My one experience with actual science was working summer of
1964 in the gut lab (officially "Gastro-Intestinal Research," later
"Gastroenterology") at Michael Reese Hospital and Research Center in
Chicago. One of the projects I was tangentially involved with — possibly
washing the equipment — was up for renewal of funding, and as part of my
education, and maybe to get some work out of me as an English major, I was
given a draft of the grant proposal to read. My only comment on content was on
the paragraph listing all the wonderful potential of the project: a raised
eyebrow and the sort-of question, "Cancer?" We were doing pretty pure
basic research, which likely would have some use in dealing with ulcers, but
cancer …? The response I got was my cryptic main title: well, "It could have something to do with
cancer"; down the line, what we found out about gut motility — or whatever
the project was — could throw some light on cancer. I muttered something about "Why
not ulcers (maybe)?" and was told something like, "Americans aren't
scared silly about ulcer."
Now people in our lab were
doing research into early detection of cancers — we made Time magazine with that project — so
our claim of a cancer connection was credible, and our work was solid basic
physiology, however labeled. Still, I was struck by the idea of fads and
fashions in diseases and that the biggest gun fashion in mid- and late-20th-century
diseases was cancer.
I've been thinking about that cancer quote since I got an
ad with my newspaper on pink paper stock, with print and shading in a variety
of blue few men have a word for — "dark lavender"? — and featuring a photo
of a woman. At the top left of one side, balanced down the page by a
black-and-white photo of a mature woman, was the sentence, "Let Us Help
You Detect Your Risk Early".
The ad was for "Life Line Screening" not for
breast cancer, as I initially thought, but for cardiovascular disease.
Which is as things should be.
"According
to the American Heart Association," citing statistics in line with those I've seen from
more disinterested sources, "cardiovascular disease — including heart
disease, high blood pressure, and stroke — kills nearly a half-million women in
the U.S. each year. That figure exceeds the next seven causes of death
combined. More women die from [CVD, cardiovascular diseases] than of all
cancers (including breast cancer, which kills about 40,000 women annually),
respiratory conditions, Alzheimer's disease, and accidents combined." Into
the 1990s, the American Heart Association was estimating that "1 in 2 women will
eventually die of heart disease or stroke, compared with 1 in 25 who will
eventually die of breast cancer" — and even allowing for Heart Association
bias and hype and capacity for error, the point is still that coronary heart
disease and stroke are far more dangerous to women than breast cancer.
Now the flip side of the Lifeline Screening ad was specific: "We Can Help You Avoid Cardiovascular
Disease," but the color stock remained (of course), and I suspect I was
not the only person to first think, "Breast cancer."
I had an aunt who had breast cancer,
and a friend, and the daughters of two friends, but that probably wasn't why I
thought "Breast cancer"; breast cancer has VIP friends and gets a lot
of publicity, much of it using pink. As an embedded quotation in Sandy M.
Fernandez's "Pretty in Pink " article has it, in her brief
"History of the Pink Ribbon" (1998):
“Pink is the quintessential female
color […]. The profile on pink is playful, life-affirming. We have studies as
to its calming effect, its quieting effect, its lessening of stress. [Pastel
pink] is a shade known to be health-giving; that’s why we have expressions like
‘in the pink.’ You can’t say a bad thing about it.” Pink is, in other words,
everything cancer notably is not.
And pink was picked up by
powerful commercial allies in the war on breast cancer, as Fernandez very
usefully documents, and as a feminist cause, picking up the ribbon from the red
ribbon of (gay-inflected) AIDS activism, and — in a move Fernandez doesn't discuss
— inspiring later emphasis on prostate cancer (totally for men, usually
straight and older).
These, too, are important disease threats, and I'm
sympathetic, with an uncle who had prostate cancer and a good friend who died
young from it; and I still contribute to AIDS research (I'll send my check to
GMHC this week, guys, honest!).
Still ….
Still, working backward: The 20th-c. emphasis
on finding a cure for AIDS as what in the United States was initially a
syndrome among young, gay men, drew attention away from AIDS prevention as part of wider programs
against the spread of sexually-transmitted diseases and the occurrence of
unwanted pregnancies. Gay activists did yeoman's work in encouraging use of
condoms in the gay community; the attention paid to a high-voltage disease like
AIDS, however, distracted from the necessity to reduce the spread of
increasingly endemic diseases like gonorrhea and syphilis — and distracted in
sex-talk from discussions of male responsibility in contraception. Finding a pharmaceutical/medical
cure for AIDS was an easy cause to push as opposed to a wide-scale, loudly
public WRAP
THAT WILLY! campaign encouraging use of condoms, and spelling out in a
full-monty propaganda effort when condoms were most important. As I challenged
a group of newspaper editors in south-west Ohio, "If it would save ten
lives a year to do so — and it would save at least ten in our area — would you
run large public service ads proclaiming in large font. 'Butt-Fucking Is Risky.
WRAP THAT WILLY!'"? Promoting medicines to control AIDS bears far fewer
costs than breaking linguistic taboos and taking on, among others, the
hierarchy of the Roman Catholic Church.
The emphasis on breast cancer and then prostate cancer
drew too much attention from non-sexy (pun intended) but deadly menaces such as
heart disease. Equally bad, the emphasis on early detection of breast and
prostate cancer led to overtesting and
overdiagnosis, and in some cases overtreatment with serious harm.
Additionally, there were the monetary costs of testing, plus the figurative but
important costs of anxiety from false positives from screenings and the
human-hours appropriated and rendered unpleasant by the unpaid tasks of going
for mammographies, PSA (prostate-specific antigen) tests,
biopsies, and digital rectal exams (DREs). Added to that, and getting back to
my initial topic, there is the warping of research when funding is too much for
the "popular" diseases: a particularly perverse application of
middle-school ethos obsession with popularity.
In some ways, it is amusing that there are fads and
fashions in disease. Mostly, though, attention to high-profile diseases because
they have been rendered high profile — is a bad thing. Yes, ladies, get mammograms
made if, but only if, you're in one or more categories at risk for breast
cancer; and, gentlemen, get your PSAs and DREs — if, but only if, prostate
cancer is a significant risk for you, personally, at your age. (Face up to it
guys: live a long life, and you
will get prostate cancer.) And
contribute to worthy causes fighting cancer.
But —
But recall that other important initialism and contribute
a bit more generously for research into CVD, cardio-vascular disease, which is
more likely to kill you than cancer. And quit smoking and keep your weight down
and get exercise and get your blood pressure checked and do those other
unexciting things related to low-profile diseases that don't get ribbons and
their own color and fail to attract friends in high places.
You want to save women's lives? Spread the word about
heart diseases — and try to see it as a mild advantage that you might save a
few guys' lives as well.
