Friday, October 29, 2010

HARPER = threat to health

“I’ve been here for five hours,” a patient shouted at the end of my shift, and they were not alone. Working in an ER I see the individuals behind the overcrowding statistics, and the conditions to which patients and healthcare providers are subjected—long waits, being short staffed, assessing and treating patients in the waiting room, admitting people to a hallway. I recently saw someone with a bleed in their brain who left the hospital because they couldn’t stand having to sleep in the hallway.  Last week a man died in an ER waiting room in Montreal, while Alberta ER doctors are also sounding the alarm.

     Ten years ago the Canadian Association of Emergency Physicians identified ER overcrowding as “a national problem” and “a chronic state in many departments”. They diagnosed this as symptom of the broader healthcare system: “increased waiting times for transfer to an inpatient bed has become the most important cause of Emergency Department overcrowding. Over the past 5 years, hospital beds in Canada have been reduced by almost 40 percent nationally”. According to the Canadian Health Coalition, there were 64,000 hospital bed cuts between 1988 and 2002 and this has not visibly changed for the better since then. This is not because healthcare is unsustainable but because it is underfunded, at both federal and provincial levels.

What’s more frustrating is that this unacceptable situation persists despite available resources. Prime Minister Harper did not create this situation, but he (along with provincial governments) in choosing to ignore it. Instead of spending $1 billion on health, he spent it on the biggest mass arrest in Canadian history. Instead of building much needed hospitals, he is spending $9 billion to build prisons despite a falling crime rate, and $18 billion to build fighter jets when most Canadians are opposed to the war. Instead of bailout out healthcare, he is bailing out corporations with $47 billion in corporate tax cuts

     ER overcrowding from underfunding is the most visible way in which the government is neglecting our health. But in a broader sense, patterns have emerged over the years of a government agenda that does not just ignore health, but actively undermines it. In the field of health, HARPER has come to stand for:

Humanitarian aid politicization: the Harper government has repeatedly undermined health in Palestine—making Canada the first to cut humanitarian aid to the Palestinian Authority, the first to cut funding to UNRWA that provides healthcare to refugee camps, and the first to criminalize George Galloway for delivering ambulances, food, and medicine. It’s no wonder this bias cost Canada a UN Security Council seat for the first time. In addition, the government militarized aid to Haiti, while practically ignoring the catastrophic floods in Pakistan. The cost of G20 security could have twice covered the $460 million that the UN requested—and has still not received—for health security in Pakistan.

AIDS facilitation: While 25 million people have died of AIDS worldwide and 40 million live with HIV, Harper refused to attend the 2006 International AIDS Conference in Toronto, preferring to tour military bases in the arctic. As UN envoy Stephen Lewis said at the time:
“In a very real way it's a slap in the face to the international community of activists and scientists and researchers and advocates and agencies all gathered to deal with the single greatest problem on the planet… it's just profoundly inappropriate and I think it's a measure of the government's commitment to (fighting) the disease."
     This year, Harper renewed this inappropriate commitment by quietly joining others in underfunding the Global Fund to Fight AIDS, TB and Malaria. As Dr. Jennifer Cohn, MSF HIV/AIDS Policy Advisor said a few weeks ago:
“Today marks a sad turning point in the fight against AIDS, TB, and malaria: world leaders have officially under-financed the Global Fund. This decision will result in the death of millions of people from otherwise treatable diseases.”
     The cost of new fighter jets—built to destroy life—could cover twice over the $8 billion shortfall required to save lives.

Reproductive health prejudice: Conservative MPs introduced two anti-choice bills in 2006 and one in 2008. This year the Harper government is imposing its anti-choice agenda on women in the developing world with a “maternal health plan” that specifically excludes abortion services. According to the Lancet, one the world’s leading medical journals,
“This omission is no accident, but a conscious decision by Canada's Conservative Government not to support groups that undertake abortions in developing countries. This stance must change. 70,000 women die from unsafe abortions worldwide every year… Canada and the other G8 nations could show real leadership with a final maternal health plan that is based on sound scientific evidence and not prejudice.”
Psychological/physical trauma: The Harper government has been complicit in traumatizing detentions of Canadians: delaying repatriation, not apologizing for torture, and maintaining “security certificates”. The government has also been complicit in abuses overseas—transferring Afghan detainees to torture, and deporting US Iraq War resisters to jail for refusing to participate in war crimes.  Harper justifies these policies by claiming to support our troops, but he has silenced those advocating for their healthcare—from Veterans’ Ombudsman Col. Strogan, to veteran advocate Capt. Sean Bruyea—while ignoring military families who oppose the extension of the mission

Environmental pollution

While climate change leads to 300,000 deaths a year, Harper abandoned Canada’s Kyoto obligations and has supported tar sands that lead to global pollution and local cancer epidemics for First Nations communities. When Greenpeace dropped banners on Parliament to raise awareness of the health impact of climate change, the government responded by arming Parliamentary guards with machine guns.

Refugee criminalization
    The Harper government is trying to criminalize those fleeing war crimes. It issued Operational Bulletin 202 to criminalize US Iraq War resisters, which the former chair of Canada’s Immigration and Refugee Board Peter Showler described as “fundamentally wrong-headed and a violation of the UN Refugee Convention”. The government claims war resisters interfere with other refugees, but last year Harper was silent over the genocide against tamils, and this year has tried to criminalize the resulting refugees. The Canadian Council for Refugees has responded by stressing that “people who are forced to flee for their lives need to be offered asylum and a warm welcome, not punished".

     Fortunately Canadians are rejecting this bad medicine: campaigning for Medicare and the redirection of military spending, organizing an aid boat to Gaza, exposing Harper’s prejudice concerning abortion and AIDS funding, demanding the repatriation of Omar Khadr and an end to security certificates, mobilizing to support the troops by bringing them home and taking care of their health, demanding sanctuary for war resisters, organizing to stop the tar sands, and opposing the criminalization of refugees. This is truly a prescription for health.
     As I share patient frustration trying to provide individual healthcare in an overcrowded ER, I’m comforted by all the work others are doing outside the hospital to protect and strengthen our collective health.

Wednesday, October 27, 2010

Cholera: the latest war against Haitian democracy

A cholera outbreak in Haiti has killed more than 250 people killed, and infected more than 3300, in just over one week. Five of those infected were in the capital of Port-au-Prince, raising the specter of a mass epidemic. According to Imogen Wall, spokeswoman for the United Nations humanitarian office in Haiti, "It's tragedy upon tragedy for Haiti. We're working on a worst-case scenario. We're planning for a national outbreak."

     Worse than a tragedy, this is a crime. Cholera is terrifying but easily preventable and treatable. Spread through contaminated water it causes such severe diarrhea that it can kill through dehydration in a matter of hours. But it is treated with large volumes of simple fluids—either intravenous or oral rehydration—and can be prevented with clean water and proper sanitation. The science of cholera prevention has existed for 150 years, ever since Dr. John Snow famously plotted the deaths of a London outbreak on a map and found them to centre around a contaminated water pipe. When he persuaded the authorities to shut off the pump the number of cholera cases dropped.
     Rudolf Vircow, who studied epidemics at the time of Snow, concluded that “if disease is an expression of individual life under unfavourable circumstances, then epidemics must be indicative of mass disturbances”. The emergence of a cholera epidemic in Haiti, like the massive death toll following the January earthquake, exposes the mass disturbance imposed on Haiti by centuries of foreign intervention.

