"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-20^th-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 20^th-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.

Old Enough to Fight, Old Enough to Vote; Old Enough to Vote, Old Enough to Drink (and Smoke)

REFERENCE:

Jonathan J. Cooper, AP, "Bill would make California 2nd state with smoking age of 21"

           <http://www.chicagotribune.com/lifestyles/health/sns-bc-ca-xgr--california-tobacco-laws-20160303-story.html">

Editorial: "State should pass bill to increase smoking age to 21"

   
        
In spite of short-term public health benefits of raising the "smoking age" for tobacco to 21, the State of California should resist the temptation to do so and move instead to a thorough revamping of our drug and criminal laws to make them more rational and to make 18 a consistent and rigorously-enforced "age of majority" (legal adulthood).

            As many Americans argued during the 1960s, "Old enough to fight, old enough to vote," a principle enacted in 1971 in the 26^th Amendment to the US Constitution. I.e., if someone is responsible enough to decide whether or not to register for the military draft and, if called, whether or not to agree to conscription; if someone is mature enough to decide whether or not to put his (sic) life in danger for his country; if someone is capable of deciding whether or not to agree to kill for his country — then that person is responsible enough to vote and deserves the vote.

            Alternatively American society would have to say that what we want for the Army is pretty much cannon fodder who needn't think a lot; and/or acknowledge that in approving the 26^th Amendment we knew that not enough young people would vote as a bloc to matter much whether they're responsible citizens or not.

            And if someone is old enough to vote — again, unless we say voting isn't really important — that person is old enough to decide whether or not to use a drug like ethyl alcohol or nicotine.

            As long as it's set a decent interval after puberty, the age for legal adulthood is more or less arbitrary and should be part of rites of passage that make it a self-fulfilling prophecy. If people are told they're adults, expected to act like adults, and are held accountable as adults a rite of passage can work its magic and children become adults. "Late adolescence" was invented during my lifetime, and treating young Americans as adults at 18 — including demanding adult behavior — could have them again young adults. As Mike A. Males has demonstrated in two major books and other writing, older American teens are pretty much a normal adult American population or frequently doing better than their elders. If a fair number of teens are irresponsible jerks, well, so are many of their elders, the older folk just having less energy to be noisy in our evil and experienced enough to be, usually, more discreet.

            Instead of the traditional grousing about them damn youngins and their bad habits, older Americans need to admit that main-stream adult America is a drug culture with a lot of immature, irresponsible and self-destructive behavior starting with pounding beers and popping pills. And then we need to take vigorous public health actions to help addicts, and public policy actions to significantly tone down the marketing of drugs of all sorts and reverse the message that relief from all manner of pain is at the bottom of a bottle.

            As long as it's illegal for an adult to give 20 grams of marijuana to a friend, it should be a felony to design a marketing campaign around "Bitter Beer Face" and push a gateway beer like Keystone Light to young people.

            Rather than passing laws so that "Parents that host / Lose the Most," we should encourage parents to teach their children that drinking is a choice, and if they choose to drink they can sip like ladies and gentlemen and use alcohol (and softer drugs) responsibly. It should not be too hard to return to the old idea that getting sloppy drunk and puking on a date isn't signaling sophisticated maturity.

            As for tobacco use, we need more to harness even more of those fiendishly brilliant pushers of beer and wine and stronger booze and get them working on ad campaigns that show nicotine use "Soooo 20^th-century!", fit only for old people and the terminally uncool (or whatever the cool word will be for "uncool").

            Making cigarettes a symbol of adulthood is not a good idea.

            Taking yet another step teaching 18-20-year olds that we think they're children and expect them to act that way: that is an invitation to even more arrested development among American youth and a very bad idea.

Solidarity For-ev-er! (repeat 2x): E.R.A.! E.R.A.! NOW! (9 Oct. 2014)

            I've recently sent in a contribution for HIV/AIDS research, and, when contacted, I contribute to the local group that helps poor women get breast cancer screenings; and once a year or so I contribute to research on prostate cancer. These are all worthy causes, but aside from using the return-address labels for GMHC and their "Essential Survives to Men, Women, and Families Living with HIV/AIDS" — and aside from what I just wrote (and purchasing [sic] a life-membership in the National Organization for Women) — I haven't done anything more for those causes.

