The Anorexia Debate: Biology v Culture

June 5, 2005 9:52 AM

A recent study of 60 people with anorexia suggests that a biological mechanism may be a causative factor. It was found that there was a reduction in blood flow to a specific area in one of the temporal lobes in those with the eating disorder. The author of the study believes that sociocultural factors have been over emphasized. Not all agree. By way of contrast, another research group has just published findings which purport to show that "even small amounts of exposure to thin bodies can have a short-term negative effect on body image." And adult anorexia rates are said to be rising.
There's associated debate too, regarding the contributing role played by therapy that seeks to personify eating disorders. Flourishing underground online communities derive some thinspiration by referring to their 'lifestyle choices' as 'Ana' (for anorexia) and 'Mia' (for bulimia). Argentina is responding to the body image controversy by enacting a size law. previous mefi threads [via + via ]
posted by peacay (44 comments total)

If anyone has institutional access, here's the "Functional neuroimaging in early-onset anorexia nervosa" [Lask B, Gordon I, Christie D, Frampton I, Chowdhury U, Watkins B.] [Journal of Eating Disorders 2005;37 Suppl:S49-51; discussion S87-9] abstract - not much to read as is, I'm afraid.
posted by peacay at 9:55 AM on June 5, 2005

Thanks for an interesting post with a whole bunch of related and different links. I have to get reading....
posted by fluffycreature at 10:11 AM on June 5, 2005

The reporting of this work in both the news article (including quotes from the lead author) and blog comments betray a fundamental misunderstanding of the relationship between brain and behavior. Showing that there are temporal abnormalities associated with anorexia says nothing about whether the disorder has a biological cause. All behavior depends on the brain; it'd be shocking if there weren't brain abnormalities associated with anorexia. But showing that there's a correlation doesn't imply that an underlying biological predisposition causes anorexia. Environment and brain interact. The data reported are entirely consistent with a model on which brain changes are driven by environmental factors.

That said, it would also be surprising if anorexia wasn't at least partially due to biological factors. For one thing, it's known to be strongly associated with certain personality dimensions (e.g., obsessive, neurotic individuals are much more likely to develop anorexia), and virtually all personality dimensions have a strong genetic component to them (typically about 50%). On top of that, there are bound to be genetic factors working at the level of feeding/body regulation mechanisms (e.g., hypothalamic-pituitary axis) or, in line with the current article's findings, at the level of object/person-processing systems in the temporal lobe or elsewhere.

Given the available evidence at this point, it'd be dumb to try to attribute a disorder as complex as anorexia wholly to either environment or genes. There's almost certainly a substantial component of both. Existing estimates based on behavioral genetics studies suggest that heritability of anorexia is somewhere between 50 and 80% (with the remainder attributable to environmental causes).
posted by heavy water at 10:34 AM on June 5, 2005

Great post, peacay. I'm really into the Argentinian size law, I have to say. Even when I was so thin that people thought I was ill, I still wore a 12 in lots of clothes, and it drives me nuts that for status reasons shops won't carry my size clothes. It's like your allowed to be short and pudgy or tall and skinny, but never ever tall and pudgy or even broad. I wonder what sort of effects the laws will have, if everyone will come to appreciate it over time, even those it doesn't effect directly.
posted by dame at 10:48 AM on June 5, 2005

It was found that there was a reduction in blood flow to a specific area in one of the temporal lobes in those with the eating disorder.

I see a chicken-egg problem here. Is the difference in brain chemistry causing one to be more likely to suffer from anorexia, or are anorexics changing their brain chemistry because their diet's (or lack thereof) effect on the body?
posted by Civil_Disobedient at 10:52 AM on June 5, 2005

Nice post; I look forward to combing through this later.

Seed magazine had a terrif article on this topic a bit ago...
posted by Sticherbeast at 10:52 AM on June 5, 2005

And as for the Argentinian size-law controversy, I am surprised that they are so concerned about anorexia and bulimia when, epidemiologically, they are far, far less widespread (and less of a public-health concern) than obesity.
posted by Civil_Disobedient at 10:54 AM on June 5, 2005

Professor Lask:

"It is such a specific effect in only one part of the brain. If it were the result of starving yourself you would expect global changes round the brain. And it tends not to return to normal when weight is regained. That is why we think it is cause rather than effect."

posted by peacay at 11:14 AM on June 5, 2005

Thanks, peacay. "you would expect" does not strike me as particularly scientific, however.
posted by Civil_Disobedient at 11:20 AM on June 5, 2005

I don't know that the existence of the law means they are less concerned about obesity, C_D. Not making clothes that fit people isn't going to make them any skinnier, but pushing for a healthy representation of body size may make some people feel okay about being a reasonable size. And we are talking here about reasonably sized people: there is a vast difference between obesity and being overweight, and with the whole BMI rethinking, there's a good chance that the line is not where stores with size two mannequins and no clothes over an 8 or 10 seem to think it is.