     Two-hundred years ago Haitians carried out the only successful slave revolution. But France forced them to pay $21 billion for “lost property”, which it took over a century to pay. Throughout the 20th century the US has interfered in Haitian development, invading in 1915 and staying for 20 years, and supporting the Duvalier dictatorship from 1957-1986. The people of Haiti overthrew the dictatorship in 1986, but was saddled with its debt. The IMF provided loans that forced Haiti to privatize services and slash tariffs on rice, which destroyed the agricultural sector and drove people into sweat-shops in Port-au-Prince. The lack of local agriculture has made Haiti dependent on food aid, and--along with poverty and the privatization of electricity--forced Haitians to cut down the forests for income and charcoal for fuel.

     Twice Haitians have voted for Jean Bertrand Aristide—to restore services and raise wages—and  twice he has been overthrown by coups, in 1991 and 2004. Since then Haitians have protested against the occupying UN force, which has done nothing to improve their lives. The war against Haitian democracy has a political purpose that connects back to the original overthrow of slavery. As Haitian-Canadian Ronald Charles explained on the Real News
“you have a country independent for 200 years now, and from the beginning that was a bad example in the eyes of the big powers of the time. So when some people would say, look at them after more than 200 years look at their condition. So all the people around the world, all the people fighting for liberation, for freedom, the colonial powers will point Haiti to them and say look. For example, In Martinique and Guadelope they had elections to see if people wanted to be independent from France, some people said we don’t want that, and one of the arguments is look at Haiti. And many big powers want to use Haiti as an example of what not to do.”
     Centuries of deliberate interference in Haitian democracy paved the way for two “natural disasters” this year, one geological and one biological. While a 7.0 earthquake in San Francisco in 19189 killed less than 60 people, and 7.0 earthquake in New Zealand this year killed 2, and a 9.0 earthquake in Chile this year killed 1000, a 7.0 earthquake in Haiti killed 230,000.

     This had less to do with events under the ground as on top of them—where centuries of foreign intervention has turned a wealthy and lush nation into an impoverished deforested nation, concentrated in urban slums, living in inadequately built houses on eroded soil, with almost non-existent governmental services, in the midst of a multimillion dollar occupation force that interferes with democracy and development. That the earthquake was so deadly after 6 years of UN occupation exposes its true purpose. According to Peter Hallward, author of Damning the Flood: Haiti, Aristide and the Politics of Containment:
“The international community has been effectively ruling Haiti since the 2004 coup. The same countries scrambling to send emergency help to Haiti now, however, have during the last five years consistently voted against any extension of the UN missions’ mandate beyond its immediate military purpose. Proposals to divert some of this ‘investment’ towards poverty reduction or agrarian development have been blocked.”
     The same factors that produced a large earthquake death toll have produced conditions for the emergence of cholera. Partners in Health explain how the  environmental destruction of Haiti has magnified natural disasters, which have destroyed infrastructure—along with poverty—concentrated the population in overcrowded areas with poor sanitation:
 “in Gonaives the capital of the Artibonite has been destroyed in two waves of floods and mudslides, after tropical storm Jeanne in 2004 and after the series of hurricanes in 2008, made possible because of the environmental devastation of the region. The destruction contaminated the water supply and left the infrastructure (including the health infrastructure) of the upper Artibonite in ruins, forcing people to seek residence and medical care in St. Marc. The St. Marc region itself experienced significant flooding in 2008, displacing thousands of people. Lastly, the earthquake of January 12, 2010 resulted in the displacement of 1.7 million Haitians. While reliable statistics are not available currently, the last estimate, as of March of 2010 was that 300,000 addition Haitians had fled Port au Prince to the Artibonite. As there are no “camps” in the region, these displaced persons are “home hosted”—joining poor relatives in already overcrowded conditions, without water security or adequate sanitation. The dispersal of displaced people makes it difficult to provide centralized services.”
     In addition, Haitians are subject to poverty and a lack of food (reducing immunity), lack of transportation (impacting the precious hours between infection and death for those who have to travel to seek healthcare), and lack of healthcare. Coming 9 months after the quake, the cholera epidemic exposes how little “aid” has been provided since the quake. While ordinary Canadians delved deep into their pockets and organized fundraisers across the country, our government cynically used aid to justify a military response to the quake while announcing huge aid sums that clearly weren’t delivered. Harper announced $1 billion in aid for Haiti, and yet clearly Haitians don’t have access to the most basic services.

     This is not first time the great powers have colluded in cholera epidemics, doing John Snow’s experiment in reverse. In their Orwellian-named “Sourcebook on Community Driven Development in the Africa Region—Community Action Programs”, the World Bank pushed African nations to privatize their water, explaining that “work is still needed with political leaders in some national governments to move away from the concept of free water for all.” The South African government followed suit by installing pre-paid water meters that cut people off from free water. Predictably, those who couldn’t pay drank stream water, resulting in an epidemic of cholera that killed 180 and infected 80,000.
     During the Gulf War and the sanctions that followed, the US intentionally destroyed Iraq’s water treatment facilities and blocked the importation of required equipment, knowing it could lead to cholera. As intelligence documents explain: “failing to secure supplies will result in a shortage of pure drinking water for much of the population. This could lead to increased incidences, if not epidemics, of disease…unless the water is purified with chlorine, epidemics of such diseases as cholera, hepatitis, and typhoid could occur.”
     While Bush junior was sounding the alarm on Iraq’s supposed “weapons of mass destruction”, he was maintaining sanctions that spread cholera in Iraq, while cutting funding to water treatment in Haiti. Before joining Canada to overthrow the democratically elected Aristide, Bush waged an economic war that included cutting funding for water sanitation—including to the Artibonite region currently affected by cholera. As Partners in Health explain:
“In 2000, a set of loans from the Inter American Development Bank to the government of Haiti for water, sanitation and health were blocked for political reasons. The city of St. Marc (population 220,000) and region of the lower Artibonite (population 600,000) were among the areas slated for upgrading of the public water supply. This project was delayed more than a decade and has not yet been completed. We believe secure and free access to clean water is a basic human right that should be delivered through the public sector and that the international community’s failure to assist the government of Haiti in developing a safe water supply has been violation of this basic right.” 
     Humans are made up mainly of water, making access to water our most basic and life-sustaining right. That 100,000 people around the world continue to die of cholera, 150 years after its prevention was discovered, is a clear indication that people’s most basic rights are being ignored. According to Dr. Lyon from Partners in Health:
“70% of the population have no access to clean water or sanitation. People cannot protect themselves. So the country is terrified at this point. It’s a terrifying situation rooted in the lack of infrastructure, lack of sanitation and clean water, which has been very clearly slowed down by manipulation from the outside…cholera will not go away in Haiti until the conditions that make people vulnerable are changed”.
In Haiti, the fight against cholera is part of the fight for democracy--which includes the right to water, the right to their democratically-elected president Aristide instead of an unwanted UN occupation,  and the right to reparations for $21 billion taken as punishment for a slave revolution that should be celebrated. 

Monday, October 25, 2010

5 lies and 3 truths revealed by wikileaks

We all know the Iraq War was based on lies: Iraq did not pose a threat, there were no WMDs, there was no link to 9/11. The recently leaked Pentagon files reveal five more lies that are key to understanding the nature of the war, and three truths that guide future actions.

LIE #1: “WE DON'T DO BODY COUNTS” (US General Tommy Franks)

     The most obvious lie revealed by the leaked files is that the US does indeed to body counts. Through files detailed enough to provide a map of casualties across the country, the military’s own estimate show the Iraq War has killed over 100,000 people, two-thirds of them civilians.
     But the General was right in some respects. The documented death toll do not include any casualties of the initial “shock and awe” invasion, nor do they count a single casualty when the military leveled the city of Fallujah. So 100,000 is a gross underestimation of the impact of the Iraq War.


