Is it political correctness or altruism?
It's Breast Cancer Awareness Month, so maybe you've noticed all the ads, publicity and Races for the Cure going on in your town. I know I have; my local newspaper, The News Sentinel, had a front page story entitled, "Pink Panters" describing the 10,000 runners who showed up, despite the rain, to show support for breast cancer victims. A few days before the race, swarms of concerned women headed to the mall to pick up their t-shirts and register for the race. I turned on the tv and celebrities and famous people were doing their part to increase breast cancer awareness. Yesterday, on a trip around town to do errands, I could not escape the onslaught of breast cancer literature, t-shirts, ribbons and yes, even a breast cancer stamp which I was offered at the post office. Even the stores at the mall advertised part of their profits going to breast cancer research. At first glance, all of this concern looked very altruistic and I thought about my grandmother and other relatives who have died of breast cancer and what a triumph this would be for them. Yet, somehow, I felt unsettled, and I finally pinpointed my sense of ill-ease.
It was from an article I had read recently at Slate, entitled, "Condi, Hillary....and Angelina? When celebrities act like politicians, and politicians act like celebrities." The article stated, "Big companies shun political controversy, but these days all of them want credit for behaving in a "socially responsible" manner." The media and companies (and of course, celebrities) have a love affair with breast cancer because it shows their support for women (and has to do with boobs) and yet, is not a controversial topic. It puts them in a good light and helps raise more money or recognition for their product, image etc.
So, what harm does this do? It convinces most women (and men who are concerned about women) that breast cancer is just around the corner, especially for younger women. This could not be further from the truth. In 2001, only 900 women under 30 had invasive breast cancer. In fact, almost half a million women die every year from heart disease compared to 40,000 from breast cancer. Yet, heart disease gets little publicity--our local newspaper is not even expected to show up at this year's heart walk; and there are almost no celebrities I can think of that have taken up the cause for heart problems. Heart disease is thought of as an "old person's disease and a good way to die (even if this is true, which it is not, isn't this a little cruel?)."
Yes, it is wonderful that we are finding cures for breast cancer, but if we are doing so at the expense of finding cures for other diseases that take more lives, even those of younger women, are we really fighting diseases to extend the lives of those who have them or are we just trying to make ourselves feel good?
It was from an article I had read recently at Slate, entitled, "Condi, Hillary....and Angelina? When celebrities act like politicians, and politicians act like celebrities." The article stated, "Big companies shun political controversy, but these days all of them want credit for behaving in a "socially responsible" manner." The media and companies (and of course, celebrities) have a love affair with breast cancer because it shows their support for women (and has to do with boobs) and yet, is not a controversial topic. It puts them in a good light and helps raise more money or recognition for their product, image etc.
So, what harm does this do? It convinces most women (and men who are concerned about women) that breast cancer is just around the corner, especially for younger women. This could not be further from the truth. In 2001, only 900 women under 30 had invasive breast cancer. In fact, almost half a million women die every year from heart disease compared to 40,000 from breast cancer. Yet, heart disease gets little publicity--our local newspaper is not even expected to show up at this year's heart walk; and there are almost no celebrities I can think of that have taken up the cause for heart problems. Heart disease is thought of as an "old person's disease and a good way to die (even if this is true, which it is not, isn't this a little cruel?)."
Yes, it is wonderful that we are finding cures for breast cancer, but if we are doing so at the expense of finding cures for other diseases that take more lives, even those of younger women, are we really fighting diseases to extend the lives of those who have them or are we just trying to make ourselves feel good?
posted by Helen at 9:08 AM
32 Comments:
You even have to ask?
How about the deaths from prostate cancer? Speaking of disposable men.
To allicent:
One stat I read regarding breast cancer research stated that 386 million dollars was spent on breast cancer research in 1998 vs. 89 million for prostate cancer--both have about the same number of people affected so it does seem biased in favor of breast cancer. There is a good article about sex bias issues in the Atlantic Monthly (you can google sex bias and medical myths with Atlantic monthly) to see it if you are a member of their online subscriptions.
This is completely off topic, Dr. Helen, but, most women I know are not as concerned as you seem to be with bias against men in the U.S. I truly appreciate you getting the word out about this issue, and I agree. I'm just wondering why you feel so strongly about these issues. Does my question make sense? I'm just trying to get a peak inside your head, that's all.
