Fat phobia, the "obesity epidemic" and the medicalization of inequality

     Recently Toronto's progressive weekly newspaper, NOW, had a photoshopped front cover and feature pages showing rightwing mayor Rob Ford posing naked. This was clearly aimed at making fun of his weight, a recurring theme. When he announced he was running, NOW wrote about it in an article titled "fat chance", and during the election campaign right-wing rival George Smitherman suggested he "doesn't have the fitness for the rigour pace" (comments reinforced by media photos of his abdomen).  Last week while I was leafleting for the April 9 rally to protest Rob Ford's policies, one passerby grabbed a leaflet and called Ford a "fat fuck", a term reproduced on youtube clips and internet sites.

     There's plenty of reasons to criticize Rob Ford--from his racism and homophobia to his attacks on transit workers and public services--but his weight is not one of them. NOW defended itself on freedom of speech grounds, but that's besides the point. Free speech shouldn't pander to fat phobia or any other form of oppression. As one blogger noted,

"Ask yourself if NOW would ever do a Photoshopped cover of a female mayor in her underwear? The naked truth is that NOW would never have dared such a cover with Barbara Hall as mayor...Or if George Smitherman was the new mayor, can you imagine a cover with his worship wearing nothing but chaps and making fun of his sexual orientation?"

THE PSEUDOSCIENCE OF THE "OBESITY EPIDEMIC"

     One of the reasons fat phobia is so accepted is because it's become medicalized, giving it a veneer of legitimacy.  We're told that we live that we're gripped by an "obesity epidemic", which kills 300,000 Americans a year, a "threatening storm" that an article in the New England Journal of Medicine blames for a future decline in life expectancy. The policing of body size has entered daily medical practice with the "metabolic syndrome", a concept aimed at describing the inter-dependence of diabetes, high cholesterol and high blood pressure; to assess for this every family doctor is trained to measure their patient's blood pressure and lab tests...plus weight circumference. We're then supposed to council patients to "chose a healthy lifestyle" based on low-fat foods, on the notion that this will reduce obesity and its associated health problems. But this picture doesn't fit reality.

     Despite the focus on evidence-based medicine, much of the "obesity science" is arbitrary. Gerald Reaven, a leading scientist on insulin resistance, exposed the pseudoscience behind the metabolic syndrome, especially its inclusion of waist circumference:

"Not only are the cut points for the five chosen criteria arbitrary, there is no reason to believe that the individual elements of the metabolic syndrome are equally reflective of either the presumed basic defect or the risk of cardiovascular disease...although being overweight/obese increases the chances of an individual being significantly insulin resistant, by no means are all overweight/obese individuals insulin resistant, and, of greater clinical relevance, weight loss in overweight/obese individuals who are not insulin resistant does not lead to substantial clinical benefit."

 The site size-acceptance.org has also busted the "300,000 deaths a year" myth, noting that the authors of the quoted study objected to the misrepresentation of their findings, and that furthermore: 

"[the study] may have actually built upon the results of the 20 year long Cooper Institute Studies of 20,000 men which showed that fitness level and amount of exercise determined the morbidity risk rate regardless of what people weighed i.e. fat couch potatos and thin couch potatoes seemed at equal risk whereas fat exercisers seemed at no more risk than thin exercisers and at much less risk than thin couch potatoes."

     Not only does the supposed problem "fat = unhealthy" not stand up to scrutiny, but the supposed solution of lecturing people to "stop eating fat" doesn't reduce weight or the supposed obesity-related illnesses. The Women's Health Initiative followed 50,000 women for years, telling one group to eat a low-fat diet while the control group followed their usual diet. The results:  "Women assigned to this eating strategy did not appear to gain protection against breast cancer, colorectal cancer, or cardiovascular disease. And after eight years, their weights were generally the same as those of women following their usual diets." Despite the simplistic call for "good lifestyle choices", people can choose health in the same way that they can choose housing, income, working conditions, the food they eat, the air they breathe. In the market, people's ability to make choices depends on their socioeconomic condition.

 

 MASS OR CLASS?

