in upwards of 5% of IVF attempts, and are discarded because, while they might develop into blastocysts in vitro, they absolutely do not develop further in vivo. In other words, these are non-viable creations4 with a built-in suicide switch: they’re never going to develop into bouncing babies, Chinese or otherwise. In fact, it was because of the very specific concerns over CRISPR/Cas9-mediated gene editing in normal embryos that Zhou, Huang, et al used 3PN zygotes: it says so, right there in the paper. (So what was that about ethical concerns, again? You can’t really say they weren’t thinking about it when they put it right there in the paper. Repeatedly.)

If I were to be moved by the creation of these 3PN CRISPR creations as somehow unethical, then wouldn’t I also be obligated to find human embryonic stem cells unethical? I don’t,5 so in practicing a policy of consistency,…

Conclusion

Look, the panic over the CRISPR paper comes down to this: people somehow believe that there’s “moral control” if Westerners do this research. To which all I can really say is, DURC folks? Maybe y’all missed the boat on how to get traction on this issue, and should have run around all a-panic, OMG THE JAPANESE!6

More seriously, the history of science and medicine should underscore and emphasize the fact that “like us” does not mean “moral and ethical.”

As I was pointing out to Razib Khan and others on Twitter, I was around during the OMG DOLLY NOW WE’RE GOING TO CLONE HUMANS AND THE END IS NEAR panic, which as Khan noted, hasn’t happened–or at least, the Raelians haven’t made us believe. Will the same happen to CRISPR/Cas9-mediated gene editing?Gattaca It’s hard to say, because the technology is so new, and whether or not we’ll be able to overcome random DNA insertions and mosaic, chimeric embryos is down the line enough that it’s speculative.

But whether we’re on our way to a GATTACA-esque future or not, one thing is certain: the first step to any dialog over CRISPR/Cas9-mediated gene editing isn’t going to be an Asilomar-like conference. It’s going to be to stop demonizing “The Chinese” as being a-moral, immoral scientists.


Edited to add: BTW, this was originally a stream-of-conscious Twitter rant that I was goaded to turning into a full blog post. You can read the original, see comments, etc, starting here.


Angelina Jolie & Frank Talk About Women’s Health & Personal Choices

Angelie Jolie has written another NYTimes Op-Ed, this one on her double mastectomy and subsequent bilateral salpingo-oophorectomy (removal of both ovaries and fallopean tubes). It appears she took note of the concern that her first op-ed (on her mastectomy choice) possibly having undue influence on other women with BRCA mutations, because she says, clearly:

I did not do this solely because I carry the BRCA1 gene mutation, and I want other women to hear this. A positive BRCA test does not mean a leap to surgery. I have spoken to many doctors, surgeons and naturopaths. There are other options. Some women take birth control pills or rely on alternative medicines combined with frequent checks. There is more than one way to deal with any health issue. The most important thing is to learn about the options and choose what is right for you personally.

I really appreciate her matter-of-factly discussing health issues that are “the domain of women,” discussing her treatment choices, her uterus, her IUD, and so on. It’s frank talk women don’t hear often enough when medicine discusses our bodies.

I also think that her emphasis on feeling feminine, even though she’s had a double mastectomy and salpingo-oophorectomy, is really important. Women too often receive the message that their femininity is through their breasts or their ability to reproduce, which can be especially harmful and self-destroying in the face of cancer. Being feminine isn’t contained within breasts, ovaries, or fallopean tubes, and the more open discussion we have about how you can feel and be feminine regardless of primary or secondary sex characteristics, the better.

Primum Non Nocere and the Hippocratic Oath

HippocraticOathUnless you’ve been under a rock or on a boat in the middle of the oceanTrue story: I’ve known of major news stories that have happened while people were on a research cave trip and while on a no-internet-except-for-work research cruise in the middle of the ocean, so apparently this happens more than you’d think., you’re aware that the United States is in the middle of a measles outbreak that has, so far, infected over 100 people, and was traced back to December Disneyland visits.

There’s been a lot of chatter lately over encouraging adherence to vaccines, lawsuits,I highly recommend Dorit Rubinstein Reiss’s paper on this, and am endebted to J.H. for pointing me to it. and so on-and in the ways of the world, in the last 24 hours, people have suddenly shifted to what the Hippocratic Oath says and whether primum non nocere (“do no harm”) is part of the Oath, and what that means for doctors who peddle anti-vaccine beliefs (and in particular, charming Arizona cardiologist and vaccine refuser Jack Wolfson).

As I mentioned on Twitter this morning, this would be a really convenient time to have someone with a piece of paper saying they have a degree in medical history around. (Hi.) So, a quick summary and expansion of this morning’s question and answer:

Is “primum non nocere” part of the Hippocratic Oath?

No, not in the original versions of the Oath that we have. This isn’t to say that the idea of what we would now call the principle of non-maleficence isn’t written in to even the earliest examples of the Oath, merely that the particular phrasing doesn’t show up. What does occur in the early versions of the Oath are phrases like “abstain from harm” – which is pretty close. The phrase “do good and do no harm” does occur in another part of the Hippocratic Collection, the Epidemics.

So what’s the origin of the phrase primum non nocere?

Good question–one that many people have made dissertations and other research projects out of. The last I was reading about this (which admittedly was a few years ago), the general consensus seemed to be that the specific phrase first enters American medical lexicon in the mid-1800s in reference to an earlier medical textbook.

What’s important here, though, at least in terms of talking about contemporary non-maleficence and beneficence, is that the concept behind “do no harm” (regardless of phrasing) has been a part of medicine for a very long time. This is one of the reasons the concept of “not cutting for stone” is in the Hippocratic Oath: removal of kidney stones (the stone being cut) in men used to be a rather brutal, bloody, and deadly procedure, and thus was left to the barber-surgeons, rather than the more refined doctors.

That said, I’d also say it’s equally important to not place a lot of emphasis on the Hippocratic Oath. While it is an incredibly important piece of medical history, it also banned surgery (not just removing kidney stones), providing abortions, and providing deadly medications. Those trained in medicine were expected to train their own sons in medicine, as well as the sons of their teacher – and tuition? Not a thing. Oh, and don’t forget swearing fealty to Apollo. (I wouldn’t want anyone who is anti-choice or anti-euthanasia for religious reasons to get too excited here.)

And of course, all of this ties in to the last, and common, question about the Oath: is the Hippocratic Oath actually a legally binding oath? At least in America, no.

What the Hippocratic Oath is, in many ways, is another living document that is frequently revised to reflect contemporary views–which is why the bits about leaving surgery to the professionals has been taken out–and still contains elements that have been considered essential to the art/techne of medicine for roughly 2500 years. It is a wonderful part of the history and lineage of medicine, connecting what was to what is. What it is not is a place to look for legalistic or even moral answers for contemporary medico-social issues.