Bioethics for Breakfast: Social Determinants of Elders’ Health

Bioethics for Breakfast: Seminars in Medicine, Law and Society

Anne K. Hughes, PhD, MSW, and Dawn Opel, JD, PhD, presented at the December 2 Bioethics for Breakfast session, offering perspectives and insight on the topic “Social Determinants of Elders’ Health.” Bioethics for Breakfast is generously sponsored by Hall, Render, Killian, Heath & Lyman. This session was the first of a two-part series on the theme “Paradoxes of Aging: Living Longer and Feeling Worse.” The presentation portion of the session was recorded and is available to watch on our website.

Elders in the U.S. contend with chronic illness, disability, mental health disorders, and a host of other co-morbid conditions. The COVID-19 pandemic has illuminated the complex web of social, medical, and economic challenges faced by the elderly.

Anne K. Hughes, PhD, MSW, highlighted common concerns about aging and explained how those concerns affect LGBTQ+ older adults: cognitive and/or physical decline, isolation, financial/legal, living situations, and meaning making/legacy. Hughes shared the importance of health professionals asking questions rather than making assumptions when working with sexual and gender minority older adults. She also noted research showing health disparities at greater levels when compared to heterosexual older adults, even noting that much of the research data currently available is not inclusive of bisexual, transgender, or gender non-conforming older adults.

Dawn Opel, JD, PhD, presented on older adults and food insecurity in America. She addressed the invisibility of older adults experiencing hunger in America, lessons from the COVID-19 pandemic, programs and services available for older adults in Michigan, and the future of food security for older adults. Regarding food insecurity, many older adults are living alone, and they may use trade-offs such as skipping their grocery trip to instead pay the rent or utility bill. The pandemic also made visible the reliance on unpaid caregiving and volunteerism for access to food. Sharing data that projects more than 20 percent of the U.S. population will be over the age of 65 by 2030, Opel asked attendees to consider the actions needed now to invest in infrastructure for the future.

Discussion during the Q&A portion included the concept of aging in place, with multiple attendees sharing personal anecdotes about older adults in their lives who wish to remain independent in their homes. Broadly, both speakers touched on the importance of having conversations early on with older adults in our lives, in order to be as prepared as possible before there is a crisis situation. Discussion also touched on the technological divide, having conversations with primary care physicians, and potential policy improvements that could improve the burden on those in paid and unpaid caregiving roles.

About the speakers

Anne K. Hughes, PhD, MSW, is Director and Associate Professor in the School of Social Work at Michigan State University. She was previously the director of the PhD program. She is co-founder of the MSU Consortium for Sexual and Gender Minority Health Across the Lifespan, an interdisciplinary research consortium established within the College of Social Science in 2019. Prior to coming to MSU Dr. Hughes had 14 years of clinical practice experience. Dr. Hughes’ research focuses primarily on older adults with chronic conditions and improving healthcare services for underserved older adults, particularly LGBTQ+ older adults. Dr. Hughes has received external funding for her research from: Patient-Centered Outcomes Research Institute (PCORI), the John A. Hartford Foundation, and the National Institutes of Health. She is a Hartford Faculty Scholar in Geriatric Social Work and a Fellow in the Gerontological Society of America.

Dawn Opel, JD, PhD, is Director of Research & Strategic Initiatives and General Counsel of the Food Bank Council of Michigan, where she oversees research, data, legal, and compliance functions of the organization. A lawyer and researcher, her career has included positions in academic, nonprofit, and government sectors, and broadly, she works to build strategic partnerships for social innovation. Dr. Opel’s particular focus is developing capacity in Michigan for food-as-medicine interventions in the clinical setting, and she is currently involved in the implementation and sustainability of fresh food pharmacies for chronic disease self-management in federally-qualified health centers (FQHCs). She holds a PhD from Arizona State University and a JD from the University of North Carolina School of Law. Dr. Opel is adjunct assistant faculty at Michigan State University in the College of Arts & Letters.

Bioethics for Breakfast: Fitness, Frailty, and the Challenges of Successful Aging

Bioethics for Breakfast Seminars in Medicine, Law and SocietyFrancis Komara, DO, and Scott Wamsley presented at the April 25th Bioethics for Breakfast event, offering perspectives and insight on the topic “Fitness, Frailty, and the Challenges of Successful Aging.”

In very concrete terms, what should “healthy aging” mean when we wish to be a just and caring society? We start from these facts: (1) the size of the elderly and hyper-elderly population in Michigan and nationwide is growing rapidly; (2) costly health needs are much more common among the elderly than among the non-elderly; (3) if we are completely responsive to the health needs of the elderly, will we unfairly shortchange the health needs of the non-elderly?; (4) there are great disparities among the health needs of the elderly themselves (so what do we need to do to correct that initial state of affairs?); (5) are family caregivers excessively burdened by things as they are—what can we do socially that is affordable to relieve those burdens?