Frankly, I wouldn't be surprised if better representation of reasonable body shapes didn't do a better job of encouraging fitness and healthy bodies than trying to make people feel bad that they are never going to be a stick.
posted by dame at 11:21 AM on June 5, 2005

Very interesting stuff. What I wonder is this : If there is a correlation between brain function and anorexia, why hasn't it shown up as an "epidemic" before? Or has it and rather than being documented as such has been swept under the rug of "labelling all women's diseases as hysteria?"
posted by grapefruitmoon at 11:40 AM on June 5, 2005

there's a good chance that the line is not where stores with size two mannequins and no clothes over an 8 or 10 seem to think it is.

Dame, I'm curious: what stores stop at size 8 or 10? I honestly can't recall ever being in a store where they don't actually stock anything over an 8 or 10 (though I understand that this is the case in couture wear -- but I assume we're not talking about Prada). Even here in L.A., the capital city of freakishly-shaped women (huge artificial breasts + teeny tiny waists + stick figure legs = walking Barbie dolls), the mainstream clothing lines regularly have plenty of stock in size 14 or 16 (I'm thinking of places like the Gap, Banana Republic, Ann Taylor, J. Crew, etc.) or even higher (I always see up to size 24 at my local Target and Old Navy, both in the heart of West Hollywood).
posted by scody at 11:46 AM on June 5, 2005

A bit of heartening anecdotal news: some of the slimmer girls in mrs. jonmc's school have asked about how they can gain weight, since the heftier girls seem to do better with the boys.

Anectodal, to be sure, but it seems to support the sociocultural axis.
posted by jonmc at 11:50 AM on June 5, 2005

Frankly, I wouldn't be surprised if better representation of reasonable body shapes didn't do a better job of encouraging fitness and healthy bodies than trying to make people feel bad that they are never going to be a stick.

There's a vast difference between "healthy & thin" and "stick" as I'm sure you know. I would agree that encouraging people to try for their athletic ideal is far better than emaciation, but I think some would take offense at even this, because it does not tell people what they want to hear: specifically, that fast-foods diet and sedentary lifestyles are a-ok.

I apologize for the derail.
posted by Civil_Disobedient at 11:55 AM on June 5, 2005

Scody, I'm actually thinking of boutiques and American Apparel; plus Urban Outfitters stops at 12, I think. Generally, anything over 12 is considered plus-size (which annoys the living crap out of me, since like I said, I was a twelve when I was partying-all-night, eating-a-bagel-a-day, did-she-get-sick? skinny).

But I was really extrapolating, because the law is for Argentina, but the article was pretty short, so I was assuming it was like the boutique problem. I was imagining what I would so with same law here.

American Apparel actually drives me effing batty, as I'd really like to buy nonlogoed clothes that I can guarantee were made by Americans under nonsweatshop conditions. But no, the asshole who runs it has a thing for skinny chicks--gah!
posted by dame at 12:04 PM on June 5, 2005

But no, the asshole who runs it has a thing for skinny chicks--gah!

Maybe a BBWA like me should take over and all will be well. To the barricades!
posted by jonmc at 12:08 PM on June 5, 2005

Good point from heavy water, and from Civil_D. The study assumes a biological determinism, it doesn't prove it by any means.

grapefruitmoon-Not only have we not seen an epidemic before, and hence the epidemiological basis for the biological cause of anoxeria is called into question, but there is some evidence (not all entirely sound, but not completely equivocal either) that anorexia is more prevalent in industrialized societies. During the writing of the DSM-IV there was a debate about whether or not to include anorexia nervosa in the section of "Culture-Bound Diseases." The proceedings for those meetings are available in the appedixes to the DSM. Of course the decision ultimately was to include anorexia in the main sections of the DSM.
posted by OmieWise at 12:10 PM on June 5, 2005

