People would not believe so strongly in our capability to conquer death, disease, and suffering, if this were not perceived to be a worthy goal. In a simplistic, black-and-white way, disease and suffering have become our enemies, the "bad guys." Who would disagree that if it were possible to eliminate them, we should?
This is probably more of a philosophical issue than anything else and certainly not one that has been overlooked by millions of others! It all boils down to whether or not certain forms of suffering might serve a useful purpose, or whether a life free of pain would be worth living. However, I don't think this blog is a useful place to try to answer those questions. I am more interested in the assumptions that underlie our answers to these questions.
I am not trying to argue that all medical advances are bad, or that no one should try to cure illnesses. What I am questioning here is the ultimately purpose for which we do this, the framework for understanding health that this entails, and the potential consequences of our endeavours.
What I find problematic is this: the assumption that there is one physical ideal, that any deviation from this ideal is problematic, that health should be viewed in moralistic terms, and that any inability to bring deviations under control (so that everyone can approximate the one ideal) should be viewed as a human failure, and not simply a necessary part of human existence that we should learn to accept in some way. Accepting the bodies that we have may, in part, mean accepting the occasional aches and pains, accepting weaknesses, and accepting our appearance. If we can't be content with what we have before trying to "improve" things, then we will never be happy.
I would also argue that our inability to be content with what we have, our constant desire for something more and better, is a product of capitalism and the processes by which capitalist interests attempt to increase demand by increasing want. Likewise for our unceasing faith in the ideology of progress and the benefits of science and technology, which serves to naturalize and legitimate the capitalist world order as the apex of cultural evolution.
Thursday, April 21, 2011
Wednesday, April 20, 2011
Health Myth 7: We Can Conquer Disease and Death
We spend a lot of time and money trying cure diseases. Owing to the ideology of progress, we have faith in the near inevitability that any given disease will eventually be cured, if only we devote enough research to it. Those who envision a future in which all diseases have been cured (most eradicated), allowing us to live long lives before dying peacefully of old age, are generally not considered pie-in-the-sky idealists.
Clearly our belief in progress necessitates a certain view of health as "conquest" (just as political and economic progress entailed colonial conquest). Progress involves the subordination of all things to human (generally means certain humans) control. But can death and disease ever be entirely within our control?
First, consider: everyone dies. Some people have noted that as the death rate from one disease goes down, the rates of others, by necessity go up. Is this really an accomplishment? Curing and preventing diseases never lowers the rate of death!
You may argue, "Yes, but by combating [another militaristic metaphor!] disease, even if those potentially affected die anyway, at least we have eliminated the suffering caused by that illness." True. But remember, old age comes with its own forms of suffering: mental deterioration, physical weakness and pains, accidents resulting from impaired abilities, etc. Eliminating a disease does not by any necessity reduce suffering in the long run. It might. But it might not.
"Maybe we could control that too. With medical advances, we could eventually prevent the mental and physical deteriorations of old age!" However, by believing that we can eventually control everything, we are once again relying upon the model of simple, linear causality, that is ultimately inadequate to account for a complex system like the human body. The environment is constantly changing in ways that we cannot predict (by virtue of the fact that it, too, is a complex system), and therefore the body will always be responding to these changes in unforeseen ways. The growth of antibiotic resistant bacteria is only one of many ways in which our world continues to transform itself.
To eliminate death and disease, we would have to be able to bring every single aspect of our living environment under our control. Unfortunately, the properties of complex systems and chaos make this goal completely unattainable.
Clearly our belief in progress necessitates a certain view of health as "conquest" (just as political and economic progress entailed colonial conquest). Progress involves the subordination of all things to human (generally means certain humans) control. But can death and disease ever be entirely within our control?
First, consider: everyone dies. Some people have noted that as the death rate from one disease goes down, the rates of others, by necessity go up. Is this really an accomplishment? Curing and preventing diseases never lowers the rate of death!
You may argue, "Yes, but by combating [another militaristic metaphor!] disease, even if those potentially affected die anyway, at least we have eliminated the suffering caused by that illness." True. But remember, old age comes with its own forms of suffering: mental deterioration, physical weakness and pains, accidents resulting from impaired abilities, etc. Eliminating a disease does not by any necessity reduce suffering in the long run. It might. But it might not.
