Our Own Devices: How Technology Remakes Humanity (9 page)

Because this ancient pattern of breast-feeding is difficult to study in Western societies, we still are not sure of its effects on maternal
health. There is some evidence that prolonged breast-feeding has protective value against breast cancer, especially among premenopausal women. Societies in which breast-feeding is widespread tend to have lower rates of breast cancer, and when infants are fed unilaterally, the suckled breast is significantly less likely to develop cancer. Breast-feeding is also thought to reduce ovarian and endometrial
cancer. Since the choice of whether to bottle-feed or breast-feed may be associated with so many differences in diet and other practices, these findings are more suggestive than conclusive. But it still seems likely that future clinical studies will confirm some
significant long-term differences in the health of breast-feeding and bottle-feeding women.
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There is a clear benefit for women in
natural regulation of birth patterns. In developing countries where mechanical or chemical contraceptives may be unavailable or too costly, prolonged breast-feeding—because it often inhibits ovulation—can space children naturally three or four years apart, the pattern among early hunter-gatherers. There are good evolutionary reasons for this pattern: sibling competition for a mother’s milk endangers
the survival of both infants and hence of their genes. The hormone prolactin, which stimulates milk production, is produced by the hypothalamus in response to the infant’s suckling. Prolactin also suppresses ovulation and menstruation (the medical term for this effect is
lactational amenorrhea
). Because they generally gave their children to wet nurses rather than breast-feeding them, upper-class
women in early modern Europe had much larger families than poorer women did. Swedish peasant women, and no doubt many others, were aware of this contraceptive benefit. But even in cultures where breast-feeding remains the norm, ovulation sometimes resumes while a mother is still nursing. Suckling at longer intervals appears to allow prolactin levels to sink; it is more frequent, on-demand suckling
that keeps prolactin levels elevated.
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What seemed to be an elementary chemical and mechanical challenge— duplicating the constituents of mother’s milk and making it available to infants—has become a ubiquitous technology that changes both the bodies and the social lives of most men and women in industrial societies. Nineteenth- and twentieth-century technology did
not begin humanity’s cultural tinkering with ancestral patterns of infant feeding; we have seen that wet nursing and feeders were widespread in Europe. A baby nourished today with the latest version of infant formula may lack many nutrients and hormones unique to mother’s milk, but it is certainly better off than its ancestors might have been with the often deadly mixes of their time and has far
better prospects for health than an eighteenth-century child farmed out to a wet nurse miles away. And even breast-feeding advocates have made some room for artificial feeders. Bottles and other feeding devices are now recommended for administering the stored milk of nursing mothers while they are at work. While the medicalization of infant feeding a hundred
years ago introduced some dubious concepts
and practices—for example, strictly scheduled breast-feeding—that interfere with infants’ natural demands and the beneficial synchronization of mothers’ and infants’ sleeping cycles, scientific research has also corrected errors. For example, in Europe and elsewhere, yellow early milk, called colostrum, was once discarded as poisonous to infants. While until recently some hospitals gave newborns
sugar water solutions instead, English physicians had discovered the excellent nutritional value of colostrum by the early eighteenth century. Some historians believe those physicians’ publications helped shape modern forms of family affection with maternal breastfeeding at their core.
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By 2000, the bottle and formula industry had achieved a paradoxical relationship with medical leaders and
breast-feeding advocates. The boycott of Nestlé for its Third World marketing remained in effect but was less visible in the press. The manufacturers, for their part, conceded the superiority of human milk for infants in principle but still promoted their products through hospitals and encouraged supplemental feeding. Medical authority, once firmly on the side of the bottle, now supports breastfeeding.
After declining in the 1980s, the proportion of breast-fed newborns in the United States rose to 59.7 percent by 1995, nearly equal to its 1982 level, but now the rate of breast-feeding is highest among more affluent and older women. Even in 1995, only 21.6 percent of infants were still breast-feeding at six months. There is still a vast domestic and international market for bottles and infant
formula, $3 billion annually in the United States alone.
