Category Archives: Health

Ethical and practical issues for uBiome to keep working on.

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Earlier this week, the Scientific American Guest Blog hosted a post by Jessica Richman and Zachary Apte, two members of the team at uBiome, a crowdfunded citizen science start-up. Back in February, as uBiome was in the middle of its crowdfunding drive, a number of bloggers (including me) voiced worries that some of the ethical issues of the uBiome project might require more serious attention. Partly in response to those critiques, Richman’s and Apte’s post talks about their perspectives on Institutional Review Boards (IRBs) and how in their present configuration they seem suboptimal for commercial citizen science initiatives.

Their post provides food for thought, but there are some broader issues about which I think the uBiome team should think a little harder.

Ethics takes more than simply meeting legal requirements.

Consulting with lawyers to ensure that your project isn’t breaking any laws is a good idea, but it’s not enough. Meeting legal requirements is not sufficient to meet your ethical obligations (which are well and truly obligations even when they lack the force of law).

Now, it’s the case that there is often something like the force of law deployed to encourage researchers (among others) not to ignore their ethical obligations. If you accept federal research funds, for example, you are entering into a contract one of whose conditions is forking within federal guidelines for ethical use of animal or human subjects. If you don’t want the government to enforce this agreement, you can certainly opt out of taking the federal funds.

However, opting out of federal funding does not remove your ethical duties to animals or human subjects. It may remove the government’s involvement in making you live up to your ethical obligations, but the ethical obligations are still there.

This is a tremendously important point — especially in light of a long history of human subjects research in which researchers have often not even recognized their ethical obligations to human subjects, let alone had a good plan for living up to them.

Here, it is important to seek good ethical advice (as distinct from legal advice), from an array of ethicists, including some who see potential problems with your plans. If none of the ethicists you consult see anything to worry about, you probably need to ask a few more! Take the potential problems they identify seriously. Think through ways to manage the project to avoid those problems. Figure out a way to make things right if a worst case scenario should play out.

In a lot of ways, problems that uBiome encountered with the reception of its plan seemed to flow from a lack of good — and challenging — ethical advice. There are plenty of other people and organizations doing citizen science projects that are similar enough to uBiome (from the point of view of interactions with potential subjects/participants), and many of these have experience working with IRBs. Finding them and asking for their guidance could have helped the uBiome team foresee some of the issues with which they’re dealing now, somewhat late in the game.

There are more detailed discussions of the chasm between what satisfies the law and what’s ethical at The Broken Spoke and Drugmonkey. You should, as they say, click through and read the whole thing.

Some frustrations with IRBs may be based on a misunderstanding of how they work.

An Institutional Review Board, or IRB, is a body that examines scientific protocols to determine whether they meet ethical requirements in their engagement of human subjects (including humans who provide tissue or other material to a study). The requirement for independent ethical evaluation of experimental protocols was first articulated in the World Medical Association’s Declaration of Helsinki, which states:

The research protocol must be submitted for consideration, comment, guidance and approval to a research ethics committee before the study begins. This committee must be independent of the researcher, the sponsor and any other undue influence. It must take into consideration the laws and regulations of the country or countries in which the research is to be performed as well as applicable international norms and standards but these must not be allowed to reduce or eliminate any of the protections for research subjects set forth in this Declaration. The committee must have the right to monitor ongoing studies. The researcher must provide monitoring information to the committee, especially information about any serious adverse events. No change to the protocol may be made without consideration and approval by the committee.

(Bold emphasis added.)

In their guest post, Richman and Apte assert, “IRBs are usually associated with an academic institution, and are provided free of charge to members of that institution.”

It may appear that the services of an IRB are “free” to those affiliated with the institution, but they aren’t really. Surely it costs the institution money to run the IRB — to hire a coordinator, to provide ethics training resources for IRB members and to faculty, staff, and students involved in human subjects research, to (ideally) give release time to faculty and staff on the IRB so they can actually devote the time required to consider protocols, comment upon them, provide guidance to PIs, and so forth.

Administrative costs are part of institutional overhead, and there’s a reasonable expectation that researchers whose protocols come before the IRB will take a turn serving on the IRB at some point. So IRBs most certainly aren’t free.

Now, given that the uBiome team was told they couldn’t seek approval from the IRBs at any institutions where they plausibly could claim an affiliation, and given the expense of seeking approval from a private-sector IRB, I can understand why they might have been hesitant to put money down for IRB approval up front. They started with no money for their proposed project. If the project itself ended up being a no-go due to insufficient funding, spending money on IRB approval would seem pointless.

However, it’s worth making it clear that expense is not in itself a sufficient reason to do without ethical oversight. IRB oversight costs money (even in an academic institution where those costs are invisible to PIs because they’re bundled into institutional overhead). Research in general costs money. If you can’t swing the costs (including those of proper ethical oversight), you can’t do the research. That’s how it goes.

Richman and Apte go on:

[W]e wanted to go even further, and get IRB approval once we were funded — in case we wanted to publish, and to ensure that our customers were well-informed of the risks and benefits of participation. It seemed the right thing to do.

So, we decided to wait until after crowdfunding and, if the project was successful, submit for IRB approval at that point.

Getting IRB approval at some point in the process is better than getting none at all. However, some of the worries people (including me) were expressing while uBiome was at the crowdfunding stage of the process (before IRB approval) were focused on how the lines between citizen scientist, human subject, and customer were getting blurred.

Did donors to the drive believe that, by virtue of their donations, they were guaranteed to be enrolled in the study (as sample providers)? Did they have a reasonable picture of the potential benefits of their participation? Did they have a reasonable picture of the potential risks of their participation?

These are not questions we leave to PIs. To assess them objectively, we put these questions before a neutral third-party … the IRB.

If the expense of formal IRB consideration of the uBiome protocol was prohibitive during the crowdfunding stage, it surely would have gone some way to meeting ethical duties if the uBiome team had vetted the language in their crowdfunding drive with independent folks attentive to human subjects protection issues. That the ethical questions raised by their fundraising drive were so glaringly obvious to so many of us suggests that skipping this step was not a good call.


We next arrive at the issue of the for-profit IRB. Richman and Apte write:

Some might criticize the fact that we are using a private firm, one not connected with a prestigious academic institution. We beg to differ. This is the same institution that works with academic IRBs that need to coordinate multi-site studies, as well as private firms such as 23andme and pharmaceutical companies doing clinical trials. We agree that it’s kind of weird to pay for ethical review, but that is the current system, and the only option available to us.

I don’t think paying for IRB review is the ethical issue. If one were paying for IRB approval, that would be an ethical issue, and there are some well known rubber-stamp-y private IRBs out there.

Carl Elliott details some of the pitfalls of the for-profit IRB in his book White Coat, Black Hat. The most obvious of these is that, in a competition for clients, a for-profit IRB might well feel a pressure to forego asking the hard questions, to be less ethically rigorous (and more rubber-stamp-y) — else clients seeking approval would take their business to a competing IRB they saw as more likely to grant that approval with less hassle.

Market forces may provide good solutions to some problems, but it’s not clear that the problem of how to make research more ethical is one of them. Also, it’s worth noting that being a citizen science project does not in and of itself preclude review by an academic IRB – plenty of citizen science projects run by academic scientists do just that. It’s uBiome’s status as a private-sector citizen science project that led to the need to find another IRB.

That said, if folks with concerns knew which private IRB the uBiome team used (something they don’t disclose in their guest post), those folks could inspect the IRB’s track record for rigor and make a judgment from that.

Richman and Apte cite as further problems with IRBs, at least as currently constituted, lack of uniformity across committees and lack of transparency. The lack of uniformity is by design, the thought being that local control of committees should make them more responsive to local concerns (including those of potential subjects). Indeed, when research is conducted by collaborators from multiple institutions, one of the marks of good ethical design is when different local IRBs are comfortable approving the protocol. As well, at least part of the lack of transparency is aimed at human subjects protection — for example, ensuring that the privacy of human subjects is not compromised in the release of approved research protocols.