"Maybe we could control that too. With medical advances, we could eventually prevent the mental and physical deteriorations of old age!" However, by believing that we can eventually control everything, we are once again relying upon the model of simple, linear causality, that is ultimately inadequate to account for a complex system like the human body. The environment is constantly changing in ways that we cannot predict (by virtue of the fact that it, too, is a complex system), and therefore the body will always be responding to these changes in unforeseen ways. The growth of antibiotic resistant bacteria is only one of many ways in which our world continues to transform itself.
To eliminate death and disease, we would have to be able to bring every single aspect of our living environment under our control. Unfortunately, the properties of complex systems and chaos make this goal completely unattainable.
Tuesday, April 19, 2011
Myth 6: It is Normal to be Healthy
Although it is obvious that everyone gets sick at some point, we tend to treat illness as if it were some form of a "deviation" from a normal state. Likewise with disorders, syndromes, etc. It is as if there were one particular way the body is "supposed" to function, if not affected by assaults from without or perversions within.
But the body is a complex system. It is the very nature of a complex system to embody multiple physical configurations and to respond in highly unpredictable ways to changing conditions - to itself be constantly undergoing processes of change. Thus, thunderstorms, though possibly unpleasant or even dangerous, are requisite aspects of weather systems, following directly from their internal logics, as much as nice, sunny days. The same with illness and disease.
Furthermore, what it is to be "healthy" is itself a socially determined matter. No one is exactly the same; no body functions identically to any other. We are all unique and have our individual quirks, strong points, and weaknesses. So what, exactly, is the boundary between "healthy" and not "healthy"? If I have allergies, am I still healthy? My muscles are a little less flexible than the average person, and my ankle joints are tight... does THAT make me unhealthy? Is a person with lactose intolerance (coincidentally, a much more prevalent "condition" than lactose tolerance) still healthy? What about a hemophiliac? The lines we draw are arbirtary. But they do have meaning.
I mentioned in Myth 5 that the religious aspect of the "invasion" approach to disease has only partially been shed from contemporary thought. Although modern medicine is an ostensibly "secular" enterprise, the moralization of illness and disease still persists (and, in fact, is vital to the narrative of progress). It takes the form of a pervasive yet tacit assumption that health status is a measure a person's moral worth. Disease is often associated with unhygenic, "primitive," or deviant behavior. It also tends to become associated with particular groups of people (AIDS was a "gay disease" before it became a "black disease"; hepatitis is a druggie disease; syphillis is a pervert disease; TB is an immigrant disease; etc. etc.). Our notions of "health" and "disease" are a significant means by which we imbue human bodies with social meaning.
In the era of capitalism, we may do this to create social divisions among the human population to enact a division of labor; to construct a visual map of scientific/capitalist progress using human bodies (a task which requires contemporary representatives of our "primitive," diseased past); to evaluate and manipulate personal choices; and, of course, to sustain a consumerist attitude toward physical well-being, wherein if one just "tries hard enough" by investing wisely in food, in doctors, in pharmaceuticals, etc. then one can attain "health."
But the body is a complex system. It is the very nature of a complex system to embody multiple physical configurations and to respond in highly unpredictable ways to changing conditions - to itself be constantly undergoing processes of change. Thus, thunderstorms, though possibly unpleasant or even dangerous, are requisite aspects of weather systems, following directly from their internal logics, as much as nice, sunny days. The same with illness and disease.
Furthermore, what it is to be "healthy" is itself a socially determined matter. No one is exactly the same; no body functions identically to any other. We are all unique and have our individual quirks, strong points, and weaknesses. So what, exactly, is the boundary between "healthy" and not "healthy"? If I have allergies, am I still healthy? My muscles are a little less flexible than the average person, and my ankle joints are tight... does THAT make me unhealthy? Is a person with lactose intolerance (coincidentally, a much more prevalent "condition" than lactose tolerance) still healthy? What about a hemophiliac? The lines we draw are arbirtary. But they do have meaning.
