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    Sociological Spin: Stating There Is A Genetic Cause Gets Anorexics Less Blame
    By Hank Campbell | January 11th 2008 05:39 PM | 8 comments | Print | E-mail | Track Comments
    About Hank

    I'm the founder of Science 2.0® and co-author of "Science Left Behind".

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    When people in a University of North Carolina at Chapel Hill study were told that anorexia nervosa had a biological or genetics-based cause they were less likely to put any personal accountability on anorexics than when they were told it was personal or cultural.

    That makes sense. A disease that is egalitarian and exculpatory like a genetics or biological mutation is different than a syndrome. We can't blame kids with Autism for having Autism, though we do teach them to moderate their behavior - and that's a key point.

    Anorexia nervosa is characterized by an obsessive desire to be thin and results in self-starvation and related medical complications. According to the authors, more people die from anorexia than from any other mental illness.

    “This is a potentially important finding,” said study author Michele A. Crisafulli, “because it suggests that wider dissemination of information about the biological and genetic underpinnings of anorexia nervosa could help decrease the blame-based stigma that is associated with the disorder.”

    Indeed, but that's putting the advocacy cart before the science horse, isn't it?

    What genetic underpinnings? Is there an anorexia gene? Speculation is that anorexia might be a sex hormone issue but there is also speculation that differences in the insulata of anorexic women mean they just like food less. We commonly accept that obese people like food more and have a lower metabolism to compensate for calorie intake, though studies continue to search for a genetic relationship there as well, and we know that brain patterns in anorexic women are different but unless your 'correlation versus causation' meter is completely disabled that won't mean much.

    “There is a lot of false information about anorexia nervosa disseminated in pop culture. This study suggests that even a nugget of accurate biological information can influence how health care professionals perceive the illness,” said Dr. Cynthia M. Bulik, director of UNC’s Eating Disorders Program and the study’s senior author.

    But do we want to just influence people or do we want to be accurate in our assessments of diseases and disorders? The UNC study surveyed 115 undergraduate nursing students and asked them whether or not anorexia should be given the same medical coverage by insurance companies as other diseases. The nurses who were given information stating that anorexia had a biological cause responded differently than those who were shown it was sociocultural.

    Except none of the material related to a biological cause for anorexia were included in the study so we don't know if the respondents got accurate information. Of the 25 references they included in the paper, only one had any biological information and even that was a recap of other work. The rest were all additional papers talking about the impact of framing in the perception of anorexia.

    Anorexia is a devastating thing for victims and their families so my thoughts here have nothing to do with that. We have no idea how much of anorexia could be biological and how much is cultural though we know the cultural tilt is much stronger. Yet what the authors contend ...

    “It opens up new horizons for accurate information campaigns to help the public understand that people with anorexia nervosa are not to blame for their illness and that biology plays a role,” Bulik said.

    No it doesn't, it opens up a populace already suspicious of science agendas because of conflicting global warming data and political agendas to wondering about the bias of psychologists. More insurance company money is good for them but bad for everyone else.

    There are some things that people are responsible for and we can't blame their parents, their schools, their friends, society or everyone except the actual person for everything that occurs in life. The brain is a complicated mechanism and it will take time to understand it.

    Like any other area of science, anorexia needs to be studied. It may have a biological cause or it may not. What we can't do as a society is start engineering our culture to force abdication of personal responsibility. Some people will smoke, some people will starve themselves, some people will commit suicide in many ways. It doesn't mean there is a biological cause for smoking or suicide.

    A possible genetic or biological cause for a disorder that primarily affects white teenage girls and only in the last 20 years when obesity has gone up considerably means we have to start framing anorexia for society? That doesn't sound like science, it sounds like spin.

    Next thing you know, bulimics will contend they aren't anorexic at all and demand their own disorder.

    Comments

    Laura Collins
    "Indeed, but that's putting the advocacy cart before the science horse, isn't it?" Actually, no. The head of the NIMH calls AN a "brain disorder." The evidence for a biological basis for anorexia is well-established. The work of Kaye and Bulik and others have made that clear. No single gene has yet been identified, but that is true of most illnesses understood to be biological. What is known is that anorexia is 50-80% heritable, which is higher than observed in most brain disorders and many other illnesses.
    Laura Collins www.EatingWithYourAnorexic.com
    Hank
    Hi Laura,

    My editorial was primarily on the spin aspects of framing questions to get responses about AN. I don't attempt to claim there is no biological basis for AN. However, we do need to at least consider that its prevalence in western culture, where women have the most societal freedom, and in America, where we have the most obesity, and in white girls, which has to be a demographic talking point since 'white girl' is not a dramatic genetic marker, needs to be considered outside of biology.