How does “aging in place” work, given the five challenges listed above, especially for those elderly who are in near poverty conditions? This Bioethics for Breakfast explored these and other questions.

Francis Komara, DO
Dr. Francis Komara is a Professor in the Department of Family and Community Medicine (FCM) and Director of the Geriatric Fellowship Program in the Michigan State University College of Osteopathic Medicine. Dr. Komara is a geriatrician who formerly practiced at the FCM clinic at MSU, and was formerly medical director of the Medical Care Facility and Rehabilitation Services of Ingham County, and medical director of McLaren Visiting Nurse & Hospice. Dr. Komara received his medical degree from the Chicago College of Osteopathic Medicine.

Scott Wamsley
Scott Wamsley is Deputy Director of the Aging & Adult Services Agency in the Michigan Department of Health and Human Services. Mr. Wamsley has more than twenty years of experience in the field of aging services. He holds a master’s degree in public administration and a bachelor’s degree in political science from Eastern Michigan University.

About Bioethics for Breakfast:
In 2010, Hall, Render, Killian, Heath & Lyman invited the Center for Ethics to partner on a bioethics seminar series. The Center for Ethics and Hall Render invite guests from the health professions, religious and community organizations, political circles, and the academy to engage in lively discussions of topics spanning the worlds of bioethics, health law, business, and policy. For each event, the Center selects from a wide range of controversial issues and provides two presenters either from our own faculty or invited guests, who offer distinctive, and sometimes clashing, perspectives. Those brief presentations are followed by a moderated open discussion.

Botox for Millennials?

Bioethics in the News logoThis post is a part of our Bioethics in the News series

By Devan Stahl, PhD

When I was in my mid-twenties I went to my physician to have a mole on my face removed. Before my dermatologist began the procedure, however, she suggested I consider another procedure: Botox. Botox for someone my age was “preventative,” she explained; if I could not move my facial muscles, I was less likely to develop wrinkles. To add insult to injury, she held up a mirror and pointed out all the lines on my face when I frowned (which I was doing at that moment, irked that my doctor was trying to push Botox on me). The experience was unsettling. Our culture is saturated with impossible beauty standards for women, but I did not expect my doctor to perpetuate these standards or to try to make money off of my potential insecurities.

I had nearly forgotten about this experience until last month, when my social media and online streaming services were inundated with advertisements for Botox® and Juvéderm® fillers that smooth wrinkles and plump lips. The advertisements were clearly geared toward millennial women such as myself. The ads push messages of personal empowerment. “My lips are my vocal advocates for self-acceptance,” one model says. “Command it, boss it, #juvedermit,” reads the tagline.

The drug company Allergan produces both Botox and Juvéderm, which some have deemed “cosmeceuticals” or cosmetic pharmaceuticals. According to news reports, Allergan’s aim over the next year is to increase sales to millennials as more products come on the market. According to a spokesperson for the company, they aim to “educate and empower consumers to do what is right for them when it comes to aesthetic treatments.” This push means that millennials are likely to see an increasing number of targeted ads that play upon social norms of beauty and youth to sell injectable toxins that have unknown long-term side effects. And although the short term risks might be seen as minimal (including pain at injection site, trouble breathing or swallowing, double vision, drooping eyelids, and more), studies have shown that when advertisements rely upon idealized forms of beauty to market cosmeceuticals, the social and psychological risks of not using the product detract from its known physical risks.

Botox and fillers are part of a multibillion dollar beauty and anti-aging industry in the U.S. According to a 2017 report by the American Society of Plastic Surgeons, 7.2 million Botulinum Toxin Type A procedures are performed in the U.S., which is up almost 800% since 2000. Although Botox and fillers have traditionally been used by an older demographic, millennials (ages 20-34) make up a fast growing demographic of Botulinum users. This means big money for companies like Allergan. The effects of Botox only last 4-6 months and cost around $300 to $400 a session. Their consumer potential means millennials are now being aggressively targeted by doctors (both dermatologists and dentists) as well as pharmaceutical companies. The pitch to these mostly wrinkle-free patients is that Botox will prevent wrinkles from forming, “it is best to clean your room before it gets dirty,” claims one dermatologist.

juvederm capture
Image description: A still from a Juvéderm® video advertisement shows a young woman touching her face with two fingers; text reads “SMOOTH IT Juvéderm® XC.” Source: JUVÉDERM IT : JUVÉDERM®/YouTube.

Beauty expectations for women have always been high, but some have speculated the turn to cosmeceuticals by young women has likely increased as a result of celebrity endorsements (Kylie Jenner famously announced she is a frequent user of lip fillers) and social media platforms such as Instagram that allow users to filter pictures. As Botox and other cosmeceuticals become more mainstream (and Allergan hopes they will by producing not only advertisements, but also blogs and podcasts), social norms are beginning to change such that young women are feeling increasing pressure to use biomedical technologies to preserve and enhance their youth. Cosmeceuticals increase the pressure on women to look young and cultivate feelings of inadequacy, according to Dana Berkowitz, author of Botox Nation: Changing the Face of America. Young women begin Botox because of their fear of looking older, even before they begin seeing major age-related changes in their faces.