I mentioned in Myth 5 that the religious aspect of the "invasion" approach to disease has only partially been shed from contemporary thought. Although modern medicine is an ostensibly "secular" enterprise, the moralization of illness and disease still persists (and, in fact, is vital to the narrative of progress). It takes the form of a pervasive yet tacit assumption that health status is a measure a person's moral worth. Disease is often associated with unhygenic, "primitive," or deviant behavior. It also tends to become associated with particular groups of people (AIDS was a "gay disease" before it became a "black disease"; hepatitis is a druggie disease; syphillis is a pervert disease; TB is an immigrant disease; etc. etc.). Our notions of "health" and "disease" are a significant means by which we imbue human bodies with social meaning.
In the era of capitalism, we may do this to create social divisions among the human population to enact a division of labor; to construct a visual map of scientific/capitalist progress using human bodies (a task which requires contemporary representatives of our "primitive," diseased past); to evaluate and manipulate personal choices; and, of course, to sustain a consumerist attitude toward physical well-being, wherein if one just "tries hard enough" by investing wisely in food, in doctors, in pharmaceuticals, etc. then one can attain "health."
Sunday, April 17, 2011
Myth 5: It's All About Genes and Germs
Or: Understanding a medical condition involves locating a gene or isolating a foreign agent.
The fundamental premise of this myth is that the human body is characterized by simple, linear cause-and-effect relationships. Granted, some leeway may be given for multiple causes and "complicating facors," but these are mere qualifications of the basic linear model which is employed.
Example 1: Genes. Medical researchers have become obsessed with finding the gene or set of genes responsible for everything from autism to homosexuality to political preference.
However, any responsible researcher will also admit that the relationships between genes, "internal" bodily processes, and "external" environment are not clearly understood. Furthermore, as discussed in Myth #4, many of these conditions may not be of a homogenous or easily definable nature (i.e. they are not "things" that can take part in a linear causal chain), and some (such as sexuality and political preference) are social constructions. This is akin to looking for the gene that causes one to speak French rather than English! True, genetic correlations are often found. But correlations are pretty easy to construct, and they do not by any necessity have any real significance.
Example 2: Germs. "Sickness" is most often conceived in terms of infections and germs. We take all sorts of measures to avoid "catching" other people's germs, which some people carry to the point of clinically-defined neurosis. We also view germs within a military framework - invasions and attacks - and seek all-out assaults on the perpetrators of illness via copious use of pharmaceuticals.
The whole idea that ill-health is caused by the intrusion of foreign agents derives from a Medieval religious perspective in which physical malady was conceived as a moral condition caused by the invasion of the body by tiny demons. This idea has persisted and, stripped (partially) of its religious component, frames our current understanding of illness. In fact, medical researchers throughout history have often ASSUMED the presence of foreign agents with absolutely no proof of their existence, and worked laboriously to find material evidence to back up what they already believed to be true.
There are several shortcomings of the "invasion" perspective. First, the body does not have a clear "inside" and "outside." In fact, the skin is the largest organ of the human body. Second, there is not always a clear distinction between what is part of the body and what is "foreign." Parasitic relationships are extremely common, and the human body also makes use of this arrangement. Bacteria, in fact, perform many vital functions in the human body. If you have ever taken an antibiotic that has killed too many of your intestinal bacteria and experienced the uncomfortable results, then you might not think of them as intruders! Third, most disease-causing agents are already present in the body under normal circumstances.
Some in the medical field have sought alternatives to the "invasion" metaphor. Ludwik Fleck suggested that the human body might more effectively be likened to a garden, in which the key to health involves a particular balance among its various components. Certain stressors or events may upset the balance from time to time. Since there is no distinct barrier between the "outside" and "inside," altered balances in the overall environment (for example, the people who surround you) may ripple and affect you as well. This is still a notion of contagion, to be sure, but a more holistic one, which does not rely as heavily on a linear causal chain, and views the body together with its environment as a unified, complex system.
The fundamental premise of this myth is that the human body is characterized by simple, linear cause-and-effect relationships. Granted, some leeway may be given for multiple causes and "complicating facors," but these are mere qualifications of the basic linear model which is employed.
Example 1: Genes. Medical researchers have become obsessed with finding the gene or set of genes responsible for everything from autism to homosexuality to political preference.