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The infant formula industry has achieved a curious symbiosis with its foes, the breast-feeding advocates. Even with the best lactation counseling and banked human milk from volunteers, at least a small number of infants will need formula. Our knowledge of the new revival of breastfeeding in the 1990s comes not from the U.S. Census Bureau
or the Public Health Service but from a survey conducted by the Ross Products Division of Abbott Laboratories, a major producer of formula. Formula companies not only sponsor conferences on breast-feeding but fill a gap in consumer information: in Britain one formula maker sent out to parents 300,000 articles in support of breast-feeding. Companies openly acknowledge the superiority of breast
milk and try to approach its composition more closely, though they obviously cannot replace the mother’s enzymes and antibodies. But this research and improvement are also controversial, and not just because they may encourage bottle-feeding.
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The long-chain fatty acid DHA, present naturally in mother’s milk, is known to help develop infants’ brain cells. The WHO and the Commission of the European
Community have endorsed it, and premium formulas overseas include it. The U.S. Food and Drug Administration approved it for inclusion in formula in 2001. Yet there are more than 160 other fatty acids in breast milk that do not appear in formula, and scientists are still unsure whether synthetic and natural nutrients are equivalent. The formula makers’ goal has changed; where Liebig aimed to
duplicate human milk, manufacturers now seek to match the “performance” of breast-fed babies. The position of the U.S. Food and Drug Administration appears in a headline in its consumer magazine: “Second Best but Good Enough.”
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And as formula makers extol and emulate breast milk, even scientific advocates of breast-feeding are adding cautions. Alan Lucas, the infant nutrition scientist whose
work on nutritional programming is some of the most powerful evidence against the bottle, recently called attention to studies concerning the long-term effects of early feeding on heart disease. When adult baboons were fed a typical Western high-fat “unphysiologic” diet, those that had been breast-fed in infancy developed more fatty arterial streaks than those that had been formula-fed. Human studies
also suggest that prolonged breast-feeding increases the risk of cardiovascular disease in men. And environmental hazards may create new risks. In the 1960s, strontium-90 was found in Americans’ breast milk, and dioxin was found in the 1980s. A Dutch study in the late 1990s revealed that polychlorinated biphenyls (PCBs), a neurotoxic threat to intelligence and learning, appeared in the bloodstreams
of breast-fed children at a concentration 3.6 times higher than that found in the bloodstreams of their bottle-fed counterparts. Though these results are tentative and Lucas cautions against drawing any inference against breast-feeding, they do show that as we change our environment inadvertently, we modify ourselves unexpectedly as well.
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Despite all the evidence against it, the bottle is likely
to remain the first technology of a substantial part of humanity. It gives fathers a nurturing opportunity denied them by nature. (In the 1980s, a prominent American male physician even invented the Baby Bonder, a bib of terrycloth and fleece with nipple openings through which men could nourish their children.) Formula is certainly superior to the animal milk that traditional societies used
as a breast-milk substitute. Because American physicians still have limited training in helping with breast-feeding technique, but extensive information on prescribing formula, and because American insurers
are reluctant to pay for lactation consultants, mothers are likely to breastfeed for a matter of months rather than the year or more that medical societies as well as evolutionary biologists
and epidemiologists recommend.
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One reason is that breast-feeding, like many other techniques, conveys conflicting values. Many of its advocates consider it a feminist act, a rejection of the contemporary sexualization of the breast. It is an affirmation of women’s autonomy and unique capacity in the face of medical and commercial interests that initially sponsored “scientific” feeding, from
the patriarchal Dr. Liebig onward. But breast-feeding, as we have seen, has also attracted male (and conservative female) campaigns to restrict married women to a nurturant domestic sphere. The health benefits of nursing for mothers appeal to liberals’ greener side, but if expressed too forcefully they can also appear to some progressives as holistic fascism. The bottle, and modern infant formula,
are much easier to oppose in the developing world than in Western societies that do not seem prepared to pass legislation guaranteeing nursing mothers equality in careers, or even decent accommodation in public spaces. Even where breast-feeding could save money for governments, as in U.S. income-supplement programs for women, infants, and children, authorities have not promoted it vigorously. Bottle-feeding
may exact a high price in medical costs, but as long as medications exist to treat the illnesses it increases, the technological treadmill will roll on.