This is not to say that there is no reasonable discussion to have about striving for more IRB transparency, and more consistency between IRBs. However, such a discussion should center ethical considerations, not convenience or expediency.

Focusing on tone rather than substance makes it look like you don’t appreciate the substance of the critique.

Richman and Apte write the following of the worries bloggers raised with uBiome:

Some of the posts threw us off quite a bit as they seemed to be personal attacks rather than reasoned criticisms of our approach. …

We thought it was a bit… much, shall we say, to compare us to the Nazis (yes, that happened, read the posts) or to the Tuskegee Experiment because we funded our project without first paying thousands of dollars for IRB approval for a project that had not (and might never have) happened.

I have read all of the linked posts (here, here, here, here, here, here, here, and here) that Richman and Apte point to in leveling this complaint about tone. I don’t read them as comparing the uBiome team to Nazis or the researchers who oversaw the Tuskegee Syphilis Experiment.

I’m willing to stipulate that the tone of some of these posts was not at all cuddly. It may have made members of the uBiome team feel defensive.

However, addressing the actual ethical worries raised in these posts would have done a lot more for uBiome’s efforts to earn the public’s trust than adopting a defensive posture did.

Make no mistake, harsh language or not, the posts critical of uBiome were written by a bunch of people who know an awful lot about the ins and outs of ethical interactions with human subjects. These are also people who recognize from their professional lives that, while hard questions can feel like personal attacks, they still need to be answered. They are raising ethical concerns not to be pains, but because they think protecting human subjects matters — as does protecting the collective reputation of those who do human subjects research and/or citizen science.

Trust is easier to break than to build, which means one project’s ethical problems could be enough to sour the public on even the carefully designed projects of researchers who have taken much more care thinking through the ethical dimensions of their work. Addressing potential problems in advance seems like a better policy than hoping they’ll be no big deal.

And losing focus on the potential problems because you don’t like the way in which they were pointed out seems downright foolish.

Much of uBiome’s response to the hard questions raised about the ethics of their project has focused on tone, or on meeting examples that provide historical context for our ethical guidelines for human subject research with the protestation, “We’re not like that!” If nothing else, this suggests that the uBiome team hasn’t understood the point the examples are meant to convey, nor the patterns that they illuminate in terms of ethical pitfalls into which even non-evil scientists can fall if they’re not careful.

And it is not at all clear that the uBiome team’s tone in blog comments and on social media like Twitter has done much to help its case.

What is still lacking, amidst all their complaints about the tone of the critiques, is a clear account of how basic ethical questions (such as how uBiome will ensure that the joint roles of customer, citizen science participant, and human subject don’t lead to a compromise of autonomy or privacy) are being answered in uBiome’s research protocol.

A conversation on the substance of the critiques would be more productive here than one about who said something mean to whom.

Which brings me to my last issue:

New models of scientific funding, subject recruitment, and outreach that involve the internet are better served by teams that understand how the internet works.

Let’s say you’re trying to fund a project, recruit participants, build general understanding, enthusiasm, support, and trust. Let’s say that your efforts involve websites where you put out information and social media use where you amplify some of that information or push links to your websites or favorable media coverage.

People looking at the information you’ve put out there are going to draw conclusions based on the information you’ve made public. They may also draw speculative conclusions from the gaps — the information you haven’t made public.

You cannot, however, count on them to base their conclusions on information to which they’re not privy, including what’s in you’re heart.

There may be all sorts of good efforts happening behind the scenes to get rigorous ethical oversight off the ground. If it’s invisible to the public, there’s no reason the public should assume it’s happening.

If you want people to draw more accurate conclusions about what you’re doing, and about what potential problems might arise (and how you’re preparing to face them if they do), a good way to go is to make more information public.

Also, recognize that you’re involved in a conversation that is being conducted publicly. Among other things, this means it’s unreasonable to expect people with concern to take it to private email in order to get further information from you. You’re the one with a project that relies on cultivating public support and trust; you need to put the relevant information out there!

(What relevant information? Certainly the information relevant to responding to concerns and critiques articulated in the above-linked blog posts would be a good place to start — which is yet another reason why it’s good to be able to get past tone and understand substance.)

In a world where people email privately to get the information that might dispel their worries, those people are the only ones whose worries are addressed. The rest of the public that’s watching (but not necessarily tweeting, blogging, or commenting) doesn’t get that information (especially if you ask the people you email not to share the content of that email publicly). You may have fully lost their trust with nary a sign in your inboxes.

Maybe you wish the dynamics of the internet were different. Some days I do, too. But unless you’re going to fix the internet prior to embarking on your brave new world of crowdfunded citizen science, paying some attention to the dynamics as they are now will help you use it productively, rather than to create misunderstandings and distrust that then require remediation.

That could clear the way to a much more interesting and productive conversation between uBiome, other researchers, and the larger public.

The ethics of opting out of vaccination.

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At my last visit to urgent care with one of my kids, the doctor who saw us mentioned that there is currently an epidemic of pertussis (whooping cough) in California, one that presents serious danger for the very young children (among others) hanging out in the waiting area. We double-checked that both my kids are current on their pertussis vaccinations (they are). I checked that I was current on my own pertussis vaccination back in December when I got my flu shot.

Sharing a world with vulnerable little kids, it’s just the responsible thing to do.

You’re already on the internet reading about science and health, so it will probably come as no surprise to you that California’s pertussis epidemic is a result of the downturn in vaccination in recent years, nor that this downturn has been driven in large part by parents worried that childhood vaccinations might lead to their kids getting autism, or asthma, or some other chronic disease. Never mind that study after study has failed to uncover evidence of such a link; these parents are weighing the risks and benefits (at least as they understand them) of vaccinating or opting out and trying to make the best decision they can for their children.

The problem is that the other children with which their children are sharing a world get ignored in the calculation.

Of course, parents are accountable to the kids they are raising. They have a duty to do what is best for them, as well as they can determine what that is. They probably also have a duty to put some effort into making a sensible determination of what’s best for their kids (which may involve seeking out expert advice, and evaluating who has the expertise to be offering trustworthy advice).


But parents and kids are also part of a community, and arguably they are accountable to other members of that community. I’d argue that members of a community may have an obligation to share relevant information with each other — and, to avoid spreading misinformation, not to represent themselves as experts when they are not. Moreover, when parents make choices with the potential to impact not only themselves and their kids but also other members of the community, they have a duty to do what is necessary to minimize bad impacts on others. Among other things, this might mean keeping your unvaccinated-by-choice kids isolated from kids who haven’t been vaccinated because of their age, because of compromised immune function, or because they are allergic to a vaccine ingredient. If you’re not willing to do your part for herd immunity, you need to take responsibility for staying out of the herd.


Otherwise, you are a free-rider on the sacrifices of the other members of the community, and you are breaking trust with them.

I know from experience that this claim upsets non-vaccinating parents a lot. They imagine that I am declaring them bad people, guilty of making a conscious choice to hurt others. I am not. However, I do think they are making a choice that has the potential to cause great harm to others. If I didn’t think that pointing out the potential consequences might be valuable to these non-vaccinating parents, at least in helping them understand more fully what they’re choosing, I wouldn’t bother.

So here, let’s take a careful look at my claim that vaccination refuseniks are free-riders.


First, what’s a free-rider?


In the simplest terms, a free-rider is someone who accepts a benefit without paying for it. The free-rider is able to partake of this benefit because others have assumed the costs necessary to bring it about. But if no one was willing to assume those costs (or indeed, in some cases, if there is not a critical mass of people assuming those costs), then that benefit would not be available, either.