Oh, but Peacay, good links, thanks.
posted by OmieWise at 12:11 PM on June 5, 2005

The Majikthise link is a good one, and has an interesting point. There is a therapuetic method, formalized out of just the kind of therapy she talks about, called Narrative Therapy, in which externalization is sometimes used to help patients separate their problem from their sense of culpability about it. I'm not a big fan, mostly because I believe that therapy works through common factors and not through the kinds of specific interventions advocated by the people who subscribe to Narrative Therapy, but it does work in some cases. There's a great case report by this guy called Michael White, the big NT guru, in which he gets a young kid who keeps shitting his pants to call his problem "stinky poo," to great therapuetic effect and complete and instant cure.

But the point in the link, that some of this externalizing might fit too neatly into a different agenda that patients have is something to consider.
posted by OmieWise at 12:21 PM on June 5, 2005

There's a vast difference between "healthy & thin" and "stick" as I'm sure you know.

There is also a difference between "fit and healthy" and "thin" for an awful lot of people.

I would agree that encouraging people to try for their athletic ideal is far better than emaciation,

Yes, but what you and other people who seem to take umbrage at other people's weight often don't get is that "the athletic ideal" for some folks still isn't going to be thin--and that's okay.

but I think some would take offense at even this, because it does not tell people what they want to hear: specifically, that fast-foods diet and sedentary lifestyles are a-ok.

I don't. Because I don't think people are waiting around to hear that, really. I think people are often weak, often busy, and often fuck up. And we managed to set up a society where living in a healthy manner takes extra effort. Should people take that effort? Yeah. Is scolding them, making them feel bad about how they look, and almost exclusively offering up unobtainable examples going to encourage them to make that effort? No. If anything it's going to make them feel so far away that not bothering makes far more sense. So if you really care about other people's health (instead of your supposed superiority as evidenced by having the right kind of body), you'd work to make a culture where health was the easiest option.

Anyway, jonmc and I have a revolution to foment.
posted by dame at 12:25 PM on June 5, 2005

*passes dame bag of chips and a can of Schlitz*
posted by jonmc at 12:28 PM on June 5, 2005

"the athletic ideal" for some folks still isn't going to be thin--and that's okay.

exactly, there are plenty of 250+ NFL defensive tackles and even baseball players like Cecil Fielder who despite not being thin, are definitely athletic. So why should it be any different for the ladies?
posted by jonmc at 12:32 PM on June 5, 2005

Scody, I'm actually thinking of boutiques and American Apparel; plus Urban Outfitters stops at 12, I think.

Ah, interesting -- I hadn't realized either AA or Urban Outfitters stopped at 12 (goes to show you how long it's been since I shopped at UO). As for boutiques, I guess it hadn't really registered -- most of the boutiques I shop at size at S-M-L-XL (where XL=10 or 12), and the correlating numbers just didn't really click in my head. On that point, though, it's interesting to note what one of my favorite boutiques says here about precisely that same issue: basically, that they don't stock above an XL (i.e., 12) because the manufacturers/retailers they buy their stock from don't go above a 12 themselves. It sounds as if they'd actually like to to stock larger sizes if they could.

*grabs a chip from the bag as it passes*
posted by scody at 12:41 PM on June 5, 2005

*passes dame bag of chips and a can of Schlitz*

Can I have a cupcake and a Brooklyn Weisse instead?
posted by dame at 12:43 PM on June 5, 2005

scody, the chips are these, so you may want a swig of Schlitz as well (and dame don't worry, the bacon flavor is artificial (but oh so tasty) so your vegetarianism wont be compromised.)

I don't have no cupcakes, and money's tight. Schitz is $5/12 pack, you'll drink it and you'll like it.
posted by jonmc at 12:46 PM on June 5, 2005

mmmmm...this is so much better than the sandwich I was going to make for lunch....
posted by scody at 12:49 PM on June 5, 2005

This is just an appetizer. I'll nuke up the left over calimari from the greek joint down the block for the main course.

Back to the topic: see, food is a pleasure, not to be denied for the sake of measuring up to some dipshit magazine editors idea of beauty. Dig in.
posted by jonmc at 12:53 PM on June 5, 2005

Yeah, scody, I don't believe them. It seems like a case of "Oh it would be nice, but we can't, and we'll do it if it's easy, but we're not really bent out of shape . . ."