     Last month, Scientific American published a study on the "diabetes belt" through the US:

the diabetes belt

"Going past national statistics, a new map shows more than 640 counties in mostly southern states had higher-than-average rates of diabetes, suggesting the need for more targeted prevention...the 644 counties in the diabetes belt match up to known risk factors for the disease, including: a high obesity rate, sedentary lifestyles, lower education levels, and more non-Hispanic blacks...The 15 states that have counties in the diabetes belt are Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana, Mississippi, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, Virginia and West Virginia." 

the poverty belt

But there is a clear marker, almost universally ignored, that matches both diabetes and those "risk factors": poverty. These 15 states include 11 states with the highest poverty rates: Alabama, Arkansas, Georgia, Kentucky, Lousinana, Mississippi, North Carolina, South Carolina, Tennessee, Texas, and West Virginia. Fortunately not all the medical literature ignores poverty and income inequality. In another article in the New England Journal of Medicine--"Class, the ignored determinant of the nation's health", the authors reveal that:

"On the whole, people in lower classes die earlier than do people at higher socioeconomic levels, a pattern that holds true in a progressive fashion from the poorest to the richest... Unhealthy behavior and lifestyles alone do not explain the poor health of those in lower classes. Even when behavior is held as constant as possible, people of lower socioeconomic status are more likely to die prematurely."

     This is not to say that personal agency is not important. On the contrary: challenging the social and economic conditions that constrain choice is the best way to promote personal agency. Instead, many studies on obesity take these conditions for granted, controlling for differences in race and occupation—either explicitly, or implicitly by enrolling white middle-class people. This means filtering out the health impacts of racism and class, two of the most potent determinants of health. The premise is that these are natural and unchangeable, and should be eliminated from analysis, and that instead we should blame the difference in weight amongst ourselves. (For other good blogs on the obesity-shaming epidemic go visit here and here.) While this perspective is not medically useful, it serves economic and ideological purposes. 

BIG PROFITS

     The fear mongering about obesity can't be separated from the market that profits from it--from the multibillion dollar diet industry, to commercialization in general that thrives on reducing people's self-esteem so it can sell them a product. Meanwhile, the Canadian guidelines for the treatment of obesity were written by the president of Obesity Canada (an organization sponsored by food and drug companies) who owns stocks in Glaxo-Smith Klein and Eli Lilly, two pharmaceutical giants who happen to sell anti-obesity drugs. Like all free market industries, the pharmaceutical industry is made up of rival firms competing for market share. In the field of health this produces a pressure to pathologize (especially women). Obesity was turned into a "risk factor", and now its own disease, making fat phobia a very modern phenomenon.

MEDICAL SCAPEGOATS

phrenology

     But medicalized discrimination is far older. Far from being objective and neutral, medical ideology plays an important role in policing society, by pathologizing those who don't conform to narrowly-defined norms. Instead of focusing on economic conditions that collectively put us at risk of diabetes and heart disease, the obsession with obesity personifies these diseases, presenting them as the result of individual, lazy, and reckless behavior. The obsession with obesity recalls other instances in which groups of people have been labeled as “abnormal” or “at risk” because of their shape, origin, sexual orientation, gender identity, ability, and religion.

     The obsession with measuring people's waists in order pass to judgment on them is reminiscent of the early pseudoscience of phrenology, which measured people's heads as a basis of justifying social inequalities. Almost every oppressed group has at one time in history been blamed for an infection disease: First Nations blamed for TB, European Jews blamed for chlamydia, Mexican-Americans blamed for typhus, African-Americans and sex-trade workers blamed for syphilis, Haitians and gay men blamed for AIDS. Homosexuality was considered a psychiatric disease until the Gay Liberation Movement. Transgender people continue to fight against being pathologized. People with disabilities call for a broader definition of health instead of mainstream medicine's desire to “fix” them. Muslims are resisting attacks on civil liberties that use the language of “public safety” in order to restrict their rights to movement, attire, athletic competition, occupation, and voting.