    I used the word 'exculpatory' rather precisely, because there is some danger in abdicating personal responsibility.

    I am intrigued by this 50-80% inheritability number. If it's genetic, and inherited, why is it only common in the last few decades? People have had cancer throughout human history, for example, but were people dying of anorexia 200 years ago?

    Want more no-nonsense, independent science? Buy Science Left Behind
    Laura Collins
    People did get and die from what we now call anorexia nervosa throughout history. One good book that describes this is Holy Anorexia http://www.press.uchicago.edu/cgi-bin/hfs.cgi/00/139.ctl and another is Fasting Girls http://www.amazon.com/Fasting-Girls-History-Anorexia-Nervosa/dp/0375724486. The idea that this was, and is, an upper middle class white girl's illness came from early work by a therapist of that demographic, Hilde Bruch. More recent research has established that it exists in all countries, classes, ethnicities, and both genders. It may (no way to really know) be more common now. And that is easily explained by the fact that voluntary dieting is more common now. More people value dietary restriction in the service of weight loss and social standing - putting people who are at genetic/biological risk into the beginning stages of what for them is a self-perpetuating condition - in a culture that instead of being worried will actually offer praise. As with many illnesses, increased diagnosis is directly related to increased capacity for treatment. Eating disorder treatment facilities are lucrative and less stigmatized than in the past - and although insurance coverage is spotty, it does pay most of the bills at these clinics.
    Laura Collins www.EatingWithYourAnorexic.com
    Hank
    Thanks for the links. I think your objection was to this:

    Indeed, but that's putting the advocacy cart before the science horse, isn't it?

    I do tend to look poorly on 'framing' issues in science because I don't think people are incapable of understanding if they get the facts.

    If someone had done a paper based on a questionaire of 115 undergraduate nursing students and framed the question so that it would look like AN sufferers were only doing this for attention and that it should not be covered by insurance and then issued a report saying 'people are just not being educated properly and here is how we fix them', would you have objected to that study on multiple grounds, both methodological and in agenda?

    You probably would have and rightfully so. Putting aside that their conclusion affirms a topic you feel passionately about, is this a good science study? I think if it had been written by a group that came to the opposite conclusion you would be investigating who is funding them or otherwise wonder why they wrote something with such an overt agenda and called it science.

    I would have written much the same article I wrote here because there are lots of science sites that are founded with an ideological/political/social agenda and we are agnostic about everything except the data.

    Want more no-nonsense, independent science? Buy Science Left Behind
    Laura Collins
    I agree with what you just said, and I like the way you are questioning the study structure and refusing to stand for silly science. But didn't you, in the original post, make a point of questioning the validity of AN being a biological/genetic illness? The thing is, this stuff matters in practice. The researchers weren't just studying whether different ideas make people feel better. The popular idea of AN is wrong, and it affects how patients and their families seek and evaluate care options. The biological/genetic explanation isn't just de-stigmatizing, it is correct - helping the public find and use good treatment.
    Laura Collins www.EatingWithYourAnorexic.com
    Hank
    But didn't you, in the original post, make a point of questioning the validity of AN being a biological/genetic illness?

    I made a point of questioning the validity of a biological cause based on the data available rather than defaulting to the spin in their paper, sure. There are a number of conflicting studies on the issue so listing some and not others would just be believing what we want to believe. Brain pattern differences, for example, are unlikely to be inherited but are also difficult to know whether they are cause or effect. Gay men have anorexia more often than heterosexual men - so do we segment the biology even further or do we say gay men and girls are biologically common and unleash that firestorm? At this rate, everyone on the planet will have their own listing in DSM V. :)

    In their paper, they didn't cite any of the biological data they used to show these nursing undergraduates (using only undergraduate nursing students is its own bias, since you clearly could have gotten a different result if you used construction workers) that AN was biological rather than psychological - their supporting data was all other people saying how important framing is in the anorexia issue.

    But do we want to just influence people or do we want to be accurate in our assessments of diseases and disorders?

    and

    Anorexia is a devastating thing for victims and their families so my thoughts here have nothing to do with that.

    are the points I was making. AN is a real issue no matter what I think about flawed surveys but the backlash if the public thinks they're victims of spin is not worth the temporary gain.

    Want more no-nonsense, independent science? Buy Science Left Behind
    For me it doesn't really make sens. How could anyone be born with such a disease? It's the first time when I hear it and I haven't heard of something like this until now.

    What about the Keys starvation study? The men in that study exhibited many of the behaviors of anorexia once they had been on their starvation diet for a while. Maybe the tendency is genetic, but it is set off by extreme dieting.