     The second most obvious aspect of the files, and another reason why the military is in a panic, is that these files were leaked from within the military. Clearly troops are not happy with the war, and it was opposition from within the military—combined with local resistance and a  mass peace movement—that forced the US military into its humiliating defeat in Vietnam, scarring its confidence for a generation. The next lies reveal why the troops are so unhappy.


     Periodic stories of civilian deaths over the years have been dismissed as isolated incidents. But according to the analysis of the files by Iraq Body Count:
“The new deaths are concentrated in small incidents, killing one or two people at a time, scattered all over Iraq, and occurring almost every day for the whole period. These are the small but relentless tragedies of this war that these logs reveal in unprecedented detail.”
    This tragedy is no accident. The government and military blamed defeat in Vietnam on Americans back home seeing photos of dead soldiers, so their solution was to use embedded media who would refuse to report the truth, and enhanced military doctrine that would reduce casualties. As the Guardian explains:
“Known since 2001 as force protection, it puts a high premium on minimising all conceivable risk by permitting troops to bypass traditional methods of detecting friend from foe in favour of extreme pre-emptive action.”
In other words, shoot first, ask questions later. This is exactly the experience of troops in Iraq, in countless home invasions and checkpoint killings. According to Joshua Key, who served a tour in Iraq before becoming coming to Canada as a war resister:
"“The running procedure was ‘Shoot first, ask questions later.’ We had no regard for the lives of the civilians around us. That was pretty evident in day-to-day actions, as well as the way we raided their homes and did everything else. There were no repercussions, no questions.”"
     Ironically, this so-called “force protection” contributed to at least 7 American soldiers getting killed and 34 injured in “friendly fire” attacks. Of course the impact on Iraqis has been much worse. In one instructive log, soldiers in an Apache helicopter hunted and killed two Iraqis who tried to surrender, after advice and orders from higher up the chain of command including a military lawyer. As the Guardian concluded, the “crew were not trigger-happy, but sought immediate advice from their superiors at all stages of the attack.” This is course will do nothing to dampen the emergence of a local resistance, a global peace movement, or anti-war opposition from within the military.

LIE #4: “WE DO NOT TORTURE” (George W. Bush)

     The most gruesome part of the leaked files is the accounts of torture of Iraqis handed over by the US military, who then refused to investigate. The scale of these events has led the UN to demand Obama investigate, charge, and compensate. According Manfred Nowak, the UN's chief investigator on torture:
“whenever they expel, extradite or hand over any detainees to the authorities of another state to assess whether or not these individuals are under specific risk of torture. If this assessment is not done, or authorities hand over detainees knowing there is a serious risk of them being subjected to torture, they violate article 3 of the UN convention that precludes torture.” 
Nowak said it would be up to the Obama administration to launch an "independent and objective" investigation with a view not only to "bring the perpetrators to justice but also to provide the victims with adequate remedy and reparation"


    After launching character assassination against Wikileak’s founder Julian Assange, and then pleading with media to not release the files, the US military responded to the leaks by shooting itself in the foot. It claimed that:
“The biggest potential damage here, we think, could be to our forces, because there are now potentially 400,000 documents in the public domain for our enemies to mine, look for vulnerabilities, patterns of behaviour, things they could exploit to wage attacks against us in the future.” 
How could this damage your forces if you ended the combat mission? The concern by the Pentagon exposes the fact that 50,000 troops remain and the war is not over.


    From the lies that justified the war, to the doctrine that orders soldiers to shoot civilians, to the practice of ignoring torture, wikileaks makes clear the Iraq War is a war crime. Next month former British Prime Minister Tony Blair is coming to Canada, and needs to be greeted with mass protests.


    Canadians in their hundreds of thousands mobilized before the war and stopped our government from participating. Two prominent supporters of the war were Stephen Harper (current Prime Minister) and Jason Kenney (current Immigration Minister), who have continued to support the war by deporting US Iraq War resisters to US prisons, and declaring them criminally inadmissible to Canada. Persecuting soldiers who refuse to participate in war crimes makes Harper and Kenney complicit in war crimes.


     For 6 years US Iraq War resisters have been coming to Canada to seek refuge, and the Pentagon vindicate their reasons: they don’t want to take part in the daily widespread practice of killing civilians and ignoring torture. That they volunteered and signed a contract is completely irrelevant. The Nuremberg principles demand soldiers refuse participation in war crimes, and wikileaks proves that this is the daily experience in Iraq. Furthermore, the majority of Canadians and their MPs support war resisters.

The only rational conclusion from wikileaks is for the US to finally end its occupation of Iraq, and for Canada to welcome war resisters.

Thursday, October 21, 2010

Colonel Williams and violence in the military

The Canadian military is scrambling to separate itself from convicted killer Colonel Williams. This is the latest attempt to hide the reality of military training and the results it produces on soldiers and civilians--from Somalia, to Iraq, to Afghanistan.

     The Canadian military claim to have no idea how one of their rising stars, Russel Williams, who has been in the military since 1987 and climbed the ranks to colonel, could have been guilty of stalking, sexual assaulting, confiing, torturing and killing women. But the military is sure it's not their problem. According to  Lt.-Gen. Andre Deschamps, chief of air staff:
“What could we have done differently? I’m not sure we’re going to get answers to that. There are no answers yet... This individual was a man of tremendous capacities. I still can’t reconcile the two individuals we’ve seen, the professional we knew and the criminal who is in prison now....We haven’t found one thing that needs to be changed yet...There’s nothing wrong with the uniform, there is something wrong with the individual who was in the uniform...We feel this was an aberration."
     These statements show a willful ignorance of military training and its intended results.

     Canada’s General Rick Hillier famously put to bed the notion that the Canadian military is for peacekeeping when he proclaimed, “We are the Canadian Forces, and our job is to be able to kill people”. But it's a real testament to our true human nature that people are not born with this "ability". Instead it needs to be hammered into people with rigorous training, consciously aimed at desensitizing people to human suffering.
     In Michael Moore's book Will They Ever Trust Us Again (a collection of letters he's received from soldiers and their families), someone who’s brother was to be deployed to Iraq, described the process of desensitization:
“He is being trained to run over children who stand in the way of the conveys because they could be potential threats. Kids like his own, kids who may just want to get food. He’s at Fort Dix practicing, knocking over cardboard cutouts.”
Despite this intense training many people still can't bring themselves to go along with violence. Jeremy Hinzman, the first war resister to come to Canada, went AWOL after his experiences in boot camp showed him how the military turns people into killers:
“We were marching around chanting songs like, ‘Train to kill. Kill we will.,’ Or during bayonet training they’d ask, ‘What makes the grass grow?,’ and we’d say ‘Blood, blood, bright red blood.’“When we would thrust [the bayonet] the drill sergeant would yell that, and we’d have to scream back. People would actually get hoarse yelling this crap. I could never really get into that stuff. Some people ate it up because I think there is an opportunity in groups to kind of let go of your inhibitions and do wanton things... We’d sing cadences as we ran about going through villages and killing babies and stuff. It’s all presented, at least on the surface, as, ‘Oh, it’s just in humor, and no one’s around listening to it,’ but I think that really does put that mindset in a soldier that they’re killers.”
     With such "training" its no wonder brutal acts like those committed by Williams have been a regular feature of US and Canadian intervention overseas, not an aberration. In 1993 Canadian soldiers savagely tortured to death a Somali teenager, Shidane Arone, and like Colonel Williams took “trophy photos”. Then too, the military "didn't find one thing that needed to be changed". They tried to cover up the killing, recently dropped charges against the killer, and promoted the commanding colonel to general.
     The same stories have emerged from Iraq. In 2004 "trophy photos" of torture and sexual violence emerged from Abu Ghraib. In 2005 US marines went house to house in Haditha killing 24 civilians including children as young as one year of age. In 2009 Obama blocked the publication of a large number of photos, including of rape and torture, of prisoners in both Iraq and Afghanistan. This year the Pentagon is scrambling to contain the information released by wikileaks, including a video of a massacre of civilians.