"social hygiene" warning

     In all these situations the “target of intervention” has been the supposedly monolithic and deviant behaviours of oppressed groups rather than the social and economic conditions that place them, and others, at risk. The results have been social stigma or repressive laws, rather than accessible health care, better housing, and higher wages. In the 19th and 20th century when infectious disease dominated there was a "social hygiene movement" that provided medical justification for a moral crusade against deviant sexuality (everything from dancing to prostitution, along with homosexuality and inter-racial partnerships) but as the major medical problems for industrialized countries have shifted to diabetes, heart disease and cancer, the source of the blame has shifted from people's hygiene to their size. This ignores the real problems that threaten to undermine life expectancy: income inequality, lack of health care, unhealthy food driven by competition in the food industry to make things as cheaply as possible, and cuts to social services that deprive schools or community centres of fitness opportunities. (For a discussion of how biomedical reductionism affects our understanding of cancer, see my other posts here and here).

TOWARDS A HEALTHY WORLD

     The most important determinants of health are: 

1. Income and Income Distribution 2. Education 3. Unemployment and Job Security 4. Employment and Working Conditions 5. Early Childhood Development 6. Food Insecurity 7. Housing 8. Social Exclusion 9. Social Safety Network 10. Health Services 11. Aboriginal Status 12. Gender 13. Race 14. Disability

These are the issues on which to challenge Rob Ford; not his body but his policies that undermine the key social determinants of health. That's why thousands of people--representing a healthy diversity of bodies united in the demand for a better and healthier world for all--will be protesting this saturday. Fat phobia not welcome. 

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 OFFICIALLY TOXIC
     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.”

BREAST CANCER EPIDEMIC: BIKINI MEDICINE OR THE GLOBALIZATION OF CHEMICALS?
     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.

TOXIC CONSUMPTION
     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 AND WORK
     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.

"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.




"FEMALE VIAGRA"
     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.”

WEAPONS OF MASS PRESCRIPTION
     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.

WOMEN’S HEALTH
     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.

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.

INFECTIONS: VIRGIN SOIL EPIDEMICS?
     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."

DIABETES:  A THRIFTY GENE?
     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.

INDIGENOUS RIGHTS DAY
     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.

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).

SEXISM, RACISM
     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.

HOMOPHOBIA
     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.

GLOBAL TUSKEGEE EXPERIMENT
     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.

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.

UNDERMINING COMMUNICATATION
     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.

MEDICAL DISCONNECT
     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.”

CONQUER CANCER: SHUT DOWN THE TAR SANDS, GOOD GREEN JOBS FOR ALL
     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.

Thought for Food: two great books on the politics of food

Below are reviews of two great books I've read on the politics of food, an issue around which an increasing number of people are radicalizing.

IN DEFENSE OF FOOD, by Michael Pollan

     Common explanations of the unhealthy “Western diet” blame fast food companies and gluttonous consumers. But for Michael Pollan, the problem is the commodification of food under capitalism, which harms the earth and humans: the increasing geographical separation of food production and consumption robs the soil of nutrients, and the profit-driven processing of food then purges those nutrients. This has produced “a radical and abrupt set of changes over the course of the last 150 years, not just to our foodstuffs but also to our food relationships, all the way from the soil to the meal”.
     In Defense of Food focuses on the “nutritional industrial complex” that has emerged in recent years: governments deregulate food production, marketers sell artificial food as healthy, and scientists provide the ideological justifications.
Pollan explains how food is “a virtual wilderness of chemical compounds, many of which exist in intricate and dynamic relation to one another, and all of which together are in the process of changing from one state to another”. He contrasts this with the “official ideology of the Western diet”, nutritionism, which reduces food to a static and simple collection of individual nutrients. As a consequence fertilizers ignore and sabotage the earth’s own ability to feed plants, sapping their quality; attempts to simplistically create food produces toxic alternatives; and reducing food to a delivery mechanism for nutrients undermines its cultural diversity and pleasure. Pollan concludes with a series of steps to regain a healthy diet, summed up with his maxim: “Eat food. Not too much. Mostly plants.”
    While In Defense of Food provides a brilliant analysis of food under capitalism, it doesn’t provide a very effective solution: “Not everyone can afford to eat high-quality food in America, and that is shameful; however, those of us who can, should. Doing so benefits not only your health, but also the health of the people who grow the food as well as the people who live downstream and downwind of the farms where it is grown.”
    The problem is that Pollan sees humans and the planet relating to each other primarily through the act of consumption, rather than production—relegating those who actually produce the food to a passive role. But if those workers and others had democratic control over the production, they could consciously grow food in ways that are healthy for humans and the earth.
While In Defense of Food does not provide this ultimate solution, it takes the first step by showing us how food is “no mere thing but a web of relationships among a great many living beings, some of them human, some not, but each of them dependent on the other, and all of them ultimately rooted in soil and nourished by sunlight”.