However, any responsible researcher will also admit that the relationships between genes, "internal" bodily processes, and "external" environment are not clearly understood. Furthermore, as discussed in Myth #4, many of these conditions may not be of a homogenous or easily definable nature (i.e. they are not "things" that can take part in a linear causal chain), and some (such as sexuality and political preference) are social constructions. This is akin to looking for the gene that causes one to speak French rather than English! True, genetic correlations are often found. But correlations are pretty easy to construct, and they do not by any necessity have any real significance.
Example 2: Germs. "Sickness" is most often conceived in terms of infections and germs. We take all sorts of measures to avoid "catching" other people's germs, which some people carry to the point of clinically-defined neurosis. We also view germs within a military framework - invasions and attacks - and seek all-out assaults on the perpetrators of illness via copious use of pharmaceuticals.
The whole idea that ill-health is caused by the intrusion of foreign agents derives from a Medieval religious perspective in which physical malady was conceived as a moral condition caused by the invasion of the body by tiny demons. This idea has persisted and, stripped (partially) of its religious component, frames our current understanding of illness. In fact, medical researchers throughout history have often ASSUMED the presence of foreign agents with absolutely no proof of their existence, and worked laboriously to find material evidence to back up what they already believed to be true.
There are several shortcomings of the "invasion" perspective. First, the body does not have a clear "inside" and "outside." In fact, the skin is the largest organ of the human body. Second, there is not always a clear distinction between what is part of the body and what is "foreign." Parasitic relationships are extremely common, and the human body also makes use of this arrangement. Bacteria, in fact, perform many vital functions in the human body. If you have ever taken an antibiotic that has killed too many of your intestinal bacteria and experienced the uncomfortable results, then you might not think of them as intruders! Third, most disease-causing agents are already present in the body under normal circumstances.
Some in the medical field have sought alternatives to the "invasion" metaphor. Ludwik Fleck suggested that the human body might more effectively be likened to a garden, in which the key to health involves a particular balance among its various components. Certain stressors or events may upset the balance from time to time. Since there is no distinct barrier between the "outside" and "inside," altered balances in the overall environment (for example, the people who surround you) may ripple and affect you as well. This is still a notion of contagion, to be sure, but a more holistic one, which does not rely as heavily on a linear causal chain, and views the body together with its environment as a unified, complex system.
Saturday, April 16, 2011
Myth #4: Diseases are Discrete Entities
Modern medical practice is essentially built upon the idea that deviance comes in discrete packages ("disease," "infection," "disorder," "syndrome," etc.). This leaves the following tasks for medical researchers and health practitioners:
1. Refine the definition of the deviance-entity; draw sharper boundaries.
2. Improve the process by which it can be recognized according to its symptoms.
3. Identify the cause(s).
4. Discover potential treatments.
If a patience presents a heretofore unencountered set of symptoms, medical professionals immediately attempt to determine "what" this person "has," and isolate the essence of this newly discovered entity.
This regimen has produced two major tendencies:
1. The proliferation of diseases and disorders. As new realities are encountered, new entities are devised to account for them. Additionally, new diseases mean new research programs, new grants, more journal articles, more conferences, different ways to market treatments: in effect, more ways to circulate capital and sustain the work of those in R&D fields.
2. Growing prevalance of certain diseases. In part, this occurs when new experiences are not separated into new disease categories, forcing already existing ones to expand. And in part, this results from the pathologizing of characteristics that were previously viewed in a different light. Once again, from an economic standpoint, escalating rates of disease mean expanded investment in research and increased markets for treatments.
This is not to say, of course, that capital investments are the only (or even most important) driving force behind these tendencies, or that the medical establishment does not accept these premises concerning the nature of disease with all intellectual sincerity.
However, this does highlight the way in which our propensity to view health in terms of discrete, material entities is shaped by a capitalist organization of social institutions (including those related to medical research and public health), in which capital investments are discretely categorized and allocated according to quantifiable outcomes; goals and results are measured in terms of material inputs; and individual human bodies serve as the primary site of intervention (as opposed to integrated social processes).