There are smaller websites that have larger sizes and sell wholesale. Besides, if they really cared about being inclusive (as opposed to avoiding hate mail), they would put pressure on their wholesalers and manufacturers to start making bigger clothes. Hence the reason I like this law. Or it would be nice to pick a middle size, say 6 or 8, and then say that for every size below you go, you have to go above. So if you have a 0, you have to make a 16 too. Because I realize it's a bell curve thing, but it pisses me off that the top of the bell curve gets fucked in way the bottom doesn't.
posted by dame at 12:55 PM on June 5, 2005

Besides, if they really cared about being inclusive (as opposed to avoiding hate mail), they would put pressure on their wholesalers and manufacturers to start making bigger clothes.

Which they very well may have tried to do. You've got no way of knowing whether or not she (the woman who runs the place) has tried to do exactly this with her wholesalers and manufacturers. There's not a doubt in my mind that she'd stock size 16s within the same price and style range of the rest of her store if she could get access to them, purely based on the fact that she'd clearly sell more.
posted by scody at 1:44 PM on June 5, 2005

Well, no scody, that's my point. I looked at that website. They could find more clothes that come in larger sizes than they now have up there if they tried. So I doubt they care as much as they claim--because they haven't given the evidence.
posted by dame at 1:52 PM on June 5, 2005

Is scolding them, making them feel bad about how they look, and almost exclusively offering up unobtainable examples going to encourage them to make that effort? No.

While there is a lot of "scolding" as you say, merely having attractive, thin people on magazines isn't some magazine editor's idea of teaching people the error of their ways. Those paradigms of "beauty" are on the covers for a reason: people have always been more interested in fantasy than in reality. The covers are merely a reflection of the aspirations of millions of women (and men).

If anything it's going to make them feel so far away that not bothering makes far more sense.

Probably very true, though there have been many inspirational stories that the media has also tried to play up.

I hadn't realized either AA or Urban Outfitters stopped at 12

Let's not forget that there has been noticable size "inflation" that has corresponded with the ballooning American mid-section.
posted by Civil_Disobedient at 2:04 PM on June 5, 2005

They could find more clothes that come in larger sizes than they now have up there if they tried. So I doubt they care as much as they claim--because they haven't given the evidence.

And my point is you've got absolutely no way of knowing how hard they've tried to find other manufacturers/distributors or how much they've tried to pressure their existing ones. The shop is basically a one-woman operation, with a handful of additional staff. You're the one who pointed out that American Apparel doesn't even make items above a size 12 -- so why is it a stretch to conclude that the even-smaller manufacturers that fit into her particular style/price/esthetic range also do not make above a size 12? It seems to me that it's a question of supply being out of touch with demand, rather than the spite or laziness you seem to attribute it to.

*can't believe, as an anti-capitalist, am discussing supply and demand; grabs one of jon's beers*
posted by scody at 2:26 PM on June 5, 2005

I think the root of this is sexism. If it was a man's illness, doctors would have found a cure for this when it was still called "Rich Girls' Wasting Disease."
posted by Mayor Curley at 3:19 PM on June 5, 2005

Scody, I just don't believe her. That doesn't make me right. Until someone emails her and she carefully documents it all, we're both speculating equally. Then again, if there were a glorious size law, it wouldn't matter, because she could be as lazy as she wanted.

Oh, and to be more accurate, American Apparel may make above a size twelve in their tees and few other selected items. They didn't in most if not all the skirts and dresses and undies they had last time I was there--a little over a year ago. I'd hate people to think I was lying on purpose.
posted by dame at 3:19 PM on June 5, 2005

In my psych classes I learned that Anorexa was caused by an overabundance of Dopamine in the brain, which causes nerviousness and "unrest". By eating less, the reduce the amount of raw material used to create dopamine, and thus reduce dopamine. The key is that by not eating they gain more normal brain chemistries.

But what do we do to 'treat' it? Tell them they're crazy and have a "negative body image". And then rant and rave about cultural standards of beauty.

It's just so stupid.