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On balance, then, the twentieth century gave a scientific and moral victory to breast-feeding but a de facto social and economic victory to bottle-feeding after the first few months of life. But breast-feeding advocates, scientific and lay,
have made remarkable gains in transmitting and improving a sometimes challenging technique over a technology that, for all its progress, has remained merely adequate. Now there is the prospect, equally heartening and disturbing, of cows genetically engineered to produce human milk. What Liebig’s chemistry was to the nineteenth century, molecular biology will surely be to the twenty-first. But even
if the children are healthy and the cloned cows contented, and even if women could take safe medication that conferred on them the benefits nursing provides, could the transmission of one of the most profound human skills become threatened?
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W
HILE NURSING IS
our first technique—and, for many of us, the bottle our first technology—the first rite of technical passage for the greater part of humanity is the use of footwear. We are not the only animal that uses external things to modify its body: hermit crabs, for example, inhabit discarded shells of other creatures. Nor are we the only animal that makes
things to modify its body: chimpanzees sometimes use large leaves for walking, as they do for eating. But we are the only animal that both makes and needs these objects for its well-being. None changes us more significantly than shoes. Footwear alters the foot itself, sometimes disastrously, but it helps prevent conditions that may have even worse effects. It changes not only our contact with
the world but our perception of it. And through the meanings which have been assigned it, it affects how we relate to others socially.

The footwear consultant and columnist Dr. William Rossi has identified seven and only seven styles of shoe: moccasin, sandal, boot, clog, pump, mule, oxford. The moccasin, a piece of leather wrapped around the foot and fastened with a leather thong or other material,
is thought to be the oldest foot covering. But sandals—pieces of leather or other material held on the foot with straps or other devices—are almost as ancient. Other footwear forms are combinations or extensions of the moccasin and sandal. Our word
sole
is derived from the Latin
solea
, a sandal made of heavy leather or woven straw with loops for straps of plaited straw or rawhide, and many of
our other shoe styles are moccasins sewn or bonded to a sandal platform. North American Indians had three styles: moccasins with continuous soft soles, hard-soled moccasins, and (especially in what is
now the U.S. Southwest and parts of Central America) sandals of hide or plant materials.
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Because true moccasins are unsuitable for contemporary paved roads and sidewalks, the sandal remains the
most ancient form of footwear in common use. In fact, rubber and plastic sandals are among the most plentiful manufactured objects on the earth’s surface. No official international statistics are available, but the Canadian shoe industry specialist Phillip Nutt estimates that in the last sixty years, the earth’s factories have produced fifteen billion to twenty billion pairs. The thong sandal, with
two straps anchored at three points, forming a
V
with its apex between the first and second toes, is known to nearly every nation and social class. The variety of its names in English alone reflects its ubiquity: zori (
zories
is the official term of the U.S. Customs Service), thongs (originally Australian), flip-flops (originally New Zealand), slippers (Hawaii), slaps, flaps, beach walkers, and
go-aheads. On one Caribbean luxury cruise, the writer David Foster Wallace counted over twenty makes. Used apparently independently by societies around the world for millennia, the thong, or zori, went into mass peacetime production more than fifty years ago thanks to new materials and manufacturing techniques. Like other body technologies, it helps shape body techniques. But to understand the zori,
we must start by asking why people need even this simplest of footwear.