This all occurs in the face of one undeniable fact: it is really hard to define diseases in such a way that they may be sustained as discrete entities. In actuality, we don't discover diseases; they are not just sitting there, waiting for us to learn of their existence. We create diseases, disorders, syndromes, etc. Faced with a complex and variable reality, we impose categories upon our experience in order to simplify and more easily understand it. Oftentimes definitions of diseases are based more upon history and accident than on any coherent set of principles. Furthermore, a single disease may present such widely varying symptoms that any two people may experience it in entirely different ways, and the causes may be multiple or unknown. (Autism is a great example.) Why, then, should it be considered a single "thing"? Still, we proceed as though the categories that we have created have an essence and an existence all of their own, and our task is to simply discover what that essence is.
There are significant social and political implications as to what behaviors and conditions become pathologized (or de-pathologized, in the case of the removal of "homosexuality" as a psychiatric disorder). What we see as a "problem" is deeply socially embedded. It should also be noted that the creation of "problems" is, in itself, a strategy that is employed by dominant forces to mobilize social and political resources, as well as capital flows, in the service their own agenda. Not that every new disease is a conscious and strategic creation of a conspiring economic elite, but one should be aware of the way in which this generalized (and non-uniformally applied) strategy can be employed in the domain of health.
1. Refine the definition of the deviance-entity; draw sharper boundaries.
2. Improve the process by which it can be recognized according to its symptoms.
3. Identify the cause(s).
4. Discover potential treatments.
If a patience presents a heretofore unencountered set of symptoms, medical professionals immediately attempt to determine "what" this person "has," and isolate the essence of this newly discovered entity.
This regimen has produced two major tendencies:
1. The proliferation of diseases and disorders. As new realities are encountered, new entities are devised to account for them. Additionally, new diseases mean new research programs, new grants, more journal articles, more conferences, different ways to market treatments: in effect, more ways to circulate capital and sustain the work of those in R&D fields.
2. Growing prevalance of certain diseases. In part, this occurs when new experiences are not separated into new disease categories, forcing already existing ones to expand. And in part, this results from the pathologizing of characteristics that were previously viewed in a different light. Once again, from an economic standpoint, escalating rates of disease mean expanded investment in research and increased markets for treatments.
This is not to say, of course, that capital investments are the only (or even most important) driving force behind these tendencies, or that the medical establishment does not accept these premises concerning the nature of disease with all intellectual sincerity.
However, this does highlight the way in which our propensity to view health in terms of discrete, material entities is shaped by a capitalist organization of social institutions (including those related to medical research and public health), in which capital investments are discretely categorized and allocated according to quantifiable outcomes; goals and results are measured in terms of material inputs; and individual human bodies serve as the primary site of intervention (as opposed to integrated social processes).
This all occurs in the face of one undeniable fact: it is really hard to define diseases in such a way that they may be sustained as discrete entities. In actuality, we don't discover diseases; they are not just sitting there, waiting for us to learn of their existence. We create diseases, disorders, syndromes, etc. Faced with a complex and variable reality, we impose categories upon our experience in order to simplify and more easily understand it. Oftentimes definitions of diseases are based more upon history and accident than on any coherent set of principles. Furthermore, a single disease may present such widely varying symptoms that any two people may experience it in entirely different ways, and the causes may be multiple or unknown. (Autism is a great example.) Why, then, should it be considered a single "thing"? Still, we proceed as though the categories that we have created have an essence and an existence all of their own, and our task is to simply discover what that essence is.
There are significant social and political implications as to what behaviors and conditions become pathologized (or de-pathologized, in the case of the removal of "homosexuality" as a psychiatric disorder). What we see as a "problem" is deeply socially embedded. It should also be noted that the creation of "problems" is, in itself, a strategy that is employed by dominant forces to mobilize social and political resources, as well as capital flows, in the service their own agenda. Not that every new disease is a conscious and strategic creation of a conspiring economic elite, but one should be aware of the way in which this generalized (and non-uniformally applied) strategy can be employed in the domain of health.
Thursday, April 14, 2011
Myth #3: Causes of Ill Health are Physical and Personal
By now I have just about hammered home the point that, as a general principle, the health profession looks for causes that are physical and tied to the individual. This approach has led so many in the field to focus on diet (fat, cholesterol, salt; now carbs, transfats, etc.), personal habits (how much do you exercise, how long do you sleep, how much do you smoke, how many sexual partners do you have...), family medical history (in so far as "the family" represents a personal gene pool), exposure to disease causing agents, and the like.
