Us and Them: The Blog

The transforming power of identity

The French call it ``deformation professionelle.'' If you want to be a member in good standing of a certain group, you train yourself to be like members, not like a civilian. Here's an example of recent research on the phenomenon in doctors.

It's not race, it's social class . . .

That accounts for different outcomes in prostate cancer among American men. So says a report in the journal Cancer.

Important because medical statistics (including the different outcomes for prostate cancer in whites and blacks) are often cited in support of the dubious notion that ``race is real!''

Race, in the US, is indeed real, because so much of our society has been organized by racial beliefs. Race is not, though, a simple biological fact. For that reason, race-based medical categories need to be examined closely, and alternative classifications considered. Which is what this study did.

Moriah

People often choose identity over health, or even over life. They'll suffer, or even die, as martyrs to religion, or nation, or culture -- instead of changing their ways. That is remarkable, even though it is so much a part of life that we seldom notice how remarkable it is.

Other animals fight for kin and friends, and some can be said to have ``culture.'' Chimpanzees, for example, have ways of doing things that are passed down from one generation to the next, and differ from group to group. But if you put a chimp into a new setting, where no one sticks his arm straight up during grooming, he won't prefer to die rather than change his ``culture.''

Human beings are not chimps, and this is one of the ways we differ: The pains we take to maintain our symbols of connection to entities beyond family and neighbors.

Case in point: New York City's Department of Health has issued warnings about the dangers of a practice common in Hasidic circumcision ceremonies, as the New York Times reports here. In this tradition, metzitzah b'peh, the man who circumcises the infant then sucks the blood from the wound to clean it.

The problem: Many adult mouths contain a herpes virus. Oral suction can transmit this to the newborn. According to the city department of health, five recent cases of herpes in infants (one fatal, another the cause of permanent brain damage) can be attributed to metzitzah b'peh.

Now, a lot of Hasidic infants are circumcised in New York every year, so it would appear the risk is small. Still, why take the chance, right? Surely any parent would decide to skip this part of the traditional rite, and be safe rather than sorry.

Not so. Last week a group of rabbis met with the city's health commissioner and tried to intimidate him into backing off. Rabbi David Niederman of the United Jewish Organization in Williamsburg put it this way: "We will not compromise on performing the ritual the way it has been done for thousands of years."

Why not? Let us not tiptoe around the issue, out of a misplaced respect for religious belief: The rabbis' position is that the small risk is worth it, because this symbol of continuity is more valuable than an infant.

This is not, of course, how the rabbis frame the issue. They say the herpes link is not proven. But that's not the motive for their rejection of the city's claim. After all, they called for an end to the education campaign, and an end to investigations of particular men who may have spread the virus to the infants. It may be that the herpes link is an open question, but if that is so, then why tell the city to shut up and butt out? Why not let the question be answered?

People take risks to preserve their feeling of membership, is why. What bothers me about this story is that the potential risk being taken in the name of ``thousands of years'' of tradition is not being taken by the men at the microphones. If the city's public health research is correct, newborn infants are the ones taking the chance.

This is a conflict between memberships in two different human kinds. To the city, the infant is a citizen, whose right to health and life must be protected by ``us,'' the people of New York. To the rabbis, the infant is a member of their community, and the signs of that membership are not to be violated by outsiders with a non-religious agenda.

It's the kind of dispute that cannot be resolved by negotiation and bromides about diversity. One side must win, and the other lose.

What it is not, though, is a fight between ``science'' and ``belief.'' For the fact of the matter is that all religions, and indeed all serious human kinds, make demands that go contrary to a simple-minded definition of ``health.'' Nations ask young people to fight and die. Businesses stick workers in unhealthy cubicles and make them sit at computer screens. Medical training -- medical training! -- asks hopefuls to lose sleep, work to the bone, and otherwise stress out.

The key point is that ``health,'' like religion, is a set of beliefs, entangled with our sense of the kind of people we are, which is, in turn, entangled with our sense of right and wrong. There is no science of health the can stand outside politics, or correct our supposedly separate beliefs.

To me, then, claims that this or that belief is ``contrary to health'' have a hollow ring. I doubt there is a human being on earth who doesn't do things contrary to health for the sake of being a good member of the congregation, or a good citizen, or a worthy member of some guild.

This is a political conflict, about a political issue: Are newborns first of all part of the entire community, or are they owned by the leaders of the religious or cultural group into which they were born? I think the former, and so I hope the city sticks to its guns.

Not Who You Are, Not Where You Are, But Where You THINK You Are . . .

Another important study from the always-interesting Nancy Adler, who studies how people's health is affected by their perceptions of their place in society. Adler's work suggests two important points about the mind-body connection:

1. Individual experience matters. Two people who are ``objectively'' in the same income and education categories may have different notions of their status, and that difference predicts how they'll score on measures of health and longevity.

2. Status matters. We don't know if it's the perception of inequality, as Richard Wilkinson suggests, or if it's that low-status associates with lack of control over one's life, as Sir Michael Marmot says. But status -- not income, not access to medical care, not nutrition, just status itself -- has an effect on how long people live, and how well.

Equality is a Public Health Issue, or, Being Poor Can Make You Crazy

It's no joke: Being at the bottom of a social hierarchy in childhood is a risk factor for psychosis in adulthood. A new review of the evidence finds a clear link.

Class and Status: What money can buy

Want to have a peaceful, dignified death with little pain? It's simple enough. Just be wealthy.

Obesity, Race and Class

In this new paper in the American Journal of Public Health, Esa M. Davis of Case Western and her colleagues say weight-loss methods that work for white and middle-class women probably don't work as well for African-Americans and poor people.

Some of the claims seem obvious enough -- diets that don't take cost into account aren't a good idea for low-income families. Others, like the finding that whites lean toward exercise, as a weight-loss solution, more than black women, who prefer to stress changes in what they eat -- aren't as predictable.

Of course, it shouldn't be surprising that race and class might affect people's outlook on food. It would be interesting to know how women in other human kinds (working class, wealthy, Asian-American, etc.) differ.

Ethnic Medicine Watch: A Patented Ashkenazic Gene?

A Utah company has won a European patent one of the BRCA cancer genes found in unusually high frequencies in women with Ashkenazic ancestors. As New Scientist reports, a doctor in the EU who wants to test for this gene must, legally, ask the patient if she's an Ashkenazi Jew, in order to know if a fee is due the company.