SOIL NOT OIL, by Vandana Shiva

     In her latest book, renowned scientist and environmental activist Vandana Shiva shows capitalism is the root of the climate crisis, and its profit-driven solutions will only makes things worse.
In this short and accessible book, Shiva blends science and politics to analyze three crises—climate chaos, peak oil, and the food crisis—showing how they are interconnected and based on two centuries of an unsustainable quest for profits that drives people off the land and privatizes nature.
     She looks back on the results of the “Green Revolution”, which claimed to promote food security but instead concentrated a monoculture of climate-sensitive crops in the hands of oil-dependent corporations, whose production and use poisons the earth and promotes climate change, and whose expensive patented seeds and fertilizers creates huge debt that has produced an epidemic of farmer suicides.
     Now we are presented with a new series of pseudo-solutions—nuclear power, carbon trading, and biofuels—that will only exacerbate the climate crisis. As Shiva points out, “nuclear winter is not an alternative to global warming.”
     Shiva shows how these pseudo-solutions are rooted in capitalism’s incessant commodification: “some things should not be tradable—water and biodiversity are too valuable to be reduced to marketable commodities. Other things, like toxic waste and greenhouse gases, should not be generated. To turn them into tradable commodities ensures that they will continue to be produced. Instead of putting a value on clean air, emissions trading schemes value pollution”.
Meanwhile, the production of biofuels drives communities and trees off the land, and uses oil and large amounts of water to divert food production into crops to run cars, while wild speculation on these profits drives up food prices and creates artificial famines.
     For Shiva, the solution will come from the periphery of the system and a focus on small farms: “the solution to the climate crisis begins with the cultures and communities who have not contributed to it”. While she condemns capitalism for two centuries of driving people off the land into polluting cities, she does not articulate a role for the urban working class in fighting back. She claims that “as the fossil fuel economy has grown, it has substituted energy for humans”, rendering “humans redundant to the economic process”, and “replacing people with fossil-fuel driven machines”. Seeing no contradiction in capitalism, she calls for a “cultural transition” with an appeal to a mystical energy force.
     But machines do not run themselves, they run on human labour, and the working class has the collective power to bring the system that produces climate chaos to a halt. The 100 million workers in India who struck at the start of the month—shutting down coal, power, port, and road transportation—show how the working class can be a key ally of peasant communities fighting climate choas.
     Despite this shortcoming, Soil not Oil is valuable reading for anyone seeking to understand the climate crisis and the dangers of profit-driven solutions

End the Ban: 5 reasons to oppose the Canadian Blood Services' ban on blood donations from men who have sex with men

An Ontario Superior judge recently dismissed a constitutional challenge of the Canadian Blood Services (CBS) ban on donations from men who had sex with men. Kyle Freeman had challenged the ban by openly lying about his sexual history, and when he was sued he counter-sued arguing his Charter rights had been violated. The court sided with CBS and ordered Freeman to pay $10,000 for filling false papers. The media have largely defended the court and the ban on the grounds that safety trumps equality, and that gay men are a risk for HIV.