Thus, when I claim that people who opt out of vaccination are free-riders on society, what I’m saying is that they are receiving benefits for which they haven’t paid their fair share — and that they receive these benefits only because other members of society have assumed the costs by being vaccinated.


Before we go any further, let’s acknowledge that people who choose to vaccinate and those who do not probably have very different understandings of the risks and benefits, and especially of their magnitudes and likelihoods. Ideally, we’d be starting this discussion about the ethics of opting out of vaccination with some agreement about what the likely outcomes are, what the unlikely outcomes are, what the unfortunate-but-tolerable outcomes are, and what the to-be-avoided-at-all-costs outcomes are.


That’s not likely to happen. People don’t even accept the same facts (regardless of scientific consensus), let alone the same weightings of them in decision making.


But ethical decision making is supposed to help us get along even in a world where people have different values and interests than our own. So, plausibly, we can talk about whether certain kinds of choices fit the pattern of free-riding even if we can’t come to agreement on probabilities and a hierarchy of really bad outcomes.


So, let’s say all the folks in my community are vaccinated against measles except me. Within this community (assuming I’m not wandering off to exotic and unvaccinated lands, and that people from exotic and unvaccinated lands don’t come wandering through), my chances of getting measles are extremely low. Indeed, they are as low as they are because everyone else in the community has been vaccinated against measles — none of my neighbors can serve as a host where the virus can hang out and then get transmitted to me. (By the way, the NIH has a nifty Disease Transmission Simulator that you can play around with to get a feel for how infectious diseases and populations whose members have differing levels of immunity interact.)


I get a benefit (freedom from measles) that I didn’t pay for. The other folks in my community who got the vaccine paid for it.


In fact, it usually doesn’t require that everyone else in the community be vaccinated against measles for me to be reasonably safe from it. Owing to “herd immunity,” measles is unlikely to run through the community if the people without immunity are relatively few and well interspersed with the vaccinated people. This is a good thing, since babies in the U.S. don’t get their first vaccination against measles until 12 months, and some people are unable to get vaccinated even if they’re willing to bear the cost (e.g., because they have compromised immune systems or are allergic to an ingredient of the vaccine). And, in other cases, people may get vaccinated but the vaccines might not be fully effective — if exposed, they might still get the disease. Herd immunity tends to protect these folks from the disease — at least as long as enough of the herd is vaccinated.


If too few members of the herd are vaccinated, even some of those who have borne the costs of being vaccinated (because even very good vaccines can’t deliver 100% protection to 100% of the people who get them), or who would bear those costs were they able (owing to their age or health or access to medical care), may miss out on the benefit. Too many free-riders can spoil things even for those who are paying their fair share.


A standard reply from non-vaccinating parents is that their unvaccinated kids are not free-riders on the vaccinated mass of society because they actually get diseases like chicken pox, pertussis, and measles (and are not counting on avoiding the other diseases against which people are routinely vaccinated). In other words, they argue, they didn’t pay the cost, but they didn’t get the benefit, either.


Does this argument work?


I’m not convinced that it does. First off, even though unvaccinated kids may get a number of diseases that their vaccinated neighbors do not, it is still unlikely that they will catch everything against which we routinely vaccinate. By opting out of vaccination but living in the midst of a herd that is mostly vaccinated, non-vaccinating parents significantly reduce the chances of their kids getting many diseases compared to what the chances would be if they lived in a completely unvaccinated herd. That statistical reduction in disease is a benefit, and the people who got vaccinated are the ones paying for it.


Now, one might reply that unvaccinated kids are actually incurring harm from their vaccinated neighbors, for example if they contract measles from a recently vaccinated kid shedding the live virus from the vaccine. However, the measles virus in the MMR vaccine is an attenuated virus — which is to say, it’s quite likely that unvaccinated kids contacting measles from vaccinated kids will have a milder bout of measles than they might have if they had been exposed to a full-strength measles virus out in the wild.
 A milder case of measles is a benefit, at least when the alternative is a severe case of measles. Again, it’s a benefit that is available because other people bore the cost of being vaccinated.


Indeed, even if they were to catch every single disease against which we vaccinate, unvaccinated kids would still reap further benefits by living in a society with a high vaccination rate. The fact that most members of society are vaccinated means that there is much less chance that epidemic diseases will shut down schools, industries, or government offices, much more chance that hospitals and medical offices will not be completely overwhelmed when outbreaks happen, much more chance that economic productivity will not be crippled and that people will be able to work and pay the taxes that support all manner of public services we take for granted.

The people who vaccinate are assuming the costs that bring us a largely epidemic-free way of life. Those who opt out of vaccinating are taking that benefit for free.


I understand that the decision not to vaccinate is often driven by concerns about what costs those who receive the vaccines might bear, and whether those costs might be worse than the benefits secured by vaccination. Set aside for the moment the issue of whether these concerns are well grounded in fact. Instead, let’s look at the parallel me might draw: 
If I vaccinate my kids, no matter what your views about the etiology of autism and asthma, you are not going to claim that my kids getting their shots raise your kids’ odds of getting autism or asthma. But if you don’t vaccinate your kids, even if I vaccinate mine, your decision does raise my kids’ chance of catching preventable infectious diseases. My decision to vaccinate doesn’t hurt you (and probably helps you in the ways discussed above). Your decision not to vaccinate could well hurt me.


The asymmetry of these choices is pretty unavoidable.


Here, it’s possible that a non-vaccinating parent might reply by saying that it ought to be possible for her to prioritize protecting her kids from whatever harms vaccination might bring to them without being accused of violating a social contract.


The herd immunity thing works for us because of an implicit social contract of sorts: those who are medically able to be vaccinated get vaccinated. Obviously, this is a social contract that views the potential harms of the diseases as more significant than the potential harms of vaccination. I would argue that under such a social contract, we as a society have an obligation to take care of those who end up paying a higher cost to achieve the shared benefit.


But if a significant number of people disagree, and think the potential harms of vaccination outweigh the potential harms of the diseases, shouldn’t they be able to opt out of this social contract?


The only way to do this without being a free-rider is to opt out of the herd altogether — or to ensure that your actions do not bring additional costs to the folks who are abiding by the social contract. If you’re planning on getting those diseases naturally, this would mean taking responsibility for keeping the germs contained and away from the herd (which, after all, contains members who are vulnerable owing to age, medical reasons they could not be vaccinated, or the chance of less than complete immunity from the vaccines). No work, no school, no supermarkets, no playgrounds, no municipal swimming pools, no doctor’s office waiting rooms, nothing while you might be able to transmit the germs. The whole time you’re able to transmit the germs, you need to isolate yourself from the members of society whose default assumption is vaccination. Otherwise, you endanger members of the herd who bore the costs of achieving herd immunity while reaping benefits (of generally disease-free work, school, supermarkets, playgrounds, municipal swimming pools, doctor’s office waiting rooms, and so forth, for which you opted out of paying your fair share).


Since you’ll generally be able to transmit these diseases before the first symptoms appear — even before you know for sure that you’re infected — you will not be able to take regular contact with the vaccinators for granted.


And if you’re traveling to someplace where the diseases whose vaccines you’re opting out of are endemic, you have a duty not to bring the germs back with you to the herd of vaccinators. Does this mean quarantining yourself for some minimum number of days before your return? It probably does. Would this be a terrible inconvenience for you? Probably so, but the 10-month-old who catches the measles you bring back might also be terrible inconvenienced. Or worse.

Here, I don’t think I’m alone in judging the harm of a vaccine refusenik giving an infant pertussis as worse than the harm in making a vaccine refusenik feel bad about violating a social contract.


An alternative, one which would admittedly required some serious logistical work, might be to join a geographically isolated herd of other people opting out of vaccination, and to commit to staying isolated from the vaccinated herd. Indeed, if the unvaccinated herd showed a lower incidence of asthma and autism after a few generations, perhaps the choices of the members of the non-vaccinating herd would be vindicated.