     This institutionalized violence, deliberately created and directed towards a racialized "other" to justify war and occupation, inevitably spills over onto fellow troops and civilians. Within the first year of the war in Afghanistan, military wives at Fort Bragg reported high rates of domestic abuse, including 4 killings. Last year the BBC published an article about the sexual violence female soldiers face. They reported studies by the US Department of Veteran Affairs that found 30% of military women are raped while serving, 71% are sexually assaulted, and 90% are sexually harassed. This includes Army specialist Chantelle Henneberry, who served a year in Iraq:
"I was the only female in the platoon of 50 ot 60 men. I also the youngest, 17. Because I was the only female, men would forget in front of me and say these terrible derogatory things about women all the time. I had to hear these things every day. I'd have to say 'Hey!' Then they'd look at me, all surprised, and say, 'Oh we don't mean you'. One of the guys I thought was my friend tried to rape me. Two of my sergeants wouldn't stop making passes at me... During my first few months in Iraq, my sergeant assaulted and harassed me so much I couldn't take it any more. So I decided to report him. But when I turned him in, they said, 'The one common factor in all these problems is you. Don't see this as a punishment, but we're going to have you transferred.' Then that same sergeant was promoted right away. I didn't get my promotion for six months... I was fresh meat to the hungry men there.I was less scared of the mortar rounds that came in every day than I was of the men who shared my food."
US war resister Skylar James is seeking sanctuary in Canada  because she fears for her own safety as a lesbian in the military.

     Sexual violence within the military is not confined to the US military in Iraq. Canadian Prime Minister Stephen Harper claimed Russel Williams is "unique case. The Canadian Forces are the victim here, as are the direct victims of these terrible events." But before she became the first Canadian female soldier killed in Afghanistan, Nichola Goddard wrote a letter home about the treatment of female soldiers in her camp: "there were 6 rapes in the camp last week, so we have to work out an escort at night." Russel Williams is only unique because the military have refused to look elsewhwere. Whereas Goddard herself knew of 6 cases of sexual assault in one week, the Canadian Forces admits to only one conviction for sexual assault over the past 6 years.
     The impact that the deliberate creation and coverup of violence has on our own soldiers is a microcosm of what's inflicted on the people of Afghanistan.  Hiller justified the barbaric war in Afghanistan by claiming the soldiers were killing "detestable murderers and scumbags". Harper prorogued Parliament rather than allow public scrutiny of torture, and dismissed Williams as unique despite the experiences of troops on the ground. The words and actions of Harper and Hiller, the top of the chain of command, show that Colonel Williams is not an aberration but a product of militarism.
     Everyone opposed to what Colonel Williams was turned into should support two campaigns of the Canadian peace movement: letting US Iraq War resisters stay, and ending the war in Afghanistan.

Tuesday, October 19, 2010

Victory for breast cancer awareness as BPA declared toxic

It’s fitting that this October--Breast Cancer Awareness Month--saw Canada add Bisphenol A (BPA) to its Toxic Substances List. This victory is thanks to a long campaign by Environmental Defence, which works to expose the daily carcinogens in our lives. For too long we’ve been told to “be aware” of breast cancer, while the carcinogens we eat, drink, breathe, and lather on ourselves have been ignored. This victory is an important first step in  raising awareness about breast cancer and how to prevent it. Below I will quote extensively from the most accessible, comprehensive and yet ignored text on breast cancer prevention I’ve come across: State of the evidence: the connection between breast cancer and the environment.

     BPA is the chemical building block of hard plastic used to make baby bottles, water bottles, and food storage containers. We are literally bathing in BPA: more than 4 billion kilograms are produced globally, and it’s been found in the bodies of more than 90 percent of people in North America. But it’s an unstable compound that can leach into food and then into people, where it acts on estrogen receptors and increases the risk of breast cancer (in addition to heart disease, diabetes, miscarriages, neurological problems, and prostate cancer). Adding BPA to Canada’s Toxic Substances List is just the first step in ending its role in breast cancer. According to Dr. Rick Smith, Executive Director of Environmental Defence, and co-author of Slow Death by Rubber Duck: How the Toxic Chemistry of Everyday Life Affects Our Health, “We look forward to now working with the federal government to take the next important step: banning BPA from all metal food and beverage cans since these can leach it into our food.”

     The designation of BPA as toxic is a challenge to the mainstream understanding of breast cancer. Health Canada exemplifies the mainstream medical model that reduces breast cancer to women and their internal hormones: while mentioning smoking, radiation, and hormone replacement therapy as risks, most risk factors they list are internal to women: female gender, older age, early menstruation, late menopause (all factors over which we have no control), having a baby late or never, never breastfeeding, and being overweight. Some have called this “bikini medicine”, reducing women’s health to those parts covered by the bikini: breasts and ovaries. This list also reads like the typical advice that  magazines bombard women with on a daily basis: be young, be thin, have children and don’t wait too long. Ironically, many of those cosmetic products designed to give a youthful appearance actually increase breast cancer risk.
     This reductionist biomedical model cannot explain the epidemic of breast cancer (or cancer in general) in which we’re living: “between 1973 and 1998, breast cancer incidence rates in the United States increased by more than 40 percent”. Conventional risk factors can’t explain this sudden rise, nor its geographical distribution:
“Globally, more than 1.15 million women were diagnosed with breast cancer in 2002. The highest rates are found in the industrialized nations of north America and western Europe…In northern Africa, as in many regions that are either developing or in transition, breast cancer rates are escalating sharply”. 
     We are witnessing the globalization of cancer, which has more to do with external  hormones than internal ones. This has been proved by the recent decline in breast cancer:
“the most recent incidence data indicate a significant decline over the past several years in both breast cancer incidence and mortality in the United States. The most widely discussed explanation for this decrease is the sharp decline in use of post-menopausal hormone replacement therapy (HRT) over the past decade and especially following the announcement in 2002 of the association of HRT use with increased risk for breast cancer.”
But obviously HRT is not the only chemical to which women are exposed:
“the increasing incidence of breast cancer [and cancer in general] over these decades paralleled the proliferation of synthetic chemicals…1000 or more new chemicals are synthesized each year. Complete toxicological screening data are available for just 7 percent of these chemicals, and more than 90 percent of these chemicals have never been tested for their effects of human health….many of these chemicals persist in the environment, accumulate in body fat, and may remain in breast tissue for decades.”
 Here are some compounds linked to breast cancer:
1) Estrogens/progestins: HRT, personal care products
2) Radiation: light at night (night-shift workers), ionizing radiation (medical radiology)
3) Xenoestrogens and other Endocrine-disrupting Compounds (EDCs): tobacco, dioxins (industrial processes), alkylphenols (detergents, hair products), parabens (cosmetic, deodorants, preservatives), BPA, phthalates(plastics, cosmetics, cleaning materials), suncreens, pesticides, food additives, hormones used in food production
4) Non-EDC Industrial chemicals: ethylene oxide (cosmetics), organic solvents, aromatic amines (tobacco, combustion), benzene (exhaust, refineries), butadiene (petroleum refineries)

     Besides the fact that tobacco is but one of multiple carcinogens, three themes emerge from this list: toxic consumption, occupational hazards, and home cleaning products.

