"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.

Perrier, Pubes, Condoms, Morēs, & Morality (10 Feb. 2013)

"Manners Are Small Morals"

             I didn't put "spittoons" in my title here, because it's a somewhat long word and a word that might in itself turn away some readers; also, in combination with "pubes," it might attract readers for a different kind of writing than this essay.

            I want to start out with spittoons, though, and the fact that you probably have never seen one outside a Western.

            I'm old enough to remember spittoons in a gym locker-room in Chicago in the 1950s, and a friend of my youth tells me he saw some as recently as the 1970s: in an old-fashioned Chicago pool hall. He wasn't sure if the 1970s spittoons were actually used, or were just traditional decor. The ones in the locker-room were used — and I won't go into details about how I'm sure of that. (Hint: Emptying them was obviously not something the janitors like to do.)

            What's significant here is that I won't go into details because the details disgust me and very likely would disgust you, even a macho guy "you." Within a century or so, spittoons have gone from a sign of increased civilization — a way to avoid spitting on the street — to just gross.

            Part of that change was motivated by concerns for health and hygiene, and enforcement of health regulations, but mostly it was a change in "morés," in social standards and customs.

            I've written before about the power of fads and fashion, and I'm going to reinforce that idea here, but looking more at the up-side.    Especially as multiple-antibiotic-resistant tuberculosis becomes an increasing health hazard, it becomes increasingly a good thing that most Americans no longer casually spit on the street, or even in spittoons — and, mostly, that change in behavior came from a change in morés, in customs, social standards, "manners."

            A couple more items of evidence: more in terms of what people do than what they don't do, with continuing emphasis on guy behavior but bringing in (very crucially) you gals.

            While having my car serviced in a recall, I went into the Parts Department to check out costs for installing fog lights and noticed that they had a refrigerated display with beverages to purchase. So far so familiar: the gas stations I grew up with often had Coca Cola machines. However, the featured item in this Parts Department in 2013 was Perrier Water.

            Trust me, when I was growing up, guys at the gas station who wouldn't shell out a nickel for a Coke, drank the gas station water out of a hose, or (as part of the creeping socialism of the 1950s) from a water fountain. That a trucker checking out mudguards at the Parts Department might drink water from a little green bottle, and pay for the privilege, is a tribute to the power of changing fashions, and to the power of advertisers and marketers to change those fashions.

            Now, moving closer to, uh, home, let us consider the pubic hair of my title.

            I grew up with the folklore about guys' playing nasty honeymoon tricks on their friends, with the nastiest trick getting the groom drunk at his stag party, then (de)pantsing him and shaving his balls. Really, really nasty and perverse friends — the real weirdoes — would shave the guy from waist to thighs, so he'd look prepubescent (not that they'd know the word) and ridiculous when his bride saw him naked.

            As The Simpson's Nelson Muntz would say, "Ha-ha!"

            A quick check of my local porn site (which seems to be in Holland) indicates that a lot of guys have no problem with shaved balls or what may be full-body shaving, with a couple movie comedies' indicting guys' doing the pubic part by themselves to themselves — have the shaving done by a really close and trusted friend.

            And there are women who go way beyond shaving.

            Jeff Foxworthy and I don't agree on a lot of things anymore, but we do agree that if Bikini waxing is ever forced on people, Amnesty International would be sending investigators — and women pay to have it done!

            Even more weirdly and permanently people of both sexes are getting pierced and tattooed — and posting videos of themselves performing naked on the Internet. I'm talking about more or less normal, or at least non-pathological people, who are institutionalized if at all on college campuses and maybe the occasional barracks. I'm talking about people painfully marked, performing private acts to an international public, with faces visible and school colors up so identifying the performers is pretty straightforward even before The Powers That Be start buying genital-recognition software.

            Okay, I'm kidding a bit here but dead serious about how standards can change quickly and how strongly behavior can be modified: piercing, waxing, and tattooing are painful. I joked once that next would come scarification and branding, and, goll-dang, you can get it done in Los Angeles by people reviewed on Yelp!

            People are enduring serious pain in places and ways I want to think about even less than spittoons.

            These changes occurred in less than a generation, and they are major changes in individual behavior and social standards.

            So there is hope for more positive shifts.

            Smoking tobacco is already becoming rare, and chewing and spitting tobacco even rarer. With more social pressure, ashtrays can go the way of spittoons, and smoking in public the way of spitting in public.

            If fads and fashions can get guys to shave their pubes to look like a child or porn star (or gay body-builder?), you can get guys regularly and consistently into condoms when they're lucky enough to find some sex. And until there are more elegant means of birth-control and sex relatively safe from STDs, those condoms are important for public health.

            O, tempera; O, morés! indeed; but we can go with that. People don't change much — not most of us individually, definitely not humans as a species — but our behavior can change.

            Steven Pinker goes over 800 pages on The Better Angels of Our Nature: Why Violence Has Declined (2011), showing as much as anything how terribly grossly horrible human beings can be; but he also demonstrates his point that we can do better and are doing better.

            Read Pinker on the earnest topic of decreasing violence, and note that he also discusses manners.

            We can't change much, but we can do better. Look around you and note the absence of spittoons. Watch an old movie and note how many people were smoking cigarettes then and how few now. Consider the utter weirdness of what people do to their bodies, the images they put up on porn sites — and have some hope that, among other improvements, we can reduce the number of unwanted, unplanned pregnancies — and abortions — and reduce the occurrence of sexually-transmitted diseases.


            Never get a pretty much smoking-free California (or wherever)? Never get guys to see condoms as cool? Maybe, but it's worth a try. "Manners are small morals" and some achievable changes in morés are imperatives of commonsense, responsibility, and morality.