In the meantime, however, opting out of vaccines but sharing a society with those who get vaccinated is taking advantage of benefits that others have paid for and even threatening those benefits. Like it or not, that makes you a free-rider.
* * * * *
An earlier version of this essay originally appeared on my other blog.

“Are you going to raise the child picky?” Interview with Stephanie V. W. Lucianovic (part 3).

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This is the last part of my interview with Stephanie V. W. Lucianovic, author of Suffering Succotash: A Picky Eater’s Quest to Understand Why We Hate the Foods We Hate, conducted earlier this month over lunch at Evvia in Palo Alto. (Here is part 1 of the interview. Here is part 2 of the interview.)

In this segment of the interview, we talk about foodies as picky eaters whose preferences get respect and about how pickiness looks from the parenting side of the transaction. Also, we notice that culinary school might involve encounters with a classic Star Trek monster.

Janet D. Stemwedel: It does seem like there are certain ways to be picky that people will not only accept but actually look at as praiseworthy. “Oh, you’ve decided to give up this really delightful food that everyone else would wallow in!” I’ll come clean: part of the reason I’m vegetarian is that I have never cared for meat. Once I moved out of my parents’ house and not eating meat became an option, I stopped eating the stuff without any kind of impressive exercise of will. And, in restaurants that are big on fake meat, I’ll end up pulling it out of my soup. The waitrons will tell me, “Oh, don’t worry, you can eat that! It’s not meat!” And I’ll say, “I can eat it, but I don’t like it, so I won’t be eating it.”

Stephanie V. W. Lucianovich: You don’t need a meat substitute if the point is that you don’t like meat.

JS: Although veggie bacon rocks.

SL: Really? Bacon, man …

JS: It’s the holy grail, taste-wise, right?

SL: There’s a thought it could be more psychological than biological.

JS: Salt and fat.

SL: And a high concentration of nutrients that you’d need to survive in the wilderness. But also, there’s the happy memory of smelling it cooking on a weekend morning, not something the scientists discount. These are learned experiences.

JS: But a favorite food can become a food you can’t deal with if you eat it right before your stomach flu.

SL: Right. It just takes one time. Except for with my husband. He had eaten a pastrami sandwich earlier in the day, then drank a lot and threw up. And his reaction was, “Oh yeah, that was a good pastrami sandwich.” As it was coming up, this is what was going through his head!

JS: Not a very picky eater.

SL: He’s such a freak! He just doesn’t get turned off to foods easily. Although he does have his bugaboos, like bologna (maybe because he didn’t grow up with it) and cheese with apples. But anyway, the aspect of choice …

JS: Like being able to say, “I can’t eat that because the dietary laws of my religion forbid it,” which generally gets some level of respect.

SL: But then there are the foodies! And that seems to be a socially sanctioned way to be a picky eater. “Oh, I would never eat that!”

JS: “I would never drink that wine! That year was horrible!”

SL: Exactly! Or, “I don’t eat Wonder Bread because it’s full of preservatives!” Foodies can certainly be moralistic, in their own way, about what they will and will not eat. But it’s annoying when they’re like that.

JS: Because their picky preferences are better than yours.

SL: It’s obnoxious.

JS: Are there some foods you don’t regret being picky about?

SL: Well, there are some foods I still don’t eat, and I’m fine with that. Bananas and raisins are right up there, and I wrote a piece for the Washington Post detailing the reasons why I’m OK not liking bananas. They’re trying to kill me in various ways — they’ve got radiation in them —

JS: We can’t grow them locally.

SL: Due to their lack of genetic diversity, they’re going to doe out anyway, so it’s probably better that I never liked them. They used to come with tarantulas in them, back in the day.

JS: That’s extra protein!

SL: So, I could list a bunch of foods that I still don’t like but without regret. Braised meats? I just don’t like them. People go on and on about how great they are, but to me it’s a big mass of everything-tastes-the-same with none of it highly flavored enough for me. WIth stews I have the same kind of issue. I think I don’t regret not liking these kinds of food now because I recognize how far I’ve come. I like so many more things than I used to, and I can get by without it impacting my health or my social life. And, when faced with them at somebody’s house, I will eat something that has bananas or whatever in it. I’ve learned how to deal with it. But I won’t choose to have it myself at home.

JS: You won’t seek it out.

SL: But I am bringing some of these foods into my home, because I don’t want to prejudice my son against them. He likes bananas, sometimes, but often they’ll end up wasted. He’ll go through a phase where he wants them, and then another where he doesn’t want them. His interest level is at the point where I can buy two bananas at a time. I have had friends ask me, “Are you going to not feed him raisins?” Of course I’m going to give him raisins. I can touch the things!

JS: “Are you going to raise the child picky?”

SL: Right! So far, the kid likes okra, so I think we’re OK. But everything on the list I give in the book of foods I still don’t like, I have absolutely no problem not liking them, because it just doesn’t impact my life. There are just a few things out there I wish I liked more, because it would vary our diet more. For example, I don’t love green beans. I toss them with pesto sometimes, but I have just not found a way to make them where I love them. I don’t love peas either, except when Evvia does them in the summertime — huge English peas that come cold dressed with feta and scallions and dill (which I normally don’t like) and olive oil and lemon, and they’re only here for like three weeks. And they’re the best damn peas — that’s the only way I want them. The things I kind of wish I liked that I don’t, I’ve tried, and I’ll try them again, but it doesn’t really bug me.

JS: I wonder how much my regrets for the things I feel like I should be able to like but don’t are connected to the fact that I was not an especially picky eater as a kid (except for not liking meat). I kind of feel like I should like asparagus, but I don’t. It’s been so long since I’ve eaten it that I can’t even remember whether I can smell the funny asparagus metabolite in my pee.

SL: I didn’t like asparagus, and then I wanted to like it and found a recipe that worked, roasting it and dressing it with a vinaigrette and goat cheese. But then we ate a lot of it, and it was really good, and after a while I was noticing that I only ate the tips, not the woody, stringy bits.

JS: And that it still tasted like asparagus.

SL: Yeah. In the end, I tried it.

JS: For me, olives are another challenging food. I’m the only one in my household who doesn’t like them at all. So we may order a pizza with olives to share, but I’m going to pick all the olives off of mine and give them to whoever is nicest to me.

SL: How do you feel about the pizza once you’ve picked them off? Can you actually eat the pizza then?

JS: If I’m hungry enough, I can. I guess it depends. The black olive penetration on pizza is not as extreme as biting into a whole olive.

SL: No. I think the kind of olives they use for pizza are …

JS: Sort of defanged?

SL: Yeah. They’re just not as bitter as the whole olives you find.

JS: Are there foods you’ve grown to like where you still feel some residual pickiness? It sounds like asparagus may be one.

SL: Sweet potatoes and squash are two others I’m still on the fence about. I have to be very careful about how I make them. Lentils — maybe legumes more generally — are foods I don’t love unconditionally. They have to be prepared a certain way. Broccoli, too! I will only eat broccoli made according to the recipe I give in the book or, failing that, roasted but without the vinaigrette. Just because I like a food does not mean I fully accept every rendition of it. Speaking from a cook’s perspective, you just can’t disrespect vegetables. I will not eat broccoli steamed, I just don’t think it’s fair.

JS: Fair enough.

SL: I’m still pretty picky about how I like even the foods that I like.

JS: OK, death is not an option: a dish with a flavor you’re picky about and a good texture, or a dish with a texture you’re picky about and a good flavor?

SL: That’s so hard.

JS: You really want death on the table?

SL: It depends … How bad is the flavor? How good is the flavor?

JS: So, if the good is good enough, you might be able to deal with the challenging part?

