In this episode of Cubs Out Loud, the cubs take some time to discuss some feedback they received from their recent “Bear Issues” episode. Listen in as they get some insight on the scientific process from a fan and doctoral student. Also, first world problems, gay desserts, and holding the door.

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Introduction Topics

What’s Going On?

• Jeff: What to do
• Damon: June/July will be busy
• Gary: Pride is tiring

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Bear Underground: chubnerdchaser

Weekly Topic

Bear Issues Study Feedback  – COL367 episode feedback for discussion

[From Facebook]

Randall: great episode…i have to agree with your points on this “study” that was conducted as i am sure several of us feel it is incomplete and highly inaccurate..sadly misinformation is such a dangerous thing and does not help our community at large or how others perceive our community. Again please keep up the good work and i liked the Down Low topic being brought up..i myself have a story about a straight guy and being his “secret sex” as i am sure most of us in the bear community do

[From Email]

Hi cubs!

I just finished listening to your podcast on bear issues. I also read the journals on Instinct and the Journal of Clinical Nursing. I have been following the scientific literature on bears and their health for some time now and was very excited to see that someone wrote a systematic review! But when I read the Instinct article I was concerned. I was also concerned when I heard your thoughts and heard that you had so many questions. If you allow me, I would like to express my opinion about this issue. This email is going to be long, but bear with me(pun completely intended :P); I’m going to try to make it worth your time.

First, let me tell you why I care about this. I am a doctoral student and my line of research is on health and health disparities (how individual or social characteristics may affect health). I have previously given lectures about the LGBT and bear communities to college students. I have also worked with and for the LGBT community. I also keep my colleagues and faculty aware of the specific health issues that minorities (LGBT, Hispanics, etc.) face. Also, I have published research and served as an independent reviewer of studies and reviews for scientific journals.

When I read the article on Instinct, my academic soul hurt so much. I recently found a great and funny video about this issue and I hope you enjoy it (I know, it is 20 minutes long, but it is sooooo worth it).

I hope I still have your attention after watching the video and would like to address your questions in an organized way so that you feel free to read as much as you can/want/like:

About studies and systematic reviews:  Individual studies may contradict each other in some or all aspects. This happens in social science, physics, chemistry, biology, and computer science. As you guys pointed out, the discrepancies could be because of who researchers surveyed or interviewed, where they surveyed them, and other methods. Systematic reviews are a way of bringing all the findings together, making sense of the information at a greater scale, finding patterns, suggesting why results differ, and suggesting improvement in research (and in this case also clinical practice). The usual audience of empirical studies, systematic reviews, and meta-analysis is other researchers or clinicians with similar training. The way other researchers and clinicians interpret these articles is different than someone without the training.

As an analogue, imagine researchers finding that Hispanics have a higher likelihood of having diabetes and hypertension (this is something that has been found repeatedly). I bet someone has interpreted this as “Hispanics are fat and lazy” or “Hispanics are hot heads.” But remember, this is not what the researchers have said. They have identified that Hispanics are at a greater risk for diabetes and hypertension, but the causes are not known (more of that in a bit). The same happened in the systematic review.

About the purpose of the systematic review: I guess it would be good to know the purpose of the systematic review was two-fold: 1) to address possible health disparities among people who identify as bears so that other researchers fine tune future research and 2) motivate other clinicians to improve the health of those who identify as bears. The purpose is not to criticize or stigmatize bears. It is to address the health needs of bears. The authors of the systematic review make that clear while the author of the article in Instinct did not.

About the people studies recruited: It is impossible to recruit every person from the populations we are interested in. Recruitment for studies like the ones mentioned in the review is usually self-selective. We want people to be willing to answer some questions and not everyone has the time or the willingness. The studies cited in the review included men who self-identified as bears through a survey, an interview, or any other form. Some of the studies compared men who identified as bears to other groups like straight men or gay men who did not identify as bears (usually asking a simple question like: “Do you identify as a bear?” or “How would you identify yourself” and providing options). Here is one of the descriptions from Manley, Levitt, and Mosher (2008).

“The study was advertised through e-mails sent to listservs serving the bear community and to bear community group leaders. These postings asked for volunteers to participate in a study that sought to understand the relationships, values, and beliefs of bear-identified men.”

Another study from Moskovitz and colleagues recruited gay men from Craigslist (Australia, Canada, New Zealand, UK), IML (Chicago, 2008) and PrideFest (Milwaukee, 2008). One of the studies was done in China! Still, the concern you guys expressed that the findings may not apply to all bears is true and the authors of the systematic review mention this as a limitation:

“The total number of research studies and the small sample size within those studies may not reflect the true experiences of the men who identify as Bears. Researchers should be very cautious when interpreting the results of the studies.”

