'Lifestyle Choices' Doesn’t Explain Why Black Americans Are Dying Younger and in Higher Numbers

It's not about making poor choices, says Mary Bassett. It's about the fact that people in the hardest hit neighborhoods (like Brownsville, Brooklyn) don't have enough options to choose from.

Mary Bassett: What is killing blacks in higher numbers at younger ages are the same things that kill all of us. Mainly cardiovascular disease, that means heart disease and stroke, and cancer of all kinds. So the same thing that takes people prematurely is the same burden that’s borne by all of us. It’s not a set of exotic or special diseases. Well New York has gotten healthier and healthier in recent years and our life expectancy now exceeds that of the United States as a whole. So on average New York City is definitely a place to live to be healthy. But that average doesn’t disclose the huge variation that we see by neighborhood.

We have recently completed a whole set of community health profiles that gives people information on their community district which along with the community boards are the smallest unit of decision-making in New York City. And we find that the community district actually Brownsville, which is the neighborhood that I moved to when I was a little girl and I came to New York, has a life expectancy that is 11 years shorter than the financial district. Now Brownsville, if we considered it a country and is doing a little bit worse than Peru, a little bit better than Samoa and about the same as Sri Lanka in terms of life expectancy. We’re talking about in a city that is one of the richest cities in the world, in the country, that is the richest country in the world, we have neighborhoods where the patterns of health look like those of a developing country. That’s not acceptable. In fact, it’s unconscionable. The first thing that people might think in trying to explain that is that the people in Brownsville are making a whole set of bad choices. They’re not careful about what they eat. They smoke too much. They don’t exercise enough. And that’s why they’re unhealthy. The lifestyle hypothesis is really powerful and in many ways, it replaced the genetic hypothesis as an explanation for the poor health of the black population. But let’s unpack what we mean by lifestyle. Nobody picks a substandard building to live in with terrible issues of rodent infestation and indoor allergens that trigger asthma. That’s not a lifestyle choice. No one picks a neighborhood, you know, because they want to feel unsafe there so that they won’t use the park. Or no one picks a neighborhood where there are no grocery stores or supermarkets that carry a range of vegetables that allow them to make the healthy choices we want them to make. So when we talk about lifestyle, we’re often mixing it up with poverty and all the constraints that poor, segregated neighborhoods place on people’s ability to live a health life. So it’s not about choice. It’s about the fact that people don’t have enough choice.

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With more than 30 years in public health in America and Africa, NYC Department of Health & Mental Hygiene Commissioner Dr. Mary Travis Bassett says that the same diseases — heart disease, stroke, and cancer of all kinds — that are killing white Americans are killing black Americans younger and in higher numbers. Historically, public health has tended to "blame the victim," pointing the finger at lifestyle choices like diet. But, says Bassett, the conditions that lead to those choices, and other environmental factors contributing to the disparity, are often beyond the control of the people at risk.

It's not about making poor choices, says Mary Bassett. It's about the fact that people in the hardest hit neighborhoods (like Brownsville, Brooklyn) don't have enough options to choose from.

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Yale scientists restore brain function to 32 clinically dead pigs

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Still from John Stephenson's 1999 rendition of Animal Farm.
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  • Researchers at the Yale School of Medicine successfully restored some functions to pig brains that had been dead for hours.
  • They hope the technology will advance our understanding of the brain, potentially developing new treatments for debilitating diseases and disorders.
  • The research raises many ethical questions and puts to the test our current understanding of death.

The image of an undead brain coming back to live again is the stuff of science fiction. Not just any science fiction, specifically B-grade sci fi. What instantly springs to mind is the black-and-white horrors of films like Fiend Without a Face. Bad acting. Plastic monstrosities. Visible strings. And a spinal cord that, for some reason, is also a tentacle?

But like any good science fiction, it's only a matter of time before some manner of it seeps into our reality. This week's Nature published the findings of researchers who managed to restore function to pigs' brains that were clinically dead. At least, what we once thought of as dead.