SL: I think texture really gets me more. For example, I don’t have a problem with the flavor of flan or panna cotta. Very good flavors. Mango I’ve had, and the flavor is good, but it’s so gelatinous and slimy.

JS: To your palate, it’s wrong.

SL: Yeah. It just gets the gag reflex going for me more. But thinking about it now, I probably wouldn’t do bad flavor/good texture.

JS: So flavor might have a slight edge?

SL: Yeah. I’m thinking about stew: for me, bad all around. Everything is mushy and everything is one flavor, and it’s just very un-fun for me. But then there’s something like bananas, where my problem probably started as a texture issue, but because I disliked the texture so much, I started to associate the smell and the flavor with that texture, and now I don’t like anything banana flavored. I don’t like banana bread. I’ll eat it, but I don’t like it.

JS: And banana flavored cocktails would be right out.

SL: Auugh! Anything that’s a banana flavored cocktail is usually creamy too, and I have a problem with creamy cocktails. I used to be able to do the creamy cocktail in my youth, but now I think there’s something very wrong with them. Unless it’s got coffee.

JS: Did pickiness make culinary school harder?

SL: Yeah, it probably did. I noticed I wasn’t the only one who didn’t want to eat certain things. If you’re picky, you do have to really steel yourself to touch certain things that you might not want to touch, like fish. In general, I don’t like handling raw chicken, although I love to eat cooked chicken. I don’t mind handling red meats at all. There’s more blood to it — chicken, by comparison, is more pale and dead looking. So yeah, being picky probably made culinary school more challenging, but I was so into food by that point that it overrode some of it. I knew I would have to eat stuff like veal, stuff that would be difficult for me, and that it would be embarrassing if I didn’t, because the chefs told us we would have to taste everything. I was totally scared about that. But, the fact that it was probably harder for me than it was for someone who was an unabashed lover of all foods probably made it more of a moral victory. Just like becoming a foodie in the face of pickiness, I knew I had to work harder at it. I wasn’t born that way, I had to earn my stripes by getting over a lot of hurdles.

JS: It was a bigger deal because you overcame more adversity to get there.

SL: I think it meant more to me personally.

JS: Did you find that some of the stuff you learned in culinary school gave you more tools to deal with your own pickiness?

SL: Oh, yeah, because it just taught me better methods of cooking things that maybe I didn’t yet know. And, it really made me fearless about adding salt. Roberta Dowling was the director of the school, and nothing was ever salty enough for her. I started calling her the salt-vampire. There was a character on —

JS: Star Trek! I know that one!

SL: For every dish she tasted, she’d say, “Needs more salt,” even if we added all the salt the recipe called for. She tried to get us to recognize that the recipe was just a guideline. And salt really does do a lot for food. People who are not so confident in the kitchen get infuriated by “salt to taste,” but it really is all about your personal taste. What’s going on inside your mouth is so different from what may be going on in someone else’s, which means only you can determine whether it’s enough salt.

JS: Does pickiness look different when you’re on the parental side of the transaction.

SL: Yes. It’s so frustrating! It’s so, “Oh my God, don’t be like me!” I know my mom was like, “Whatever. You guys were picky. I wasn’t worried about it.” The doctor was like, “Give ’em vitamins.” I do think that writing the book, especially the chapter on children, relaxed me. On the other hand, I feel the same way a lot of other picky eaters who are parents feel: I’m just a little bit more conditioned to understand what they’re going through and not push it. But I have to be careful, because sometimes you can still fall into “No, no, no! I know you think you don’t like it now, but really, just try it and you’ll like it.” I have to remember that it’s him and what tastes good to him and what he wants to do. Later on in life, if he changes his mind about whatever it is he doesn’t like this week, great. This week he told me he didn’t like grilled cheese. My response was, “You’re no son of mine! How does a person not like grilled cheese? It was always there for me.”

JS: I think the right answer to, “I don’t like grilled cheese, Mom,” is “More for me!”

SL: Exactly! But yeah, it’s a very different perspective on pickiness. But again, I’m probably more conditioned to be understanding about it than a non-picky parent who gets a picky child might be. They just don’t even know what it’s like.

JS: It’s an interesting thing as they get older. Until this school year, I was the school lunch packer of the house for both of my kids, and I’d get the complaints along the lines of, “Why do you pack us stuff we don’t like?” Of course, I’d say, “OK, tell me what you would like,” but then within a few months they’d be sick of that. This year, I’m still packing my older kid’s linch, since she has to get out the door early to catch a bus, but my 11-year-old has been making her own lunches, and I catch her making these sandwiches that two years ago she would have claimed she didn’t like any components of them at all. The other day, she made a sandwich on home-baked whole wheat bread with a honey-mustard marinate she dug out of the back of the fridge, and smoked gouda, and arugula. I said, “I didn’t know you liked those things.” She said, “Me neither, but they were here, and I tried them, and they were good.” Another day, she made a sandwich with some homemade lime curd, and the parent in the vicinity said, “What about some more protein on that?” so she put some peanut butter on that sandwich and later reported that it tasted kind of Thai.

SL: Of course it did!

JS: I’ll take their word for what they like (or don’t like) this week, but that’s not going to stop me from eating other stuff in front of them, and if it smells or looks good enough to them and they say, “Can I try some of that?” maybe I’ll be nice and I’ll share.

SL: That’s the way to do it, no pressure but you keep offering the stuff, exposing them to it but not getting hurt feelings if they don’t like it.

JS: And ultimately, who cares if the kid ends up liking it? If it’s less hassle for me, one less fight? I have enough fights. I don’t need more fights.

SL: You don’t really need the bragging rights, either. “Oh, my kid is so rarefied!” Who cares?

Scientific knowledge, societal judgment, and the picky eater: Interview with Stephanie V. W. Lucianovic (part 2).

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We continue my interview with Stephanie V. W. Lucianovic, author of Suffering Succotash: A Picky Eater’s Quest to Understand Why We Hate the Foods We Hate, conducted earlier this month over lunch at Evvia in Palo Alto. (Here is part 1 of the interview.)

In this segment of the interview, we ponder the kind of power picky eaters find in the scientific research on pickiness, the different ways people get judgmental about what someone else is eating, and the curious fact that scientists who research picky eating seem not to be picky eaters themselves. Also, we cast aspersions on lima beans and kale.

Janet D. Stemwedel: Are there some aspects of pickiness that you’d like to see the scientists research that they don’t seem to be researching yet?

Stephanie V. W. Lucianovic: There was the question of whether there are sex differences in pickiness, which it seems like maybe they’re looking into more now. Also, and this is because of where I am right now, I’d really like to see them look into the impact of having early examples of well-prepared food, because I have a hunch this might be pretty important. I’m pretty sure there’s no silver bullet, whether you’re breast-fed or formula-fed or whatever. It can make parents feel really bad when they get a long list of things to do to help your kid not be picky, and they do everything on the list, and the kid still ends up picky. But I’d like to see more of the research suggesting that it’s not just early exposure to food but early exposure to good food. I’m also intrigued by the research suggesting that pickiness is not a choice but rather a part of your biology. Lots of my friends who are gay have likened it to coming out of the closet and accepting that who you are is not a choice. I’d like to see more pickiness research here, but maybe it’s not so much about the science as the sociology of finding acceptance as a picky eater. Also, I’m not sure the extent to which scientists are taking the cultural aspects into account when they study pickiness — you figure they must. I am sick of people throwing the French back at me, saying, there’s this book written by the mother who raised her kids in France, and her kids were not picky, so, generally, kids in France are not picky. And I’m thinking, you know, I’m willing to bet that there are picky kids in France, but they just don’t talk about it. Scientifically speaking, there’s a high probability that there are picky eaters there.

JS: Right, and their parents probably just have access to enough good wine to not be as bothered by it.