     The cosmetic industry bombards women with constant messages that they need to slather all sorts of chemicals on their bodies, and it turns out many of these are linked to breast cancer. How ironic then that Estee Lauder has tried to silence this message by shining pink lights on various landmarks as part of breast cancer awareness month (see my previous post on this issue). There is also a racialized aspect to carcinogenic cosmetics, as magazines and adds perpetuate the message that black is not beautiful (like L'Oreal's ads that white-washed Beyonce):
“Products marketed to women of colour often contain some of the most problematic chemicals. Skin lighteners, hair relaxers, hair dyes and skin moisturizers developed for women of colour often contain carcinogens and endocrine-disrupting compounds”
    The food industry is also producing breast cancer by their profit-driven quest to produce the largest animals in the most cramped conditions in the shortest time span, along with homogenous crops that require artificial protection from pests:
“Pesticides sprayed on crops, antibiotics used on poultry, and hormones injected into cattle, sheep and hogs expose consumers involuntarily to contaminants that become part of our bodies. Research suggests that some of these exposures may increase breast cancer risk”. 
     While cancer, and illnesses in general, are often reduced to “lifestyle choices”, there is often very little choice involved as most people are unaware of what they are consuming:
“despite opposition from physicians, scientists and consumer advocacy groups, the FDA in 1993 approved Monsanto’s genetically engineered hormone product rBGH for injection in daily cows to increase milk production. This hormone quickly found its way (without labeling) into the US milk supply [where is raises IGF-1, which is linked to breast cancer] and from there into ice cream, buttermilk, cheese, yogurt and other dairy products.”
     But in another recent victory, a US federal court ruled Ohio's ban on labeling of dairy products as hormone-free was unconstitutional.

     Women are not just breasts and ovaries, are not just consumers, they are also workers. Ignoring this fact has prevented scientific studies from discovering risk factors for breast cancer:
“The relationship between toxic exposures in the workplace and later diagnosis of breast cancer has been difficult to establish in large part because, until recently, occupational studies have not included women in sufficient numbers to evaluate relationships between environments and female-specific cancers like breast cancer.”
     Now research is emerging that links breast cancer with work done predominantly by women. I know from my work that most nurses and radiology technicians who work night shifts are women. Add to this list cosmetic industry workers, dental hygienists, and many agricultural workers. There is also a racialized aspect to these exposures:
“Many farmworkers are undocumented immigrants who enjoy fewer legal protections and less access to health care that the general population, limiting their ability to protect themselves from pesticide exposure or to seek medical care in response to chemically induced health problems.”
     In addition, many dangerous industries are located in close proximity to racialized communities, like Canada’s tar sands and its carcinogenic impact on FirstNations. Finally, women’s labour in the home has been ignored not only economically but also medically:
“although women make up nearly half the workforce in the United States, relatively few studies have been conducted to identify occupational exposures associated with breast cancer…Many women actually have two places of work: their homes and the paid workplace. Each site has its unique set of exposures to chemicals and non-ionizing radiation. However, traditional occupational exposure studies focus on exposures only in the paid workplace.”
     To truly raise breast cancer awareness we need to ditch bikini medicine and acknowledge the reality of women’s lives: pressured by sexist and racist media to douse chemicals on their bodies, consuming food laced with hormones and pesticides, working in toxic environments in the workplace and in the home, living in communities surrounded by dangerous oil industries. Only by exposing and purging all these chemicals from our lives will we have a chance to conquer breast cancer. Declaring BPA toxic marks an important first step.

Friday, October 15, 2010

"Female viagra" and the medicalization of women

The pharmaceutical giant Boehringer Ingelheim has dropped its plan to market its failed antidepressant as a “female viagra” pill. The US Food and Drug Administration slammed the drug studies for failing to produce benefits, while 15% of women dropped out of the study due to side effects like depression, fainting and fatigue. “Female sexual dysfunction” is the latest pharmaceutical attempt to pathologize women, while real healthcare needs go unmet.

     According to a recent Globe&Mail article:
“Female sexual dysfunction” – a much-debated term that includes lack of desire and inability to reach orgasm – was entrenched when a 1999 article in the Journal of the American Medical Association announced that 43 per cent of women suffer from some form of sexual dysfunction. Problematically, the lead author was revealed to have financial ties to Pfizer.” 
Marketing this drug as a “female Viagra” is also problematic: Viagra is to achieve a physical erection, while these pills for women are trying to alter their brain chemistry to promote desire they are told is insufficient.  This does not mean taking a nihilistic attitude towards medicine but to acknowledge the impact of profit-driven pharmaceutical companies (for more on this check out the documentary Orgasm Inc.). As Ray Moynihan, co-author of Sex, Lies and Pharmaceuticals: How Drug Companies Plan to Profit from Female Sexual Dysfunction explained in the article above:
“There would be a cohort of women with nerve damage after surgery, or sexual side effects of SSRIs, for which a health professional could be extremely helpful. But to categorize the changes in desire that happen as we move through our lives and relationships as symptoms of a disorder or a dysfunction is highly controversial and questionable. I’m not sure that women going through absolutely normal changes in desire want to identify themselves as suffering from some medical disorder.”
     Like all industries, the pharmaceutical industry is made up of rival firms in competition for market share. In the field of health this produces an inevitable pressure to pathologize. Men now face the prospect of getting treated for “andropause” (age-related decline in testosterone), “obesity” has gone from a risk factor to its own disease requiring pharmaceutical intervention (more on this in a future post), while the notion of “pre-hypertension” is pushing blood pressure medicine on people with normal blood pressure.
     Women have faced a long history of diseases created to pathologize and control their bodies. For centuries women were diagnosed as suffering from “hysteria”—a catch-all term uniquely imposed on women, based on the idea that their uterus (“hyster” in latin) was out of control. As one blogger has summarized:
“The symptoms of hysteria ranged from the erotic to the ludicrous and included fainting, insomnia, fluid retention, vaginal lubrication, ‘voluptuous sensations,’ and, natch, ‘a tendency to cause trouble.’ Sometimes disorders such as epilepsy, anorexia, postpartum depression, and menopause would be misdiagnosed as hysteria, but mostly ‘hysterics’ were just women with a libido and a disapproving patriarch in their lives.” 
“Treatment” varied from incarceration in asylums (more on the history of psychiatry in a later post), surgical removal of the clitoris, or forced orgasm.
     In the 20th century the medical establishment dropped “hysteria”, but  went on to universally medicate older women with Hormone Replacement Therapy (HRT) on the grounds that menopause was a disorder. Pressure from women’s groups helped expose the bad science behind this, culminating in the Women’s Health Initiative showing that indiscriminate use of HRT can lead to breast cancer, heart disease, strokes, and pulmonary emboli.
     Then along came “Pre-Menstrual Dysphoric disorder”. When the patent for the anti-depressant Prozac was about to expire, Eli Lilly got a new patent for it, under a different name, for the treatment of this new “disorder”. According to feminist psychoogist Paul Caplan, "It's a label that can be used by a sexist society that wants to believe that many women go crazy once a month...Any normal hormonal change in people of either sex can exacerbate migraines, thyroid problems, etc., but no one suggests calling men's hormonal changes kinds of mental illness".  Now, with "female seual dysfunction", BigPharma has pathologized women’s sexual lives in order to further push their products.