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Sandals, like other footwear, are a compromise. The naked foot functions best without them. While bipedalism, as the performance of apprehended drunken drivers trying to walk a straight line suggests, becomes hazardous whenever sensation and balance are compromised, the structure of the foot is not to blame. The
foot is one of a complex series of adaptations to bipedal locomotion, and one of the last to achieve its current configuration. It is a masterpiece of 26 bones, 33 joints, 107 ligaments, and 19 muscles that can withstand the repeated forces of up to 600 pounds while running. Yet each square inch of the sole has 1,300 nerve endings to make possible the constant adjustments needed for its role in
weight bearing, balancing, and propulsion. The human foot is unique in the animal world for its two arches, transverse (side to side) and longitudinal (lengthwise). These let us stand upright by spreading the weight on the plantar surface (sole) of the foot as broadly as possible and by forming a tripod, absent in
other primates. (Chimpanzees and gorillas can walk on their hind legs for a limited
distance, but they cannot stand still bipedally on the ground without an object for support.) The first digit of the human foot, the big toe or hallux, has grown to bear the stress of locomotion, and the ball of the foot cushions us and helps us push off. The human foot also retains surprising potential dexterity. People born without normal hands have been known to develop complex manipulative
skills in their feet, transferring the brain’s motor control from one set of limbs to the other. A French physician, commenting on the mediocre work of the armless painter César Ducornet (1806–1856), once widely exhibited in provincial museums, noted that the mind that conceived the work was inferior, but that the foot had executed it correctly.
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People in industrial societies may assume that
the tender sole would soon be ravaged by its environment without the protection of footwear. In fact, wearing shoes creates this sensitivity. After a week of barefoot living, the foot forms a protective thickened layer that, unlike calluses, does not generally block the pleasurable sensations of contact with the earth. A billion people on earth still go barefoot—some of them in harsh conditions,
like the Seri of the Sonoran coast of Mexico, opposite Baja California, whose feet are toughened by the sand until they form a “Seri boot.” In the rough, hilly regions of the Congo, unshod indigenous people developed a keratin coating on their soles so thick that they were able to walk on live coals without feeling pain. Some urban workers have managed without shoes. One investigation of several hundred
barefoot rickshaw men of Shanghai, whose work took them over twenty miles of cobblestones and pavement every day, found that arch deformities and foot ailments were rare.
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Even in the industrial West, a surprising number of enthusiasts for barefoot living remain, despite a cultural bias dating from Roman times, when Greek barefoot customs disappeared, sandals represented imperial power, and bare
feet became a mark of slavery or the most extreme poverty. In Coptic Christianity and later in some Western monastic orders, abandonment of footwear signified deep humility and poverty. St. Francis embraced the custom as a way of imitating Christ, though the order he founded later turned to sandals. But many other men and women, and especially children, have avoided footwear not to mortify the
flesh but to indulge it. Well into the twentieth century, country children often went barefoot, especially in Ireland. So strong was the custom that Friedrich
Engels, in
The Condition of the Working Class in England
, reported that Irish immigrants were spreading it, especially to “the poorer native women and children of the factory towns.” At the turn of the twentieth century, many Irish children
still wore no shoes, even in strictly uniformed schools. In fact, some schools barred shoes as ostentatious. To urban Americans of the nineteenth and early twentieth centuries, John Greenleaf Whittier’s “barefoot boy with cheek of tan” represented rural innocence, and now signifies nostalgia. In the sleepy county seat of Belvidere in northern New Jersey, for example, I have seen a plaque marking
the “shoe tree,” where rural children were said to have put on their shoes before entering a nearby church, reversing the injunction to Moses to “put off thy shoes” in Exodus 3:5. (Even in the United States, bare feet are still permitted in some Amish and Hawaiian classrooms.)
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In the early twenty-first century there is a vigorous barefoot hiking movement; one of its most active groups is led
by an English-born theology graduate living in Connecticut, Richard Keith Frazine, who literally seeks to tread lightly on the earth. “Walking barefoot, as Nature intended,” he explains, “humans hardly disturb even the most delicate ground cover and can delight in the soft, carpet-like feel of moss in good conscience.” His fascinating book shows how the technique of barefoot walking must be relearned.
Months of conditioning may not be necessary, as skeptics believe, but it takes several miles of practice on well-maintained trails a few days a week for two or three weeks to accustom the feet to what was once their natural activity. The rush of new sensations from the environment, while ultimately pleasurable, can at first be overwhelming in their unfamiliarity, as though we had grown up with
our ears covered. And barefoot hiking requires learning a somewhat different technique of walking, not just for enjoying contact with the forest floor, but for noticing and avoiding obstructions and poison ivy and dealing with insects. “You must choose each footfall,” Frazine explained to a local reporter as they crossed a stream. “Anticipate each step. If you kick, shuffle or drag your feet, your
chance of injury multiplies enormously.” Proper barefoot hiking demands a vertical step in which the foot conforms itself to the forest floor. A Canadian barefoot hiker describes a maneuver for reacting to sharp objects: rolling the foot and rolling off to the side. Even the return to intimacy with nature demands learning technique—and using technology like insect repellent, and lanolin as a foot
conditioner.