About risky behavior: I admit that I do not like when someone uses the words “risky,” “unhealthy,” or “low self-esteem” in the same sentence as my different identities (gay, bear, Hispanic, researcher, graduate student, poor). However, knowing that I am at a higher risk for diabetes because I am Hispanic has given me the power to take action and prevent it from happening. As I have mentioned, this review has that purpose; letting others know where to look to prevent  bad things from happening. With this, let me show you an extract of the findings and then the recommendations from the review authors:

“When compared to other gay men, men who identified as Bears engaged in more diverse sexual acts like anilingus, fisting, asphyxiation, voyeurism, and exhibitionism (Moskowitz et al., 2013). Furthermore, men who identified as Bears were found to engage in UAS more often than other gay peer groups (Prestage et al., 2015; Willoughby et al., 2008).”

These sexual activities are characterized as “diverse” in the text not as perverse or wrong. Remember that guys who self-identify as bears were reporting these behaviors more often than other gay men (who do not identify as bears).

“Men who identified as Bears were found to engage in unsafe sexual activity, like UAS, anilingus, and fisting, more often than other gay men (Moskowitz et al., 2013; Willoughby et al., 2008). Healthcare providers can offer advice regarding protective measures to help decrease the chance of infection like the use of condoms and dental dams or receiving the hepatitis A vaccine. If a client engages in fisting, healthcare providers should teach clients the risks such as laceration or perforation of the rectum or colon, which can result in serious injury.”

We know that anal sex without a condom, anilingus, and fisting increase the chances of infections and injury in everyone. With the premise that men who identify as bears are reporting these behaviors more often than other groups, bears may face specific health needs that other groups may not. Even when people engage in fisting using as much caution as possible, fisting increases the risk of injury just like driving a car increases at speed limit increases your risk of injury compared to someone who does not drive a car or someone who drives very infrequently. The authors are not condemning or suggesting other clinicians to tell clients or patients to stop these activities. They are calling for clinicians to inform their patients about the risks. Patients can, then, decide what to do with the information.

About cause and effect: One of the issues that I remember from the podcast was the feeling that the authors of the review were implying that because we are bears all bears are unhealthy and have low self-esteem. The authors are not saying or implying that, but when articles like these are interpreted by other people who are not familiar with scientific writing, it could be interpreted in many ways. The systematic review and the articles it included are basically saying: “People who identify as bears report these characteristics more often or at higher rates than people who do not identify as bears.” In other words, researchers and clinicians read this as “people who identify as bears, on average, report higher BMI, more self-esteem issues, more masculinity traits, etc.” Other researchers usually know that studies like these cannot apply to everyone, but could be useful in identifying health needs. They also know the fact that being a bear does not cause lower self-esteem, higher masculinity, etc. A study answering that question would be impossible to do.

About BMI: Yes, BMI has a lot of flaws and has created unrealistic expectations and confusion. We cannot disregard that, time and time again, research has shown that higher BMIs usually categorized in the obese range are related to worse health outcomes especially if a sedentary lifestyle, smoking, excessive drinking, sleep problems, and other issues that go together are also present. The BMI is not a great measure of health, but it reflects other issues and works to take quick decisions when you are a doctor seeing a bunch of patients for 15 minutes at a time.

There is a lot that was left out from the Instinct article that is important to know. The language used in the systematic review was neutral and without bias against bears or gay individuals. It communicated a concern about potential and specific health needs of bears. The first author seems to identify as a bear (I did a quick search on google). The article recognizes that more research needs to be done to have a clearer picture about the health needs of bears. The review has been accepted for publication, but it is not the final product. Even though the results are unlikely to change, the suggestions and interpretations may be changed in the final version.

I hope I did not bore you too much with all this info. I did this because I care about these issues and I have been involved in research, clinical practice, and the LGBT community to offer a perspective you may have not had from any of these individual sources of information. If you have any comments or questions, I’d be happy to discuss them and answer them the best way possible.

Best,

Francisco Salgado-Garcia

Cooldown Topics

I’ll Tumbl For You:

• [Jeff]: The Joys of a Cub in a Singlet
• [Damon]: In honor of “that thing we do in May”
• [Gary]: Green Field Experience

Links:

• [Jeff]: AJ & Magnus Patreon
• [Damon]:  Defining Gravity by A Capella Science (Thanks Allan!)

• [Gary]: P!nk – Just Like Fire (2016 Billboard Music Awards Performance) 

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