On the contrary, emotional, social, political, and economic causes of disease are given secondary consideration, if any at all.
I remember reading Malcom Gladwell's book Outlier, which begins with the story of an American immigrant community who presented phenomenally low levels of heart disease. Gladwell recounts the investigative process undertaken by medical rsearchers to determine the cause of this felicitous situation, including all the many dead-ends and their ultimate conclusions. I found the discussion fascinating and began describing the scenario to my mother. Immediately, she began throwing out possible explanations, in pretty much the same order as the medical investigators considered them. "It must have been their mediterranean diet" (no, they had switched to a high-fat, high-carb diet). "They must have walked frequently and performed a lot of physical labor" (not a chance). etc. etc. What never occurred to my mother, and in fact, what only occurred to the researchers after they had pretty much exhausted all other possibilities was this: the community had very tight social bonds and spent a lot of quality time together, they regularly participated in religious activities, and they exhibited a general sense of emotional well-being. Is it possible that happiness, strong social relationships, and spirituality may promote health more than diet and exercise?
In Myth #2 I discussed the role played by inflammation in such conditions as high blood pressure and heart disease. This raises the possibility that stress is more of a "root cause" of these maladies than diet, exercise, and other personal habits. It would follow that the promotion of personal, social, and spiritual well-being may be a more effective way to nurture one's physical health than avoiding salt or constantly striving to lose 10 pounds. However, interventions aimed at the individual are easier to implement and control, and are infinitely more profitable.
Another example. It is often suggested that people with less money are more likely to be fat because healthier foods are more expensive. If you have a limited budget and work two jobs, then McDonald's is going to seem like a much more attractive option. This is a great argument for those who prefer to view health in terms of personal responsibility. It is the choices poor people are making (even if their options are limited) that cause them to be fat.
Yet, it is also true that living below the poverty line is significantly more stressful than living above it, and in the case of classic urban poverty, it generally entails fractured familial relationships and impoverished communal bonds. Could the political economic processes that create conditions of poverty be responsible for obesity among the poor? Is it more than simply a matter of the food they buy?
Similarly, a lot of noise is made about how African Amercians are "naturally" predisposed to high blood pressure, heart disease, diabetes, etc. This "medical fact" is convenient in two ways: not only does it locate the cause of these diseases in personal defects, it also sustains ideas about racial difference! How nice. Once again, we must consider: 1. African Americans are more likely to be poor (go back to above paragraph) 2. African Americans have to deal with racism, which is another significant stressor. Some medical researchers, in fact, have argued that the African American "predisposition" to high blood pressure is really caused by racism.
In the above cases, emotional status, social relationships, and political economic conditions are intertwined. It should also be underscored that in some instances political economic circumstances may play an even more direct role in health. Another book provides an example.
In Stories in the Time of Cholera, Charles and Clara Briggs recount their experiences with an epidemic of cholera that swept through a portion of Venezuela, and analyze the way in which this epidemic was represented by the media and government officials as eminating from a coastal indigenous population, as a result of their "primitive" behaviors. Yet, the Briggs' describe how cholera is a distinctly modern phenomenon, in fact, nurtured by particular forms of political oppression, marginalization, and economic alienation that have been instrumental to processes of state-making and market formation during the capitalist era.
Taking the same stance, physician-anthropologist Paul Farmer argues in Pathologies of Power that disease has distinct social, political, and economic causes which are very often ignored. In order to legitimate the current world system, these factors must be ignored, because they represent a challenge to the status quo. On the other hand, focusing on individual habits (particularly those labed "premodern" and "primitive") in the promotion of health is an important means of constructing the narrative of Progress that makes the desirability of the current state of affairs seem unquestionable.
On the contrary, emotional, social, political, and economic causes of disease are given secondary consideration, if any at all.
I remember reading Malcom Gladwell's book Outlier, which begins with the story of an American immigrant community who presented phenomenally low levels of heart disease. Gladwell recounts the investigative process undertaken by medical rsearchers to determine the cause of this felicitous situation, including all the many dead-ends and their ultimate conclusions. I found the discussion fascinating and began describing the scenario to my mother. Immediately, she began throwing out possible explanations, in pretty much the same order as the medical investigators considered them. "It must have been their mediterranean diet" (no, they had switched to a high-fat, high-carb diet). "They must have walked frequently and performed a lot of physical labor" (not a chance). etc. etc. What never occurred to my mother, and in fact, what only occurred to the researchers after they had pretty much exhausted all other possibilities was this: the community had very tight social bonds and spent a lot of quality time together, they regularly participated in religious activities, and they exhibited a general sense of emotional well-being. Is it possible that happiness, strong social relationships, and spirituality may promote health more than diet and exercise?