     This does not mean dismissing the role of medicine in women’s health, but basing it on women’s needs not pharmaceutical profits. Ironically, the creation of false medical needs runs in parallel with the denial of real needs such as abortion or HIV prevention.

     An alliance between the women’s movement and the progressive medical community struck down laws against abortion, and continues to fight for access--from promoting more teaching about abortion in med schools, to challenging Canada's minority government that wants to deny abortion rights to the 70,000 women around the world who die from unsafe abortion every year. The women's movement was at the forefront of the G20 protests, exposing Harper's war on choice and leading the 40,000 strong march with a giant coat-hanger.
     Women also continue to fight for recognition and prevention of HIV. When AIDS was first discovered it was blamed on gays and Haitians and the impact on women was ignored, resulting in many women being excluded from receiving medicine, services, and disability benefits. Women demonstrated with the slogan “women don’t get AIDS, they only die from it,” demanding the definition include conditions specific to women (like invasive cervical cancer). This succeeded in 1993 and uncovered the true statistics, as the number of women with the diagnosis of AIDS tripled. But HIV continues to be blamed on gay men and promiscuity, for which the main prevention is condoms. In 1991 a group of women working on AIDS prevention in Haiti published a text countering myths about women and AIDS, a list that needs repeating almost 20 years later:
-“AIDS is a disease of men”: the data are overwhelming: AIDS was never a disease of men. Given transmission dynamics, AIDS may in fact becoe a disease predominantly afflicting women
-“Heterosexual AIDS won’t happen": Heterosexual AIDS has already happened. Indeed, in many parts of the world, AIDS is the leading cause of death among young women.
-“women’s promiscuity causes AIDS” : most women with AIDS do not have multiple sexual partners, they have never used IV drugs, they have not received tainted blood transfusions. Their major ‘risk factor’ is being poor. For others, the risk is being married and unable to control not only their husbands but also what jobs their husbands have to perform to make a living.
-“women are AIDS vectors”: ‘women are too often perceived as agents of transmission who infect men and ‘innocent babies’. Prostitutes have been particularly hard hit by such propaganda, but prostitutes are far more vulnerable to infection that to infecting; AIDS is an ‘occupational risk’ of commercial sex work, especially in setting in which sex workers cannot safely demand their clients use condoms.’
- “condoms are panacea”: gender inequality calls into question the utility of condoms in setting in which women’s ability to insist on ‘safe sex’ is undermined by a host of less easily confronted forces. Furthermore, many HIV-positive women choose to conceive children, which means that barrier methods that prevent conception are not the answer for many. Woman-controlled viricidal preventive strategies are necessary, if women’s wishes are to be respected.
To overcome the disconnect between multibillion dollar companies medicating women for manufactured diseases while millions of women are denied basic healthcare needs, healthcare needs to base itself on the needs of people not profit. Our bodies, our choice.

Thursday, October 14, 2010

workplace safety: killer company faces criminal charges

Under the pressure of community and labour organizing, those responsible for the deaths of four migrant workers last Christmas Eve have been criminally charged. This victory highlights the dangerous conditions of migrant workers, and workers in general.

    Last Christmas Eve, four migrant workers—Fayzullo Fazilov, 31, of Uzbekistan; Aleksey Blumberg, 33, of Ukraine; Alexander Bondorev, 25, of Latvia; and Vladimir Korostin, 40, of Uzbekistan fell to their deaths from a 13 floor scaffold in Toronto. Dilshod Marupova, 21, of Uzbekistan, survived the fall with broken legs and spine. At the time, there was a large emergency vigil, organized by Justice for Migrant Workers and No One Is Illegal, and including representatives from the Ontario Federation of Labour (OFL), Unite Here, the United Food and Commercial Workers, and the Canadian Auto Workers. The campaign  has continued with the OFL’s “kill a worker, go to jail” campaign. Now, those responsible—directors and project managers for Metron Construction Corporation—have been charged with criminal negligence causing death and criminal negligence causing bodily harm, the harshest charge for workplace deaths in Ontario’s history, which carries a possible life sentence.
     Bill C-45—the Criminal Code provision that allows criminal charges to be laid if a company causes death or serious harm due to negligence—is the result of a campaign by the United Steelworkers in the wake of a Nova Scotia mine explosion that killed 26 miners in 1992. The provision has existed for six years but has been gathering dust, despite widespread accidents and deaths. OLF President Sid Ryan has decried the "carnage in the workplace" and noted that noted that, "Since this piece of legislation has been enacted, we've had 300,000 accidents a year in the workplace, which is about 1.8 million accidents reported and over 240 deaths in the workplace - and not one charge has been laid until today.”

     This is partly the result of racism. Migrant workers bear the brunt of workplace accidents, as they don’t have the security to demand a safe workplace. As Jessica Ponting, a community legal worker with the Industrial Accident Victims Group of Ontario, pointed out at the emergency vigil, “Employers and recruiters pressure workers to give up rights to compensation under threat of job loss and deportation". Just three weeks ago another two migrant workers, working on a farm near Owen Sounds, died from exposure to toxic fumes. Stephen Colbert has helped raise awareness in the US about the plight of migrant workers, and concluded his congressional testimonry in a rare moment out of character: "migrant workers suffer, and have no rights".

     The experience of migrant workers and the statistics of workplace accidents/deaths also point to the systemic violence in general of work under capitalism. I certainly witness the carnage of the workplace every day at work. At my rotation in plastic surgery/burn unit during med school I was struck by how many patients were workers injured on the job—cooks scalded with oil, electrical workers electrocuted, construction workers with finger amputations. Then at my trauma rotation in residency I noticed that the biggest groups of patients were not from inter-personal violence, but car accidents (more on this type of systemic violence in a later post), and workplace accidents. I remember seeing a couple of patients who fell from scaffolds working the graveyard shift—one who broke both arms and many facial bones, another who died of a massive brain injury. I continue to suture and splint injured workers on a daily basis.
     Are all these merely accidents, if workers are forced to perform these dangerous duties to make a living? In his pioneering work on the social determinants of health, Friederich Engels broadened the notion of murder:
“When one individual inflicts bodily injury upon another such injury that death results, we call the deed manslaughter; when the assailant knew in advance that the injury would be fatal, we call his deed murder. But when society places hundreds of proletarians in such a position that they inevitably meet a too early and an unnatural death, one which is quite as much a death by violence as that by the sword or bullet; when it deprives thousands of the necessaries of life, places them under conditions in which they cannot live – forces them, through the strong arm of the law, to remain in such conditions until that death ensues which is the inevitable consequence – knows that these thousands of victims must perish, and yet permits these conditions to remain, its deed is murder just as surely as the deed of the single individual.”
The recent charges, won through community and labour campaigns, expose these daily crimes and the necessity of working towards a world where people don't die to make a living.

Monday, October 11, 2010

Columbus, colonization, and biological reductionism

Today is Columbus Day, which marks 518 years since Europeans colonized the indigenous people of the Americas. The record of Christopher Columbus is covered well here can hardly be disputed. But biological reductionist theories have emerged to rationalize the genocide against First Nations, reducing mass epidemics to immunology, and explaining persisting health gaps with genetics. By ignoring the conditions that shape infectious and metabolic diseases, these theories provide a cover for colonization that blames indigenous people for illnesses imposed on them and detracts from basic demands for self-determination.