The appeal of the technological fix is powerful to both men and women, young and old, in a culture that prizes youth and attractiveness. The reasons people use Botox and other anti-aging procedures are multi-faceted and should not simply be reduced to mere vanity. According to Berkowitz, young women claim Botox helps them get ahead in the workforce, helps them to feel good about themselves, and is common place in certain sectors of society. Whatever the reasons, however, the result of the normalization of cosmeceuticals is that aging is becoming increasingly pathologized, and our anxieties surrounding the natural aging process are likely to increase. “It is really up to you,” one Botox ad proclaims: “You can choose to live with wrinkles. Or you can choose to live without them.” Those who refuse to use cosmeceuticals are thus complicit in the dreadful aging process. Pharmaceutical companies and even some doctors are keen to encourage and capitalize on our aging insecurities.

Devan Stahl photoDevan Stahl, PhD, is an Assistant Professor in the Center for Ethics and Humanities in the Life Sciences and the Department of Pediatrics and Human Development in the Michigan State University College of Human Medicine.

Join the discussion! Your comments and responses to this commentary are welcomed. The author will respond to all comments made by Thursday, February 7, 2019. With your participation, we hope to create discussions rich with insights from diverse perspectives.

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More Bioethics in the News from Dr. Stahl: Making Martyrs of Our Children: Religious Exemptions in Child Abuse and Neglect CasesMass Shootings, Mental Illness and StigmaDisability and the Decisional Capacity to Vote

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Who wouldn’t want to live as long as possible?

bbag-blog-image-logoShould We Be Reaching for Immortality?

Event Flyer

Whether by chipping away at the diseases of aging one-by-one, or by altering the fundamental biology of aging, medical research seems to be reaching for one over-arching goal: indefinitely extending the human lifespan. Living a longer, healthy life seems like an unqualified good. So long as life is good, who wouldn’t want to live as long as possible? The question turns out to be more complicated than it sounds. Dr. Tomlinson will be explaining some doubts, from both the individual and societal points of view.

February 13 calendar iconJoin us for Dr. Tomlinson’s lecture on Wednesday, February 13, 2019 from noon until 1 pm in person or online.

Tom Tomlinson was the Director of the Center for Ethics and Humanities in the Life Sciences from 2000-Fall 2018, has written and spoken on a wide variety of bioethical issues since 1981, and has provided clinical ethics consultation services for a number of hospitals in Michigan. He received his PhD in Philosophy from MSU in 1980, and is happy to have mentored students who have embarked on successful careers in bioethics. This talk marks the beginning of a possible book project tentatively titled The Lure of Immortality.

In person: This lecture will take place in C102 Patenge Room in East Fee Hall on MSU’s East Lansing campus. Feel free to bring your lunch! Beverages and light snacks will be provided.

Online: Here are some instructions for your first time joining the webinar, or if you have attended or viewed them before, go to the meeting!

Can’t make it? All webinars are recorded! Visit our archive of recorded lecturesTo receive reminders before each webinar, please subscribe to our mailing list.

Announcing the Spring 2019 Bioethics Brownbag & Webinar Series

bbag-icon-decIt’s almost time for the 2018-2019 Bioethics Brownbag & Webinar Series to resume! This spring we’ll hear from Center for Ethics faculty on the topics of aging and extending the human lifespan, as well as the social and ethical considerations of female cosmetic genital surgery. Please join us in person, or join the webinar livestream from any location. Visit the series webpage for more information.

Spring 2019 Series Flyer

February 13 calendar iconShould We Be Reaching for Immortality?
Wednesday, February 13, 2019

So long as life is good, who wouldn’t want to live as long as possible? The question turns out to be more complicated than it sounds.

Tom Tomlinson, PhD, is a Professor in the Center for Ethics and Humanities in the Life Sciences and the Department of Philosophy at Michigan State University.

March 13 calendar iconFemale Cosmetic Genital Surgery: Social and Ethical Considerations
Wednesday, March 13, 2019

This talk will discuss the latest innovations in female cosmetic genital surgery, the history behind the medical community’s involvement in defining women’s sexuality, and the ethical and social challenges these surgeries present.

Devan Stahl, PhD, is an Assistant Professor in the Center for Ethics and Humanities in the Life Sciences and the Department of Pediatrics and Human Development at Michigan State University.

In person: These lectures will take place from 12:00-1:00 PM in C102 (Patenge Room) East Fee Hall on MSU’s East Lansing campus. Feel free to bring your lunch! Beverages and light snacks will be provided.

Online: Here are some instructions for your first time joining the webinar, or if you have attended or viewed them before, go to the meeting!

Can’t make it? Every lecture is recorded and posted for viewing in our archive. If you’d like to receive a reminder before each lecture, please subscribe to our mailing list.