Here are 5 reasons to oppose the ban:

1) The ban perpetuates a long history of homophobia
The National Post claims that “the CBS’s ban on donations from gay males is not in any way an issue of homophobia, it’s one of differing medical opinions”, implying that medical opinions are immune from homophobia. There’s a long history to the contrary. Homosexuality went from being a crime to a pathology, initially psychiatric and then a terminal illness. The gay liberation movement forced the removal of homosexuality from the list of psychiatric disorder, only to find themselves re-pathologized. When the first few people infected happened to be gay men, the medical establishment immediately labeled the new disease Gay Related Immune Deficiency (GRID). When it quickly became obvious that other people could become infected, the name was changed to Acquired Immune Deficiency Syndrome (AIDS), but it was  blamed on “high-risk groups” known as the “four-Hs” (homosexuals, heroin users, hemophiliacs, and Haitians) who were considered inherently dangerous, and blood donations from all these groups were banned. This homophobia has not ended. The National Post defended the CBS by claiming: “In choosing to continue to refuse donations from gay men, CBS is erring on the side of caution to protect our blood supply, a vital national medical resource. Any attempts to rush CBS into changing their medically defensible polices in the name of political correctness must be resisted.”[2] Run and hide, the gays are coming for our blood supply! Substitute “muslim” for “gay” for and “security” for “blood supply”, and you get the typical islamophobic argument for racial profiling.

2) The ban inappropriately focuses on demographics instead of behaviours
The homophobic sleight-of-hand that substitutes demographics for behaviours has been so ingrained that Jeffrey Simpson can pronounce in the Globe&Mail that “gay men cannot overcome the medical facts of being more susceptible to HIV”. Well, Dr. Simpson, I’d like to introduce you to Dr. Mark Wainberg, leading Canadians AIDS researcher, past president of the Canadian AIDS society and co-chair of the 2006 International AIDS Conference. Wainberg has been challenging the archaic notion of “risk groups” that have allowed homophobia to linger so long in the medical community. He recently pointed out the logical conclusion of the CBS ban: “It’s okay for a 19-year-old University of Toronto student to go out and have sex 50 times over the course of a year with a whole bunch of women that he doesn’t know, including prostitutes, that’s fine. But a gay man who has been totally monogamous for 15 years? No, that’s not okay.”

3) The ban ignores a generation of advances in AIDS research
Not only does the ban misdirect attention to sexual orientation and not sexual behaviour, but it’s become moot with the development of highly accurate HIV testing. As Wainberg pointed out, “the precautionary principle is implemented in situations in which public health is in danger, and no conclusive scientific information is available.” But that is not the case: after a generation of AIDS research we know the virus that causes it and can accurately test for it in our blood supply. According to another leading Canadian AIDS researcher, Dr. Gilmore: “Today’s technologies make it almost impossible for HIV to slip through”.

4) The ban threatens the abundance of our blood supply
So what’s the result of such an unscientific policy? It not only to discriminates against gay men and perpetuates the notion that they are inherently diseased, but also exacerbates the blood supply. As Wainberg wrote, “We clearly have a situation in which there are chronic blood shortages and we also have a situation in which gay men are totally discriminated against”. Banning donations from healthy donors whose blood will be screened does not strengthen our blood supply, it undermines it.

5) Other useless bans have been dropped
When presented with Wainberg’s writing, CBS spokesperson stated that “we don’t think Canadians want to be guinea pigs”, as if getting an accurately screened transfusion from a healthy and generous blood donor who also happened at one time since 1977 to have had one sexual encounter with another male is akin to human experimentation. As well as being inflammatory, this statement is highly misleading about the dynamics of bans. The book When Germs Travel includes a chapter on the Haitian community’s inspiring campaign to remove the ban from their blood, which was successful. As Gilmore pointed out, “Other jurisdictions, like Australia, have already replaced the lifetime ban with more balanced and realistic policies. And I think it’s time that Canada and the U.S. did the same.”

When Stephen Harper boycotted the 2006 International AIDS Conference, Wainberg said he was “on the wrong side of history”. The CBS ban, and the court that upheld it, are on that same wrong side. But the same mobilizations that ended the ban on blood donations from Haitians can reverse the longstanding homophobic, unscientific, and harmful ban on blood donations from men who have had sex with men.

To read more about AIDS politics and activism, check out Brett Stockdrill's Activism against AIDS: at the intersection of sexuality, race, gender and class, Paul Farmer's Women, poverty, and AIDS: sex, drugs, and structural violence, and Steven Epstein's Impure science: AIDS, activism, and the politics of knowledge. And go here for more information of the Canadian Federation of Student’s campaign against the ban.