SL: Or maybe their stance is just generally not to be bothered by it. Jacques Pepin said to me, “We just didn’t talk about it.” His daughter liked some things and disliked others, and he said, “You know, when she decided she liked Brussels sprouts, we didn’t get down on the floor to praise God; we just didn’t talk about it either way.” It doesn’t become a thing in the family. Parents today are so educated about food and nutrition, but it can have bad effects as well as good effects.

JS: We have the knowledge, but we don’t always know what to do with it.

SL: I’m hoping that scientists will be able to take all that they’re learning about the different facets of pickiness and put that knowledge together to develop ways to help people. People have asked me whether hypnosis works. I don’t know, and the scientists I asked didn’t know either. But there are people looking for help, and I hope that what the scientists are learning can make that help more accessible.

JS: Something occurred to me as I was reading what you wrote about the various aspects of why people like or don’t like certain flavors or different textures. I know someone who studies drugs of abuse. During the period of time just after my tenure dossier when in, I detoxed from caffeine, but I kept drinking decaffeinated coffee, because I love the taste of coffee. But, this researcher told me, “No, you don’t. You think you do, but the research we have shows that coffee is objectively aversive.” So you look at the animal studies and the research on how humans get in there and get themselves to like coffee, and all the indications are that we’re biologically predisposed not to like it.

SL: We’re not supposed to like it.

JS: But we can get this neurochemical payoff if we can get past that aversion. And I’m thinking, why on earth aren’t leafy greens doing that for us? How awesome would that be?

SL: They don’t get us high. They don’t give us the stimulant boost of caffeine. I think what your researcher friend is saying is that the benefit of caffeine is enough that it’s worth it to learn how to handle the bitterness to get the alertness. I started out with really sweet coffee drinks, with General Foods International coffees, then moved on to Starbucks drinks. I can finally drink black coffee. (I usually put milk in it, but that’s more for my stomach.) I can actually appreciate good coffees, like the ones from Hawaii. But, it’s because I worked at it — just like I worked at liking some of the foods I’ve disliked. I wanted to like it because the payoff was good. With greens, the only payoff is that they’re good for you. I reached a certain age where that was a payoff I wanted. I wanted to like Brussels sprouts because the idea of actually healthful foods became appealing to me. But there are plenty of people I know who are picky eaters who couldn’t care less about that.

JS: So, if there were more reasons apparent within our lifestyle to like leafy greens and their nutritional payoff, we’d work harder when we were in junior high and high school and college to like them? Maybe as hard as we do to become coffee drinkers?

SL: Sure! I’m trying very hard to like kale.

JS: Me too! I feel bad that I don’t like it.

SL: I know, right?

JS: I feel like I should — like a good vegetarian should like kale.

SL: Well, everyone’s trying to like it, and I’ve found some ways of liking it. But, what’s the payoff for kale? Obviously, it’s very good for you, and it’s supposed to have some specific benefits like being really good for your complexion, and cleaning out your liver. Have another glass of wine? OK, if you eat your kale. But again, “good for you” is a weird kind of payoff.

JS: It’s a payoff you have to wait for.

SL: And one you’re not necessarily always going to see. I’ve been told that eating lots of salmon also has health benefits, but I just don’t like salmon enough to eat enough of it to see those benefits.

JS: Heh. That reminds me of the stories I heard from our pediatrician that you’ve probably heard from yours, that if you feed your baby too much strained carrot, the baby might turn orange and you shouldn’t be alarmed. And of course, I was determined to sit down and feed my child enough carrots that weekend to see if I could make that happen.

SL: I’ve never seen that happen. Does it really happen?

JS: Apparently with some kids it does. I tried with mine and could not achieve the effect.

[At this point we got a little sidetracked as I offered Stephanie some of my Gigantes (baked organic Gigante beans with tomatoes, leeks, and herbed feta). I had ordered them with some trepidation because someone on Yelp had described this as a lima bean dish, and I … am not a fan of lima beans. The beans turned out to be a broad bean that bore no resemblance to the smaller, starchy lima beans of my youthful recollection.]

SL: I’ve never actually seen those lima beans fresh, just in bags in the frozen section.

JS: And assuming they still taste like we remember them, who would get them?

SL: Well, my husband is the kind of person who will eat anything, so he might. But you can also take limas and puree them with lemon juice, garlic, and olive oil and make a white bean spread. If I had to eat limas, that’s what I’d do with them. Maybe add a little mint. But I wouldn’t just eat them out of the bag, not even with butter.

JS: They’re not right.

SL: No.

JS: With so many different kinds of beans, why would you eat that one?

SL: There’s a reason why Alexander, of the terrible, horrible, no good, very bad day, had lima beans as his hated food. But, there are scientists at Monell working on flavors and acceptance of food — trying, among other things, to work out ways to make the drug cocktails less yucky for pediatric AIDS patients. They’re working on “bitter blockers” for that. (Maybe that could help with lima beans, too.) Anyway, getting Americans to eat more healthy foods …

JS: There’s probably some pill we could take for that, right?

SL: Hey, I thought we could do that with vitamins. Then I heard Michael Pollan saying, basically vitamins are pointless. (I still take them.) It’s tricky, because lots of people eat primarily for pleasure, not for health. I’m not sure why we have to see the two as being in opposition to each other; I enjoy food so much now that I find pleasure in eating foods that are good for me. But there are also plenty of people who just see food as fuel, and don’t find it any more interesting or worthy of discussion than that.

JS: At that point, why not just stock up on the nutrition bars and never do dishes again?

SL: When Anderson Cooper came out as a picky eater on his talk show, he said, “I would rather just drink my meals. I would rather have a shake.” His reaction to food was at the level where he wasn’t interested in anything more than that, at all. He’d rather go for convenience.

JS: That seems OK to me. That’s not how I am, or how the people I live with (and cook for) are, which means I can’t just blend it for meals, but that’s how it goes.

SL: For people who are like that, and know that they’re like that, if drinking meals is what works for them, that’s great. Personally, I wouldn’t want to be that way, but then again, I say that not really knowing what it’s like to be them instead of me.

JS: Do you think that interest in the causes of pickiness is driven by the amount of judgment people attach to picky eaters?

SL: Certainly, that’s my interest in it. I don’t think that’s necessarily why the scientific community is interested in it — I mean, I don’t think it bothers them very much, except in terms of understanding the psychological effects that are connected to pickiness. But yes, let’s talk about how food is the subject of judgment in general — especially among people in the Bay Area, among foodies.

JS: “Are you really going to eat that?! Do you know where that’s from?”

SL: Right, or “I won’t eat anything that wasn’t grown or raised within a 90 mile radius.” We have so many levels at which we judge what someone else is eating. My personal motivation for writing this book was to shed light on this topic because of the judgment that I saw picky eaters experience. For a while, I wouldn’t even admit my past as a picky eater. I had become a foodie and I was out here reinventing myself, but I kept my mouth shut about things I didn’t like until other people around me were admitting that they went through a picky stage of their own. Whenever I’ve written about pickiness online, the comments end up having a lot of people sharing their own stories. It seems like everyone can relate to it: “This is what I don’t like, and here’s why …” or, “I never thought I’d find anyone else who didn’t like this food for the same reason I don’t like it.” I’ve found that people can bond just as much over hating foods as they do over liking them. Let’s face it, food is often about community, so discussions of things we hate and things we love can be equally interesting to people. Even if you have the Pollyannas who say, “Who really wants to talk about something as unpleasant as what we don’t like?” guess what? We all dislike things.

JS: How many of the scientists who do research on the different aspects that contribute to pickiness outed themselves as picky eaters to you? Or do you think the scientists who study this stuff seem to be less picky than the rest of us?