            No ribbons or marches or contacting friends, and when I write, as now, it is to point out that for women in the United States, death by cancer of any sort is less likely than death by heart disease and stroke. Indeed, for White and Black women, heart disease alone — not counting strokes — is the leading cause of death. In 2008, 24.6% of deaths among White women were from heart disease, 21.6% from cancer. In 2008, 24.9% of deaths among Black women were from heart disease, 21.6% from cancer.
            And "HIV Disease" was number 14 out of 15 as cause of death in the US in 2008, ranking behind homicide and tied with congenital malformations.
            Rankings on "Morbidity and Mortality" are more reliable and significant than, say, Newsweek's ranking of colleges and universities, but such grim statistics are only suggestive; and they need to be analyzed in detail. It is significant, for example, that congenital malformations ordinarily kill children and young people 1-24, that homicide is a significant risk primarily for the young and relatively young, and that AIDS kills in the socio-economic prime of life: ages 25-44.
            What I try to stress in my writing and politics are the cold numbers of Morbidity and Mortality tables. And I stress them for the important reason that the sex-related and journalistically "sexy" diseases of breast cancer, prostate cancer, and AIDS are less of a threat than diseases with less powerful political connections like heart disease and "Cerebrovascular Diseases (Stroke)."
            "So attention must be paid" to diseases specific to women and to men gay and straight, and, to American men who are gay: very few men will get breast cancer; no women will get prostate cancer (though there may be something similar); and in the USA — as opposed to Africa — HIV/AIDS has been most importantly a disease among young gay males. And at various times that attention must be drawn by agitation, propaganda, protest, and even disruption: the standard ways political things get done by people not running a country.
            But attention must also be paid to unnewsworthy, "background" threats like heart disease and stroke, and diseases that threaten pretty much everybody: diseases that should inspire causes that can bring together working coalitions of men and women, gay and straight, incandescent White or of color of various sorts.
            Similarly, to get around to my title topic, "for everything there is a time, and a season," as Koheleth saith (Eccl. 3.1), and I think it now a time that my friends (and unfriends) on the Left return to an emphasis on coalitions, and coalitions built around the decorous uniting theme of equality.
            Greater equality of income and, more important, wealth, for a primarily goal, but that will be a tough fight: people with a lot of money are more into Pride than Greed among the deadly sins, and being better off than other people and a whole lot better off — radical inequality — is precisely the point. With a long-term fight over wealth distribution in the background, however, it is time to get to a more immediate, achievable, and too-long-put-off goal: ratification of an Equal Rights Amendment to the Constitution of the United States, with the process reinvigorated by a campaign in the 113^thor 114^th Congress.
            Look, if the old hard-radical feminist critique is correct, there is a monolithic structure of (White, European) male privilege of ancient and awesome power, and therefore not much hope for change. For sure, there'd be no reason beyond altruism for any XY and/or male-gendered human beings to do much for women or anyone else below them in the food chain. But there was never "The Man," and men are far from a monolithic group; and a lot of actually-existing guys have a fair sense of fairness and some vague idea that we are far from the top of the food chain and would be better off in a more equal world.
            And greater equality can begin logically and sensibly with the biggest inequality around: patriarchal/sexist exploitation of women. So:

Section 1: Women shall have equal rights in the United States and every place subject to its jurisdiction. Equality of rights under the law shall not be denied or abridged by the United States or by any State on account of sex.
Section 2: Congress and the several States shall have the power to enforce, by appropriate legislation, the provisions of this article.
Section 3: This amendment shall take effect two years after the date of ratification.

            Rape, sexual assault against women, and domestic abuse will remain issues in the United States, but those are crimes and need to be effectively handled as crimes. The cultural contexts in which such crimes are enabled are bigger and more complex problems; I'll note, though, that "The Law is the great teacher" — schoolmaster? — "of the commonwealth" (as someone said), and a fine teacher of the basics is specific expansion of the US Bill of Rights with an ERA for women. If "The Man" still exists in some sense and has problems with the ERA, then he can be shouted down and out-voted by the gals and guys. If some women worry that the second sentence of section 1 might make women susceptible to conscription, and if war-loving men worry that a country that drafts women would be reluctant to go to war …. Well, it may be my privileged off-White, politically straight, and XY-male privilege speaking — or just my souvenir 1-A draft card (Available for [Immediate] Military Service) — but screw 'em. If there's a literal "existential threat" against the USA, then every American from age 18 to 80 should have our names, health status, and brief résumés in the computer, and if we've got needed skills, off we go to defend the Motherland: with one Member of Congress drafted by lottery each week for the duration, and one Senator a month (I'll insist strongly on that last part: drafting members of the Congress).
            Solidarity forever folks; let's return to some old political priorities NOW, if perhaps just for now.