Monday, April 25, 2016

"It Could Have Something to Do With Cancer …": Commercialism, Identity Politics, and Disease

            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.

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