Rather then making the girls feel better about themselves we make them feel guilty about having negative body images. So now they've got negative body images and negative images of their minds.
posted by delmoi at 3:26 PM on June 5, 2005

I don't know about the behavioral versus biological debate, but I can tell you this: I was naturally thin in my early twenties. No problem; I was thin- skinny, even- and I knew it. Then I gained weight over the next 20 or so years, to the point that I was obese. It took a long time for my self image to catch up to the actual state of my body. I didn't think of myself as fat until I started having blood pressure/cholesterol/triglyceride problems to the extent I needed medication for them. Finally one day the realization hit me that I was fat.

I have since lost about 60 lb. and weigh less than the first picture I linked to. Yet, I still have a self-image that I'm fat. I look at myself in the mirror and see a fat guy still. Rationally, I know this isn't true. If anything, I just haven't fully toned back up yet (and being in my mid-40s, perhaps I never will but that remains to be seen). But even though I have lost all this weight and I know I'm thin, I still feel fat.

Perhaps the only difference between myself and an anorexic is that I am aware of this difference. But I guess my point is that even for healthy (I think I'm healthy) people, it takes a long time for a person's image of their body to catch up to changes in their body. Maybe in an anorexic, the image never quite does match the reality. Whether this is behavioral, biological, or a combination of both, I don't know.

Good post, peacay.
posted by Doohickie at 4:26 PM on June 5, 2005

From browsing some livejournals about anorxia the biology angle certainly makes more sense to me. The word "control" appears again and again, some women will write that they don't eat because it's the only thing they can really control in their lives. It's strange to see someone write about wanting to look "unattractively thin", to want to "dissapear", to be so thin people will be afraid to touch them. That seems to indicate something more complex than wanting to look like a girl in a fashion magazine.
posted by bobo123 at 4:56 PM on June 5, 2005

Or it would be nice to pick a middle size, say 6 or 8, and then say that for every size below you go, you have to go above. So if you have a 0, you have to make a 16 too.

Except that the same clothes that look good on a size 16 won't look good on a size 2 and vice versa. It's not like larger size people go naked: most of them manage to dress at least as stylishly as smaller people. Especially in this time of baby tees and low riders.

I think we need to divorce conditions like anorexia and compulsive over eating from regular weight issues. Being a size 16 and dieting to acheive a size 12 is a pretty far cry from being 90 pounds and thinking you are fat or 450 pounds and thinking you have a glandular problem. Most of us fall into the "could lose/ gain a few pounds and no-one would even notice or care" range, not the mentally ill range and it's silly to try and claim we don't. Narcisstic even.
posted by fshgrl at 7:58 PM on June 5, 2005

I would just like to further derail the thread by saying that I have never, ever understood women's clothing sizes. One number? How in the hell does that work? Why do you put up with that crap? It's almost like some psychologist told the fashion industry, "Women like to shop more than men, so make it as confounding as possible and force them to go from store to store until they find something that fits properly."
posted by Civil_Disobedient at 8:07 PM on June 5, 2005

As far as retailers not carrying sizes over 12...Urban Outfitters is mostly aimed at teenagers/young women, which could be part of that. As for American Apparel...my experience selling band t-shirts (printed on AA tees) has been that they run unbelievably small--I am very petite and a Medium is a little tight on me. But, it seems the owner is kind of a sexist asshole from what I've read, so there's that.

As for anorexia/bulimia....for some women (I think bulimics in particular), it IS a weight/body image issue--the few bulimics I have known were in this category. However, the "control" issue is also present in some women. It's probably one or the other, or a little bit of both--most mental illnesses have a number of causes, after all.

I don't know, though--while I agree that shaming people for not being "stick-thin" is wrong--I don't understand what's wrong with saying "being overweight/obese is not healthy," and I wonder if at least some of the hullabaloo over "body image" isn't just people being resistant to changing their lifestyle.

On Preview: C_D, it gets even worse--sizes don't even stay the same from store-to-store or brand-to-brand. A 4 at the Gap is NOT the same thing as a 4 at Target. Hell, even stores that use sizes similar to mens' (where 26 = 26 inch waist, etc.) don't run the same. Most distressing. :(
posted by scarymonsterrrr at 8:11 PM on June 5, 2005

Ex-anorexic here.

Given the vast body of research which seems to indicate that anorexia most frequently begins as a stress-induced problem, I'm a little dubious about calling the biological factors "causative". It does, however, seem to me extremely likely that one could have a biological *predisposition* for it, but that's not the same thing.