     The dominant theory to explain why so many indigenous people died of infections after the Europeans arrived is because Europeans brought new diseases. This theory is called “virgin soil epidemics”, or a more critical term of “biological imperialism”, both reducing mass epidemics to exposure to new microbes. While lack of immunity from prior exposure certainly plays a role in infections, reducing the epidemics to microbes and immunity is problematic.
     It plays on the notion of the “noble savage” and presents a romanticized version of First Nations as being free from illnesses. But infections were spread both ways: while the Europeans brought smallpox and plague they encountered syphilis, yet it was not the Europeans who were wiped out. Many deaths were also from hemorrhagic fever and tuberculosis, which were endemic to the Americas before contact but produced a much higher death toll after Columbus.
     Clearly it was not only microbes but also the unhealthy conditions imposed by colonialism: state violence, poverty, poor housing, malnutrition, lack of clean water, and the denial of self-determination. These factors, sustained for centuries, paved for the way for continual epidemics, but it was very convenient to ignore them. Instead, tuberculosis and its high mortality rates were dismissed as “racial traits” (see Maureen' Lux's Medicine that walks: disease, medicine, and the Canadian planins native people, 1880-1940 for an overview of how the Canadian state imposed conditions that led to epidemics, then blamed First Nations for being biologically inferior, and then quarantined them for being biological threats.)
     This deliberate denial of colonization and its impact of health persists today, resulting in further scapegoating for epidemics. While Health Canada notes there are 117 First Nations communities with boil water advisories, it blames the situation on “community decisions to lower or turn off the chlorinator”. This was clearly not the case during the huge E Coli outbreak in Kashchewan a few years ago. As others have noted with regards to clean water that
"With the federal government‘s responsibility of this community under the Indian Act, Environment Canada‘s responsibility under the Canadian Environmental Protection Act and Health Canada‘s knowledge of the horrible water quality and severe health problems, it can be argued that its refusal to take responsibility of ensuring safe, clean potable water and proper wastewater systems is environmental racism. There is further argument that this is environmental racism when the federal government refused to act on its fiduciary responsibility and refusal to evacuate the First Nations‘ people in this community."

     First Nations also get blamed for epidemic rates of diabetes, and biological reductionist theories have emerged to not only deny colonization but glorify it. The “racial trait” argument to explain tuberculosis has become the “thrifty gene” theory to explain diabetes. Since the biomedical model is ahistorical and oriented to the individual, it reduces illnesses to genetic factors and individual lifestyle choices, but how then to explain the high rates of diabetes amongst First Nations?
     According to the “thrifty gene” theory, indigenous people before Columbus had little food and adapted a gene to convert every spare nutrient to fat, but now this same gene in the context of a widely available “Western diet” leads to epidemic diabetes. This theory, also rooted in the idea of the “noble savage”, perpetuates without evidence the notion that First Nations had no stable food supplies before “western civilization”, and are now being killed with kindness.

     Canadian Prime Minister Stephen Harper claimed last year that “we have no history of colonialism”, and has refused to sign the United Nations Declaration of the Rights of Indigenous People. The declaration states “Indigenous peoples have suffered from historic injustices as a result of their colonization and dispossession”. These injustices and their persistence have produced, and continue to produce, severe health impacts for indigenous people. Let’s follow the lead of those asking that Columbus Day be re-named Indigenous Rights Day, and support for self-determination that forms the pillar of a healthy society.

Sunday, October 10, 2010

Whose "risky behaviour" is really spreading syphilis?

The US administration has apologized for intentionally infecting Guatemalans with syphilis. That’s right, from 1946 to 1948 American scientists intentionally infected 700 people in Guatemala—prisoners, soldiers, and psychiatric patients—with the infectious disease syphilis, in order to study the impact of penicillin. These days syphilis is blamed on people's "risky sexual behaviour"--especially men who have sex with men--so this story is an opportunity to review the history of syphilis scapegoats (and for links to other US human experiments, check out the recent entry from this wonderful blog).

     In 1918, rather than divert military spending to jobs and healthcare, US President Wilson funded the creation of detention centres, some surrounded by barbed wire and guards, for the forced quarantine of tens of thousands of women convicted of prostitution. As one government official explained (and if you want to read an excellent history of this read this source of this link, Alan Brandt's No Magic Bullet: a social history of venereal disease in the United States):
“The prevention of society against moral and social murder committed by the prostitute are functions in part of the detention house and reformatory. These functions are inextricable related to the control of the dissemination of gonorrhea and syphilis through promiscuous prostitution.”
     African-Americans were also accused of spreading syphilis through promiscuity. Whereas the prison system treated poor women like criminals, the medical system treated poor blacks like guinea pigs. From 1932 to 1972, the Tuskegee syphilis experiment deliberately gave fake medicine to 400 poor black men in Alabama who had syphilis, in order to study the long term and lethal health effects of the untreated disease—which destroys the cardiac and nervous systems. Then men were told they were getting free healthcare for their “bad blood”, and were promised free money for burials if they consented to autopsy after dying.

     The scapegoat for syphilis has shifted from women, to people of colour, and now to gay men. In 2003, Vancouver’s poorest neighbourhood was struck by one of the world’s largest outbreaks of syphilis. But instead of blaming poverty and healthcare cutbacks, the response was to blame gay men. A spokesperson for the BC Centre for Disease Control claimed that “we know it spreads very quickly in the gay community. Almost every other outbreak in the world is confined to that community”. Health Canada has issued similar homophobic and medically false statements, claiming that
“risky sexual behaviour among MSM (men who have sex with men) and other populations is a risking global trend. One reflection of this is the numerous outbreaks of infectious syphilis seen worldwide. In 1995, the World Health Organization (WHO) estimated that there were 12.2 million new cases of syphilis”.
     Mainstream medicine continues to view gay sex as inherently dangerous, leading to bans on blood donations from men who have sex with men (see my post on this issue), and ridiculous statements that syphilis is only spread by gay men. The actual WHO stats show that of 12.2 million new cases, 11 million are in the global south, and a majority are women. By blaming gay men of spreading syphilis, these statements ignore conditions of poverty and inequality that put both men and women at risk of syphilis. All the homophobic hysteria about “risky sexual behaviour” is redefining a broad public health concern as a behavioural problem of a minority group. Blaming syphilis on “risky sexual behaviour” is like blaming cholera on risky drinking behaviour or blaming tuberculosis on “risky breathing behaviour” and asking people to reduce their number of conversation partners. Living in poverty and not having access to healthcare or clean water isn’t an individual behaviour, it’s collective condition imposed on millions of people.

     Millions die every year of infectious disease, not because of their individual behaviour but because they are kept in poverty and denied lifesaving medicine. Tuberculosis infects a third of humanity and remains a leading infectious causes of death 50 years after the discovery of curative treatment. Treatment also exists for malaria but lack of access to it is leading to widespread deaths. And HIV now infects 40 million people and is causing a reversal of life expectancy in countries where anti-retrovirals are not available. As a result we have a global Tuskegee experiment (for a great book on this topic, read this source, Paul Farmer's Infections and Inequalities), as six million people die every year from these three epidemics not because medicine doesn’t exist but because it is denied.
     The same governments that have given billions of dollars to banks, corporations, and the military have just intentionally underfunded the Global Fund for HIV, TB, and malaria. As Medecins Sans Frontieres announced last week, “Major donor countries have chosen to undercut the main international funding mechanism to save the lives of millions of people at risk of dying from AIDS, TB, and malaria.” The Global Fund required $20 billion to expand programmes, including $13 billion just to maintain the program, but have received only $11.7 billion. Canadian Prime Minister Stephen Harper recently promised $18 billion for fighter jets, which could cover the $8 billion Global Fund shortfall twice over, or which could almost cover the entire Global Fund needs. But as MSF’s Dr. Jennifer Cohn declared, “world leaders have officially under-financed the Global Fund. This decision will result in the death of millions of people from otherwise treatable diseases.”
     This is the true risky behaviour that threatens public health, not diverse and healthy sexual expression but the deliberate maintenance of conditions that spread infections coupled with the deliberate denial of medicine to treat them.