What's dead may never die, it seems

The researchers did not hail from House Greyjoy — "What is dead may never die" — but came largely from the Yale School of Medicine. They connected 32 pig brains to a system called BrainEx. BrainEx is an artificial perfusion system — that is, a system that takes over the functions normally regulated by the organ. The pigs had been killed four hours earlier at a U.S. Department of Agriculture slaughterhouse; their brains completely removed from the skulls.

BrainEx pumped an experiment solution into the brain that essentially mimic blood flow. It brought oxygen and nutrients to the tissues, giving brain cells the resources to begin many normal functions. The cells began consuming and metabolizing sugars. The brains' immune systems kicked in. Neuron samples could carry an electrical signal. Some brain cells even responded to drugs.

The researchers have managed to keep some brains alive for up to 36 hours, and currently do not know if BrainEx can have sustained the brains longer. "It is conceivable we are just preventing the inevitable, and the brain won't be able to recover," said Nenad Sestan, Yale neuroscientist and the lead researcher.

As a control, other brains received either a fake solution or no solution at all. None revived brain activity and deteriorated as normal.

The researchers hope the technology can enhance our ability to study the brain and its cellular functions. One of the main avenues of such studies would be brain disorders and diseases. This could point the way to developing new of treatments for the likes of brain injuries, Alzheimer's, Huntington's, and neurodegenerative conditions.

"This is an extraordinary and very promising breakthrough for neuroscience. It immediately offers a much better model for studying the human brain, which is extraordinarily important, given the vast amount of human suffering from diseases of the mind [and] brain," Nita Farahany, the bioethicists at the Duke University School of Law who wrote the study's commentary, told National Geographic.

An ethical gray matter

Before anyone gets an Island of Dr. Moreau vibe, it's worth noting that the brains did not approach neural activity anywhere near consciousness.

The BrainEx solution contained chemicals that prevented neurons from firing. To be extra cautious, the researchers also monitored the brains for any such activity and were prepared to administer an anesthetic should they have seen signs of consciousness.

Even so, the research signals a massive debate to come regarding medical ethics and our definition of death.

Most countries define death, clinically speaking, as the irreversible loss of brain or circulatory function. This definition was already at odds with some folk- and value-centric understandings, but where do we go if it becomes possible to reverse clinical death with artificial perfusion?

"This is wild," Jonathan Moreno, a bioethicist at the University of Pennsylvania, told the New York Times. "If ever there was an issue that merited big public deliberation on the ethics of science and medicine, this is one."

One possible consequence involves organ donations. Some European countries require emergency responders to use a process that preserves organs when they cannot resuscitate a person. They continue to pump blood throughout the body, but use a "thoracic aortic occlusion balloon" to prevent that blood from reaching the brain.

The system is already controversial because it raises concerns about what caused the patient's death. But what happens when brain death becomes readily reversible? Stuart Younger, a bioethicist at Case Western Reserve University, told Nature that if BrainEx were to become widely available, it could shrink the pool of eligible donors.

"There's a potential conflict here between the interests of potential donors — who might not even be donors — and people who are waiting for organs," he said.

It will be a while before such experiments go anywhere near human subjects. A more immediate ethical question relates to how such experiments harm animal subjects.

Ethical review boards evaluate research protocols and can reject any that causes undue pain, suffering, or distress. Since dead animals feel no pain, suffer no trauma, they are typically approved as subjects. But how do such boards make a judgement regarding the suffering of a "cellularly active" brain? The distress of a partially alive brain?

The dilemma is unprecedented.

Setting new boundaries

Another science fiction story that comes to mind when discussing this story is, of course, Frankenstein. As Farahany told National Geographic: "It is definitely has [sic] a good science-fiction element to it, and it is restoring cellular function where we previously thought impossible. But to have Frankenstein, you need some degree of consciousness, some 'there' there. [The researchers] did not recover any form of consciousness in this study, and it is still unclear if we ever could. But we are one step closer to that possibility."

She's right. The researchers undertook their research for the betterment of humanity, and we may one day reap some unimaginable medical benefits from it. The ethical questions, however, remain as unsettling as the stories they remind us of.

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