Delmoi - Much as I agree that anorexics shouldn't be stigmatized for it, I'm not sure I buy the dopamine argument, at least based on my personal experiences with it. By the time you're getting blinding migraine headaches from low blood sugar, and when you grab something too hard you can see your skeleton outlined in green on your palm because you've got so little body fat that you've bruised yourself on your own bones, I'm dubious that it can be reasonably argued that you're doing it because it makes you feel so much better.

However, I also think that those here talking about body image and magazine pictures and clothing sizes are also missing the mark on what's actually going on. Not that I disagree with them on the merits - I was cheering tonight for many reasons when a good-looking zaftig woman with plenty of curves won the Tony for best featured actress in a musical. But bobo123 is absolutely right - in my case, and in many cases I've read about - that it's far more about control than looking good. Appearance is a factor, sure, as are the myths surrounding weight-loss-through-diet, but it's far more a matter of a pathological need to control something in your life. When I went through it, I was homeless and fleeing an abusive marriage, and I think it's fairly clear that I was attempting to have something in my life that was entirely in my power.

Of course, that's the irony of the disease - it's an attempt to control that ends up controlling you completely. By the time I spent hours trying to eat a single container of yogurt, just so I would be eating *something* that day, it was obvious that something had gone horribly horribly wrong. But I was trying to eat, and failing; possibly it started as an "I'll be prettier if I lose some weight" kind of deal (frankly I don't remember), but eventually I became quite literally unable to eat, even if I wanted to. It became something which was only about itself, not society.

Do I think that the constant images of stick-thin models are harmful? Yes. Do I think they lead to eating disorders? Probably. But ... not necessarily anorexia, so much. That happened because something broke in my head. I think it would have happened if I'd never seen a glossy magazine, quite frankly.
posted by kyrademon at 9:48 PM on June 5, 2005

kyrademon writes "'Im a little dubious about calling the biological factors "causative""....."likely that one could have a biological *predisposition*"

100% correct. It was actually phrased that way in one of the links. I had lingered over the wording when composing it (tossing up whether to include 'genetic', with all its emotive implications) and should have thought it through a bit more still. It was very interesting reading your perspective. There's a few issues in here of course and anorexia gets lumped in with other more prevalent identity issues. For me, hearing an interview with Princess Diana years ago describing how she was so screwed up that she wanted to fade away into nothingness was a powerful message. That was the first time where I thought I had any handle on the mentality/psychiatric element behind anorexia/eating disorders.
posted by peacay at 11:30 PM on June 5, 2005

delmoi writes "In my psych classes I learned that Anorexa was caused by an overabundance of Dopamine in the brain, which causes nerviousness and 'unrest'. By eating less, the reduce the amount of raw material used to create dopamine, and thus reduce dopamine. The key is that by not eating they gain more normal brain chemistries."

Delmoi-This is the kind of biological causes argument that is put forward and then revised about three times a year. For all mental illnesses. We have no idea about the causes, despite the efforts of pharmaceutical companies and biological psychiatry to convince people otherwise. What we know is that many people want to find biological causes. No one has been able to yet.

If you're curious about this, do just a cursory bit of research into the causes of schizophrenia. This flagship mental illness, where the norm of behavior and perception is so radically different from what constitutes mental health, should be the easiest on to investigate and observe biological changes with. Yet there is no consensus on cause, no consensus even on brain changes across schizophrenics. Frequently the different aetiological models are directly contradictory.

[Of course I agree that it makes no sense to stigmatize anyone with a mental illness. Positing a biological cause is not the only way to achieve that, though.]
posted by OmieWise at 6:34 AM on June 6, 2005

American Apparel's unisex line certainly doesn't stop at 12 - they sell at least some "Standard American" stuff up to "3XL", which is a 44-48 inch waist with no stretch factor. They have this to say about the "classic girl" sizing scheme, which is presumably what some posters were complaining about: "Because our fabrics are stretchy (especially our Baby Rib, which has a stretch factor of over 100%), each size can fit a wide range of women. When Classic Girl T-shirts are to be used to promote an event, our Medium/One Size (indicated by M/OS) is suggested, as it fits approximately 80% of women." Also, "XL" in that line is "12-14", not just 12. Maybe the larger clothes don't show up in the stores, but they do seem to sell them online.
posted by advil at 1:23 PM on June 6, 2005