Friday, October 8, 2010

Cancer awareness: stop the tar sands, good green jobs for all

October is breast cancer awareness month and last night Laureen Harper, the Prime Minister’s wife, helped cover the Parliament Buildings in pink light, as part of the Estée Lauder Companies’ Breast Cancer Awareness Global Illuminations Initiative. As she said, "Our message is simple - be vigilant and get regular mammograms. Connect, communicate and conquer."
     The welcome the government has provided to this initiative contrasts sharply with the reception they’ve provided to other groups raising awareness about Canada’s most notorious carcinogen: the tar sands. This difference shines a light on the problematic way in which cancer prevention is approached.

     Communication is certainly important to raise awareness about cancer. But over the past year the tar sands corporations and the governments that support them have ignored or interfered with individuals and groups communicating about the carcinogenic tar sands.
     A tar sands worker was fired for exposing his working conditions on his blog! As he wrote,  “I do not think that purchasing the rights to develop oil leases over expanses of land greater than most European countries gives these corporations the right to drop a blanket of total secrecy over their operations, treatment of people, and conditions.”
     Recently local aboriginal leaders, fishermen, researchers and health professionals called attention to fish downstream of the tar sands which have tumours, while filmmaker James Cameron and NASA top scientists James Hansen have added their voice to the opposition. As Hansen stated, “it’s not that the government’s don’t know [about the consequences], but the governments are not doing anything.”
     Worse than this, provincial and federal governments are actively intervening to silence those drawing attention to tar sands cancer. Dr. John O’Connor, who for years has spoken out about despite threats, against the high rates of rare cancers in Fort Chipewyan near the tar sands, is raising alarm over a proposed provincial bylaw that would muzzle physicians who raise health issues in the media.
     Federally, after Greenpeace scaled Parliament to drop banners reading “climate inaction costs lives”, the government arrested activists and now arms its Parliament Hill officers with submachine guns. At the Copenhagen climate treaty, an indigenous-led delegation shamed Harper on the world stage for his commitment to carcinogenic tar sands. As Eriel Tchekwie Deranger, member of the Athabasca Chipewyan First Nation and Tar Sands Campaigner for the Rainforest Action Network said:
“Fossil fuel extraction from the tar sands are killing our people with cancer, killing our culture by destroying our traditional lands, and killing our planet with CO2. It seems that Canada is more committed to fossil fuels than human rights or real action for the climate. Mr. Harper – We welcome you to Copenhagen because we want real action on climate, and that means shutting down the tar sands and a moratorium on new fossil fuel development.”
     Instead of shutting down the tar sands, Harper shut down Parliament—to escape popular pressure over climate change, the torture of Afghans, and the recession. But last night our tar sands government participated in a corporate-sponsored cancer awareness initiative, by a cosmetic corporation whose products may be linked to cancer. How can governments and corporations who play a role in promoting cancer feel so confident to bask in the light of cancer awareness, cynically using people’s genuine concerns to distract from their own actions? Biomedical reductionism is partly to blame.

     Surely the best way to conquer cancer is to understand the connections is has with modifiable aspects of our lives. But the dominance of the biomedical model decontextualizes people and their illnesses from their social and natural environments, and reduces disease to microscopic processes and individual “lifestyle choices”, for which medical intervention and “personal choices” are the only solutions. How have we done with this approach? Every year we know more about cancer and have more technology to detect and treat yet, and yet every year more people die of cancer. In fact, we are living in a pandemic of cancer: in the 1930s one in ten people developed cancer, in the 1970s it was up to one in five, and now more than one in three. While cancer was once uncommon, we now all have close family and friends with cancer.
     The failure of the biomedical approach to explain and prevent cancer is often attributed to success, with the increase in cancer attributed to better screening or living longer, as if we’re naturally pre-programmed to develop cancer. But the vast majority of cancers are not genetic (only 5% of breast cancers), many cannot be screened for (like pancreatic or lung cancer) and this level of increase far outpaces the impact of aging. I see people with cancer on a daily basis and many are less than 50—including a 30 year old man I diagnosed a few months ago with colon cancer, and a 40 year woman I just saw who died of vulvar cancer.
     This is not to say medicine does not play an important role. In fact, while there is a tremendous amount of time and resources that go into finding “the cure” for cancer, many medical advances already exist. Many cancers in the Global South are due to chronic infections for which prevention and treatment are already known but are denied due to poverty and pharmaceutical patents. Cervical cancer and much liver cancer could be prevented with access to pap smears and vaccines. Some forms of bladder cancer are caused by water-born infections that could be prevented through access to safe drinking water. The widespread availability of antiretrovirals could diminish the number of people who develop HIV-associated cancers.
     When it comes to prevention, the dominant medical model is highly selective in what carcinogens it chooses to blame. The continual rise in lung cancer is blamed solely on the dissemination of cigarettes, but cigarettes are not the only chemical to enter existence over the last century. According to the Canadian Auto Workers Prevent Cancer Campaign:
“The International Agency for the Research of Cancer has identified 24 substances that cause lung cancer in humans. Twenty-three were determined by the excess mortality of workers who were exposed to these substances. The 24th, of course, is tobacco. Why do we hear so much about the dangers of tobacco but so little about the other 23 lung carcinogens? The reason is that tobacco is claimed to be a “lifestyle” choice, so industry and the medical profession can blame the victims. The other 23 known causes of lung cancer are related to industry. They can be prevented and removed from our workplaces and our environment.”
     Since breast cancer is sensitive to estrogen, all the focus on “risk factors” are about an individual’s reproductive cycle—menstruation, conception, breastfeeding, menopause. So it came as a surprise in 2006 when a Canadian study found that women working on farms and automotive industry are far more likely to develop breast cancer. It turns out that many chemicals, like pesticides, act like estrogens in the body and increase the risk of breast cancer. When the medical model reduces women to reproductive organs, it misses the threats they face as workers in toxic environments. As the CAW guide summarizes, this is not restricted to farm or auto workers:
“Workers in certain carcinogen-laden industries are contracting cancer at rates well beyond those experienced by the general population. At least 60 different occupations have been identified as posing as increased cancer risk. Studies show that the auto industry is producing laryngeal, stomach, and colorectal cancers along with its cars. The steel industry is producing lung cancer along with its metal products. Miners experience respiratory cancers many times higher than expected. Electrical workers are suffering increased rates of brain cancer and leukemeia. Aluminum smelter workers are contracting bladder cancer. Dry cleaners have elevated rates of digestive tract cancers. Firefighters contract brain and blood-related cancers at many times the expected levels. Women in the plastics and rubber industry are at greater risk for uterine cancer and possibly breast cancer. The list goes on and on.”
     By seeing cancer connected to our natural and social environments, our vigilance does not have to be reduced to screening for cancers, but can be expanded to widespread prevention—by providing access to the medical advances that treat infectious precursors to cancer, and by developing an economy based on safe and environmentally sustainable work.  So let’s expand the scope of the pink light, not only on Parliament but on the government’s toxic devotion to tar sands, and on our carcinogenic economy. Cancer prevention must include shutting down the tar sands, and expanding green jobs to save the planet and its people.