In Myth #2 I discussed the role played by inflammation in such conditions as high blood pressure and heart disease. This raises the possibility that stress is more of a "root cause" of these maladies than diet, exercise, and other personal habits. It would follow that the promotion of personal, social, and spiritual well-being may be a more effective way to nurture one's physical health than avoiding salt or constantly striving to lose 10 pounds. However, interventions aimed at the individual are easier to implement and control, and are infinitely more profitable.
Another example. It is often suggested that people with less money are more likely to be fat because healthier foods are more expensive. If you have a limited budget and work two jobs, then McDonald's is going to seem like a much more attractive option. This is a great argument for those who prefer to view health in terms of personal responsibility. It is the choices poor people are making (even if their options are limited) that cause them to be fat.
Yet, it is also true that living below the poverty line is significantly more stressful than living above it, and in the case of classic urban poverty, it generally entails fractured familial relationships and impoverished communal bonds. Could the political economic processes that create conditions of poverty be responsible for obesity among the poor? Is it more than simply a matter of the food they buy?
Similarly, a lot of noise is made about how African Amercians are "naturally" predisposed to high blood pressure, heart disease, diabetes, etc. This "medical fact" is convenient in two ways: not only does it locate the cause of these diseases in personal defects, it also sustains ideas about racial difference! How nice. Once again, we must consider: 1. African Americans are more likely to be poor (go back to above paragraph) 2. African Americans have to deal with racism, which is another significant stressor. Some medical researchers, in fact, have argued that the African American "predisposition" to high blood pressure is really caused by racism.
In the above cases, emotional status, social relationships, and political economic conditions are intertwined. It should also be underscored that in some instances political economic circumstances may play an even more direct role in health. Another book provides an example.
In Stories in the Time of Cholera, Charles and Clara Briggs recount their experiences with an epidemic of cholera that swept through a portion of Venezuela, and analyze the way in which this epidemic was represented by the media and government officials as eminating from a coastal indigenous population, as a result of their "primitive" behaviors. Yet, the Briggs' describe how cholera is a distinctly modern phenomenon, in fact, nurtured by particular forms of political oppression, marginalization, and economic alienation that have been instrumental to processes of state-making and market formation during the capitalist era.
Taking the same stance, physician-anthropologist Paul Farmer argues in Pathologies of Power that disease has distinct social, political, and economic causes which are very often ignored. In order to legitimate the current world system, these factors must be ignored, because they represent a challenge to the status quo. On the other hand, focusing on individual habits (particularly those labed "premodern" and "primitive") in the promotion of health is an important means of constructing the narrative of Progress that makes the desirability of the current state of affairs seem unquestionable.
Wednesday, April 13, 2011
Health Myth #2: Correlation Equals Causation
Even though the axiom "correlation does not equal causation" is frequently parroted within the sciences, it is much easier to say a principle than it is to actually integrate it into one's structures of thought. Case in point, a lot of scientific thought is premised on the contrary notion that correlation equals causation. And nowhere is this more apparent than in the field of medicine.
Let's start with examples from Myth #1. The fields of medicine and public health are very concerned with how much people weigh, going so far as to decry an "obesity epidemic." What, exactly, is the problem with being fat? We are told that "excess" fat is associated with heart disease, high blood pressure, diabetes, and just about every other threatening condition you can think of. In a slippery way, "associated with" becomes "caused by," in that weight loss is recommended to prevent all of the latter conditions; but losing weight can only prevent these conditions if it is a cause.
Doctors are hard-pressed to address the inquiries of more critical patients who ask, "If the purpose of losing weight is to prevent high blood pressure and I have very low blood pressure, why are you telling me to lose a few pounds? If I eat right and exercise daily, should that not be enough?"