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Despite the still flourishing, innocuous fetishism of the baby shoe, the unshod child’s foot remains an exemplar of the body’s uncorrupted state. Bare feet appear to be safer for children than many shoes, according to one study of injuries seen in the emergency room of the Children’s Hospital of Philadelphia in 1988. Falls cause half of all childhood accidents,
and the study showed that injuries from loss of footing were more common among children with smooth-soled shoes than among the barefoot.
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Two generations ago, medical and popular opinion recommended children’s shoes not only for safety but to prevent flat feet. The stigma of the flat foot appears to date from nineteenth-century military medicine, preoccupied with foot irregularities as signs
of physical and mental degeneration and unfitness for service. (In German-speaking Europe, Jewish feet were especially suspect.) Medical authorities believed in early mechanical intervention for healthy foot development. As late as 1920, a medical text warned that “infants should be taught to creep, and early walking discouraged.” Orthopedists and pediatricians favored stiff shoes with corrective
inserts, some still used in special cases and others long forgotten. By the 1930s, no fewer than fifty “doctor’s” shoes and one hundred types of arch support were available in the United Kingdom. Manufacturers in the United States (following the lead of the physician, shoemaker, and master salesman William Mathias Scholl) were equally zealous in producing “corrective” juvenile shoes. As William Rossi
later observed, these shoes had no scientific basis. Even now there is no standard for a healthy or unhealthy, high or low arch.
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And at least in the United States, the military itself has changed its stance. For decades, North American army doctors rejected conscripts and volunteers alike for flat feet, even star athletes like Satchel Paige (who thereby enjoyed a lucrative civilian career during
World War II) and accomplished hikers like the professional hunter who was turned down after walking two hundred miles to Edmonton to enlist. A 1947 Canadian army survey of foot problems warned that training recruits with low arches was a “useless waste of time, effort and money.” This opinion was challenged only in 1989, when scientists at the U.S. Army Institute of Environmental Medicine in
Natick, Massachusetts, found that soldiers with low arches had half as many foot problems as those with high insteps. High arches may be more rigid and unstable; flat feet, unless they are painfully so, are more flexible and better equipped to absorb the shocks of
exercise. One of the study’s investigators told a reporter: “I’ve seen drill sergeants with arches as convex as the bottoms of rocking
chairs, who are active and successful.”
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Beginning in the 1970s, medical researchers began to question the value of many corrective shoes prescribed for children. They saw great variation in normal, healthy young feet. A study of the feet of 2,000 children, published in 1971, revealed that of those who were wearing special shoes for flat feet, only 43 percent had true pes valgus (the technical
term for an abnormally low longitudinal arch). The “corrective” shoes that these children had been wearing had not had any effect on their arches. In the early 1990s, orthopedists in India examined the static footprints of 2,300 children and found that the incidence of flat feet among those who used footwear, especially closed shoes, was three times higher than among children who were exclusively
barefoot, although the longitudinal arches of the great majority of the flat-footed children recovered naturally after the age of eleven. Studies elsewhere found that 80 percent of two- to four-year-old children were beginning to show malformation of the toes as a result of wearing shoes; that nearly three-quarters of children’s shoes are between a half size and 3.6 sizes too small; and that the
lasts (wooden or plastic forms on which shoes are built) of children’s shoes differ from the dimensions of normal children’s feet. After a review of the literature, the orthopedist Lynn T. Staheli concluded that the best criterion for children’s shoes is how well they approach the barefoot state, including their spaciousness, lightness, flexibility, and porosity. Except in cases of congenital deformity—some
flat feet and other conditions can be painful and do benefit from treatment—the dream of molding ideal feet through stiffly engineered shoes is as dated as the idea of the superiority of formula to mother’s milk.
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