SL: None of them really admitted to me that they were picky eaters. And I would ask them point blank if they were. One of the scientists working on the Duke study, Nancy Zucker, told me, “No. I ate everything as a kid, and I still do.” And, she told me her mom did some really weird things with food because her job was to sample products. The other scientist I spoke to on the Duke study admitted to not really liking tomatoes, but that was the extent of her pickiness. I got the sense from Dr. Dani Reed at Monell that she loves food and loves to cook. There were some foods, like organ meats, that she hadn’t quite accepted but that her friends were trying to get her to like. But, not a whole lot of people in this scientific community admitted to me that they were picky. I’m now thinking through everyone I interviewed, and I don’t recall any of them expressing food issues.

JS: I wonder if that’s at all connected with the research — whether doing research in this area is a way to make yourself less picky, or whether people who are picky are not especially drawn to this area of research.

SL: A lot of them would admit to having family members or friends who were picky. So then you wonder if they might have been drawn to the research because of this need to understand someone in their life.

JS: Maybe in the same way that losing a family member to leukemia could draw you to a career in oncology, having a family member who ruined family dinners by not eating what was on the plate draws you to this?

SL: Quite possibly. By and large, the scientists I spoke to about pickiness were so non-judgmental, probably because they’ve been studying it in various forms for various reasons. The rest of us are just now talking more about it and starting to notice the research that’s been amassed (on children, or breast feeding, or “inter-uterine feeding” and what they’re “tasting” in the womb). Since Monell is the center for research on taste and smell, they are used to journalists asking them about picky eaters. They’re also used to being misquoted and having the journalists’ accounts of the science come out wrong. (For example, they hate the word “supertaster,” which the media loves.) I got the impression that they were very non-judmental about pickiness, but none of them really described themselves as picky to me — and I asked.

JS: Maybe the picky eaters who are scientists go into some other field.

SL: Maybe. Maybe they don’t want to be involved with the food anymore.

JS: “Get it away from me! Get it away from me!”

SL: Seriously! “I lived it; I don’t need to study it!”

JS: Do you think having a scientific story to tell about pickiness makes it easier for picky eaters to push back against the societal judgment?

SL: Oh yeah. Lots of interviewers I’ve spoken to have wanted to tout this book as the science of picky eating — and let’s face it, it’s not all about the science — but people want to latch onto the scientific story because, for the lay person, when science hands down a judgment, you kind of just accept it. This is how I felt — you can’t argue with science. Science is saying, this is why I am who I am. Having scientific facts about pickiness gives you the back-up of a big-brained community, we can explain at least part of why you’re the way you are, and it’s OK. When parents can be given scientific explanations for why their kids are the way they are —

JS: And that the kid’s not just messing with you.

SL: Right! And that it’s not your fault. It’s not that you did something wrong to your kid that made your kid a picky eater. We’re really talking about two communities of picky eating, the parents of kids who are picky, and the adults who are picky eaters, and both those communities are looking for science because it’s as solid a thing as they can find to help them get through it.

JS: But here, we loop back to what you were saying earlier, as you were discussing how there’s potentially a genetic basis for pickiness, and how this kind of finding is almost analogous to finding a biological basis for sexual orientation. In both cases, you could draw the conclusion that it isn’t a choice but who you are.

SL: Exactly.

JS: But when I hear that, I’m always thinking to myself, but what if it were a choice? Why would that make us any more ready to say it’s a bad thing? Why should a biological basis be required for us to accept it? Do you think picky eaters need to have some scientific justification, or should society just be more accepting of people’s individual likes and dislike around food?

SL: Well, a psychologist would say, the first thing a picky eaters needs to do is accept that that’s who she is. Whatever the reason, whether their biology or their life history, this is who they are. The next thing is how does this impact you, and do you want to change it? If it’s something you want to change, you can then deal with it in steps. Why do we need to know that it’s not a choice? Because you get judged more for your choices. Let’s face it, you also get judged for who you are, but you get judged far more if you make what is assumed to be a choice to dislike certain foods. Then it’s like, “Why would you make that choice?” But there might also be a bully-population thing going on. There seem to be more people who like food of various kinds than who dislike them; why are they the ones who get to be right?

JS: Good question!

SL: And then there are discussions about evolution, where maybe not liking a particular food could be viewed as a weakness (because in an environment where that’s what there was to eat, you’d be out of luck). Sometimes it seems like our culture treats the not-picky eaters as fitter (evolutionarily) than the picky eaters. Of course, those who like and eat everything indiscriminately are more likely to eat something who kills them, so maybe the picky eaters will be the ultimate survivors. But definitely, the scientific story does feel like it helps fend off some of the societal criticism. Vegetarians and vegans already have some cover for their eating preferences. They have reasons they can give about ethics or environmental impacts. The scientific information can give picky eaters reasons to push back with that stronger than just individual preferences. For some reason, “I just don’t like it” isn’t treated like a good reason not to eat something.

Can science help the picky eater? Interview with Stephanie V. W. Lucianovic (part 1).

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This summer, I reviewed Suffering Succotash: A Picky Eater’s Quest to Understand Why We Hate the Foods We Hate by Stephanie V. W. Lucianovic. This month, with the approach of the holiday season (prime time for picky eaters to sit with non-picky eaters at meal time), Stephanie and I sat down for lunch at Evvia in Palo Alto to talk about pickiness while sampling foods that had previously been in our “no go” categories. (For me, this included dolmathes, for Stephanie, grilled octopus.)

In this segment of the interview, we discuss some of what scientists think they know about pickiness and why it matters. We also dip our tasting spoons into the steaming cauldron of early upbringing and cultural influences on the foods we like or don’t like, and chew on the idea that a kid’s pickiness can be developmentally appropriate.

Janet D. Stemwedel: The first question I have is about the expectations you had when you set out on this project, researching the book, about what you were going to learn about the science — whether you started out thinking science probably had a nice, neat explanation for why people are picky eaters, of whether you started out with the assumption that it was going to be a big old complicated thing?

Stephanie V. W. Lucianovic: I did not think science had the big answer, honestly. I thought science could answer the supertaster question for me personally, but that was the only answer I expected to get. In the meantime, I knew that I could ask scientists and psychologists and psychiatrists questions along with that. But I knew from what I was aware of already, the articles out there — I mean, they’re usually pop-culture articles, and they don’t always tell the science correctly or fully — I knew that science had some answers. I knew that there were so many avenues that could be explored, I really didn’t expect there to be a full answer. What I found, though, were more possibilities, like “this could be a possible reason — being a supertaster could be a reason, but it’s not the only reason.” Being exposed via breast milk — which I was not; I was a formula-fed baby — is maybe linked to being less picky, so maybe being formula-fed contributed to my pickiness. You’re never going to get an answer with 100% agreement behind it, because it’s still evolving. And science, as evidenced by Duke doing this study, for the adults at least, they don’t know what’s causing it, they just know that there are a lot of contributing factors. And, when they’re looking to treat it, it’s more like, “Well, let’s get really in-depth into what the possibilities might be that contribute to it, and let’s try to fix them” on sometimes just the psychological level.

JS: It’s an interesting kind of thing that something that goes along with studying a phenomenon like being a picky eater is the scientists saying, “And we’re going to fix it!” Like it’s something that needs to be fixed rather than just part of normal human variation. Why problematize it?

SL: Well, Dr. Nancy Zucker at Duke said what they worry about — less in my case, personally; more other people’s cases — they’re finding, if you’re a child, your development could be affected if you have what they call severe food refusal. They left the adults alone for a while, but now they’re discovering that maybe adults’ health and social lives are severely impaired by this problem, because they’re not eating the things maybe they’re supposed to be eating that can extend their lives or make them healthier, or if they don’t want to go out to dinner with friends and family, if they don’t want to be around friends, that’s a problem. So, that’s why they want to “fix” it, or at least help.

JS: So, it’s not necessarily, “We will find the picky eaters. They will all be cured. It will be a happy utopia.”