At the same time, other health professionals have noted that fat storage appears to be an inflammatory response that is co-present with other such effects of inflammation. According to this view, it is very probable that the association between obesity and things like heart disease and high blood pressure is due to another underlying cause. Furthermore, when it comes to inflammation, the probable causes start to become more nebulous, being attributable to things such as "stress." (But I will save this discussion for Myth #3.)
As with fat storage, the same goes for cholesterol. Both fat and cholesterol are vital substances that perform necessary bodily functions. However, in each case a correlation has been discovered between high amounts of these substances and undesirable health conditions, and in each case this correlation has been construed as causation. Now, both fat and cholesterol are often seen as "unhealthy." Yet, just as high fat storage may be viewed as an inflammatory response to some other (internal or external) condition, it has also been noted that the ill effects of certain forms of cholesterol only occur in the presence of.... you guessed it, inflammatory responses in the cardiovascular system that only implicate cholesterol in a tangential way.
These same cardiovascular inflammatory conditions may also have an indirect, non-causual relationship with salt (just like cholesterol). Although people now tend to view salt as "bad" and avoid it like the plague, the only direct effect of salt is that it increases water retention (which, in itself, is a neutral effect, and can, under certain circumstances be beneficial). However, in the presense of unfavorable conditions created by inflammation, the increased fluid volume can coincidentally contribute to high blood pressure. Hence, decreasing salt intake does nothing to address the inflammatory causes of high blood pressure.
Of course, it is possible that "inflammation" may eventually replace "bad diet" in the simple causal chain employed by public health professionals (a move which would by no means lend to a more complex, holistic understanding of health); but, for this to happen, the idea of "inflammation" must be condensed into a simple, material entity that can be integrated into and reconstitute the web of market relations and commodity chains that comprise the practice of public health.
Let's start with examples from Myth #1. The fields of medicine and public health are very concerned with how much people weigh, going so far as to decry an "obesity epidemic." What, exactly, is the problem with being fat? We are told that "excess" fat is associated with heart disease, high blood pressure, diabetes, and just about every other threatening condition you can think of. In a slippery way, "associated with" becomes "caused by," in that weight loss is recommended to prevent all of the latter conditions; but losing weight can only prevent these conditions if it is a cause.
Doctors are hard-pressed to address the inquiries of more critical patients who ask, "If the purpose of losing weight is to prevent high blood pressure and I have very low blood pressure, why are you telling me to lose a few pounds? If I eat right and exercise daily, should that not be enough?"
At the same time, other health professionals have noted that fat storage appears to be an inflammatory response that is co-present with other such effects of inflammation. According to this view, it is very probable that the association between obesity and things like heart disease and high blood pressure is due to another underlying cause. Furthermore, when it comes to inflammation, the probable causes start to become more nebulous, being attributable to things such as "stress." (But I will save this discussion for Myth #3.)
As with fat storage, the same goes for cholesterol. Both fat and cholesterol are vital substances that perform necessary bodily functions. However, in each case a correlation has been discovered between high amounts of these substances and undesirable health conditions, and in each case this correlation has been construed as causation. Now, both fat and cholesterol are often seen as "unhealthy." Yet, just as high fat storage may be viewed as an inflammatory response to some other (internal or external) condition, it has also been noted that the ill effects of certain forms of cholesterol only occur in the presence of.... you guessed it, inflammatory responses in the cardiovascular system that only implicate cholesterol in a tangential way.
These same cardiovascular inflammatory conditions may also have an indirect, non-causual relationship with salt (just like cholesterol). Although people now tend to view salt as "bad" and avoid it like the plague, the only direct effect of salt is that it increases water retention (which, in itself, is a neutral effect, and can, under certain circumstances be beneficial). However, in the presense of unfavorable conditions created by inflammation, the increased fluid volume can coincidentally contribute to high blood pressure. Hence, decreasing salt intake does nothing to address the inflammatory causes of high blood pressure.
Of course, it is possible that "inflammation" may eventually replace "bad diet" in the simple causal chain employed by public health professionals (a move which would by no means lend to a more complex, holistic understanding of health); but, for this to happen, the idea of "inflammation" must be condensed into a simple, material entity that can be integrated into and reconstitute the web of market relations and commodity chains that comprise the practice of public health.
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