SL: I think the picky eaters have to want the help to be “cured”. While I got over it, I don’t believe that there’s going to be a cure. It’s very individualized. You really have to want to get over it, and to be fair to picky eaters who have it worse than I do, I don’t mean to say that all picky eaters want to live that way. But you have to have a very strong impetus to push you to do it. It’s a really scary thing. A lot of picky eaters will tell you it’s not a won’t, it’s a can’t. They can’t get over it.

JS: You interacted with lots of scientists who study many different aspects of pickiness in lots of different ways. You discovered that it’s complicated. Is your sense that the scientists feel like they may be getting near a place where things start seeming less complicated, where things start falling into place? Or was your sense, talking to them, that every corner they turned, they found a new way that it’s more complicated?

SL: I think the second. I think that as they gather information, especially about the adult picky eaters — because the adults are more forthcoming about what they don’t like and why or what they remember; you don’t necessarily reason with kids when you’re trying to treat them, you just treat them — so I think that they’re finding more nuances. It’s not just about the individual foods at all. It’s the reasons, if they can figure them out. So I think, when I spoke to scientists about my own personal experience and how I feel like I got past it, for some of them that was new information. To hear about my reactions to foods, or how I went to culinary school, some of it was like, “Oh, that makes sense. You learned how to cook and that demystified the food. That makes sense, on a psychological level, that that could have helped you.” But I think it’s still such a mystery because many people struggle with how to explain a dislike. You have to be pretty introspective to do it, and you may just be unable to explain it. “I don’t know why I don’t like it; I just don’t like it. I don’t know if it’s the texture or the flavor or what.” Some people haven’t thought very hard about it. They just know they don’t like it. I’m not sure it’s that complicated of a thing, except that humans are so complicated, and pickiness is more of an internal than an external issue. That makes it pretty complex.

JS: So scientists aren’t even expecting that it’s going to end up shaking out to be like three main ways to be picky.

SL: You know, I don’t know, because when I asked Dr. Zucker, who was heading up the Duke study, what they hoped to achieve, she was very careful to say that they were in the beginning stages of just assessing information with this online survey. I will say, they were surprised at the response. I’m remembering she said in a radio interview we were both part of that she expected around 3,000 people to fill out this form, and they got like 30,000. So I think the breadth of that response, what they’re learning about how many people out there might classify themselves as picky, as having food issues — and again, they were just amassing the information, they hadn’t yet begun to process it. Maybe they’ve started that now. Because I will say, also in that same interview, I always asked the question, is there a difference between men and women. That could have been something, potentially, I talked about in the book. Although I didn’t write about it, I personally found that of the people I’ve met who are former picky eaters, who have gotten past it, more are women than men. Men I’ve met who are picky eaters seem to just be OK with their state. They deal with it and they don’t really need to change it. We could go into philosophical reasons about women being social, or feeling judged, to explain why they might be more likely to try to get past it. But anyway, when I asked if there’s a difference between men and women, [I found out] there are studies with kids found that males may be more likely to reject a new idea than females. But Dr. Zucker did say in this one interview that they are starting to find out that there might be a difference between the sexes in pickiness itself. I wanted to talk to her about it more, but I couldn’t on the radio. Anyway, some interesting correlations are emerging.

JS: But then untangling what’s going on with those, whether it’s genes or environment, figuring out if there’s a cultural component to it …

SL: Whether there’s a cultural component is something I’ve been asked about a lot in interviews. It was something I did not feel equipped to cover, because it was just so big. I could have taken on the history of picky eating — it was something my editor wanted me to do — but I wasn’t even sure how to begin tracking the history of it. On the cultural side of it, you get a lot of people saying, “Well, in India babies eat spicy foods.” Yeah, they do; that’s what’s there, what they’re used to. That’s their normal. But I also had someone tell me about being an American in North Korea, working (yes, it can be done). They went out to lunch with their Korean counterparts, and the menu had a western side and a Korean side. The western side was all pastas, pizzas, whatever, and the Koreans at the lunch thought that was absolutely disgusting food. So, it’s all about what you’re used to. It’s not that Americans are predisposed to be picky because we live in this huge country of largesse. People in different countries are going to have different reactions to different kinds of food. What might be gross to someone who’s never had Japanese food before almost certainly has an American counterpart that someone in Japan would find gross. It’s a huge topic that I couldn’t even begin to get into.

JS: It makes you wonder. I would not describe my own upbringing as full of lots of different styles of food, or of foods from lots of different cultural traditions. My parents were from the midwest. I was growing up basically in the ’70s and ’80s, and that was not necessarily a time of astounding creativity among home chefs.

SL: Not just in the midwest, it wasn’t anywhere. I’m from Minnesota, and I grew up the same time you did. It was a lot of frozen vegetables for me. Badly prepared.

JS: With the hell boiled right out of them.

SL: Right! So there was no way they were going to end up being anything good. Now, I could blame Minnesota for our lack of access to better food, but I’ve talked to a friend of mine who grew up in California —

JS: And it was the same thing?

SL: Yes. She said, “We just didn’t have the same access that we do today.”

JS: Huh!

SL: She’s a former picky eater turned foodie and food writer, and she said it wasn’t until she went to college that she was opened up to more food. Maybe it is all about what your parents are bringing home. My husband grew up in the Washington, D.C. area, and his mom always loved to cook, so she sought out the best recipes and there was more of that emphasis for him; even if they didn’t always have access to non-frozen vegetables, there was an attempt. I grew up on Chinese food and Vietnamese food, because we had a lot of it around, and I loved it, but I didn’t grow up around stuff I love now, like Ethiopian food or Afghan food. In this day and age, even in the midwest, there are more corner grocery stores that are going to have the ingredients, there are more restaurants, there’s more of an emphasis on the food culture than when you and I were growing up.

JS: Maybe that will have an impact on our kids. But, then again …

SL: It’s one thing that might help.

JS: Yeah. I have a kid who, as a two-year-old, cried inconsolably when, after her third helping of garlic broccoli, we ran out (and couldn’t get more, since it was Sunday, and the Thai restaurant down the street that we had gotten it from was closed). We said, “Child, you are not supposed to like broccoli this much!” And before that, when she was a baby, of course, every time my head was turned at the playground, she’d eat a handful of sand, I think just on principle. So, not what I would have called a super-picky child. But now, for her, there’s like a 15 minute window in which she’ll count a banana as ripe.

SL: I don’t blame her!

JS: And beyond that, she says, “It makes me gag.”

SL: Bananas are pernicious!

JS: It’s hard to know how much of this has to do with this is where her palate is right now (and it’s a moving target), and how much of it is, here’s a way to stick it to the parent.

SL: Speaking personally, I was the middle child, so I was always trying to be good. I was not ever trying to piss off my parents or run counter to them. And even my older sister, who was more the rebel, rebelled in other ways. I will say she became a vegetarian for a while, maybe to make a point — she was a teenager — but I also believe it was to avoid certain foods that neither of us liked. Speaking as a kid who grew up picky, I never consciously thought of my pickiness as a way to thwart my parents. I hated fighting with them about it.

JS: Yeah, I’m not even sure this would be a conscious thing. Once they’re thirteen, they don’t even know all the ways they’re trying to fight authority.

SL: Sometimes they’re disagreeing just to disagree.

JS: I think it’s part of demonstrating that you’re an autonomous human being; you have to reject every good idea that comes out of your mother’s mouth.

SL: Which is exactly what they’re doing around eighteen months. This is why it’s normal to see picky eaters at toddler age. It’s developmentally appropriate — they should be picky eaters. It’s the first time they can take control and say “No” and “You can’t put this in my mouth because I can now feed myself.” So yes, I learned that they’re little teenagers when they’re toddlers, with the same kinds of hormonal fluctuations going on.

JS: Well, it’s totally fun to get to do that twice with each child. Development kind of sucks.

SL: Yeah.