Hey Ben,
Thanks for your question. I will have to do a post on my life and views at some point soon. To sum it up, my emotional makeup was more "masculine" (actually, I found out later that other women felt the same--I just did not know them) while growing up in the South and I never understood the whole girl culture. I was direct with my feelings and opinions and believed heavily in individual rights and freedom.
I was also very much a believer in personal responsibility and had problems with people who used victimhood as an excuse. I originally wanted to be a pilot and flew small planes as a teenager; however this dream was sidelined as I wore glasses (so did not qualify for training as an airforce pilot) so chose my career choice which was to be a psychologist as I always had an interest in what made people violent (that is a whole different story). To make a long story short, I spent years in graduate school listening to politically correct garbage until my head would spin. One example comes to mind of another doctoral student--a male--who was thrown out for making a polically correct statement about African Americans. I realized at that time that I had better keep my views to myself.
By the time I realized this was bullshit--I had invested too many years and forced myself to sit through whatever torment was thrown my way by professors--I decided to complete my PHD and did what was necessary but not without a great deal of self-sacrifice. In my years of work in forensic psychology, I have seen many men suffer by virtue of being men--I felt it was unfair and yet, they would not or could not speak up for themselves or they simply got angry and ended up in jail for thier aggressiveness. Women have their own voice but many men and mainly young boys do not. They end up in trouble, in jail or out of work. Hope this makes sense.
Wow. Yes, it does. Thank you!
I really hate to say it, but I must admit that the um... "overkill" on the breast cancer issue has pretty much the opposite effect on me than what these people desire. Personally I don't want to hear one single more word about it - don't want to see one more pink ribbon - don't want to listen to one more lament. Sympathy fatigue has definitely set in!
I know that sounds harsh and I do feel awful for anyone who must go through such trauma - I was treated for malignant melanoma years ago so I'm not unfamiliar with cancer. But I'm burned out! Completely. There are (as you noted with heart disease) many other diseases that cause illness and death even among younger women - yet they are ignored for the most part. There are many diseases that kill men - that are given a shrug and some token sympathy.
At the moment I'd rather give my money and attention to just about any other type of disease and its treatment. And if I ever end up with breast cancer - I would want to run screaming and shrieking, far away from all these do-gooders who would want to help me so much!
One thing to remember --
Cancer is cancer. asdvances in the treatment of once form of cancer often positively affect treatment of other forms of cancer.
So all told, research dollars into breast cancer are also to a great degree research into other forms of cancer.
As for the demonization of men in America -- take a look at about 90% of commercials. men are portrayed as buffoons and idiots. Same as in sitcoms.
But we're men -- we can take a joke, unlike every other "sensitive group".
I'm burnt out on breast cancer pink everything too if for no other reason than the big marketing push. If breast cancer were the #1 killer of women, then perhaps I'd feel differently, but that is clearly not the case. Heart disease kills more women than the next six causes combined. I get that heart disease can't be marketed the same way "save the boobies!" can be marketed, but it still makes me mad.
While I fully support women being informed about their bodies and being proactive about their health, I wish the big push was in addressing the very real and under-reported #1 health risk to women. So for now, I'm done with pink ribbon anything.
(Full disclosure: My mother died at the young age of 52, 7 years ago, from heart disease. She didn't recognize the very different symptoms of a heart attack that women often experience.)
Having had breast cancer (I refuse to be a 'survivor'), I have always been bothered then and now with the over-hype on the breast cancer statistics. Virtually every woman I know feels doomed to be the 'one in eight' to get breast cancer every year. If nothing else, they could get the statistics right: If you live to age 80, you will have had one chance in 8 to get breast cancer. At 20, 30, 40, 50, the odds are much, much less. Having had breast cancer as I said, I'm still much more likely to die of heart disease and always have been.
I don't think it's just corporations who are happy to find a cause that they can support without ticking somebody off. I think everybody is glad to have something that doesn't get them in trouble with some public scold or professional busybody enforcing the latest edicts of correctness. Really, it's hard to find an untouched cause these days-- I mean, even in the middle of all the Katrina stuff, you had people slagging the Red Cross and suggesting the Salvation Army instead-- oh yeah, like GigantiCorp can support a Christian organization without controversy!
The other point about heart disease versus breast cancer is that one has at least vague relation to personal behavior and the other is a bolt from the heavens, basically. That's scarier, in sort of the same way that people are more afraid of airplanes (over which they have no control) than cars (which they imagine they can control) even though statistically that's illogical.
I had a similar reaction to last week's headlines about Herceptin (http://www.corante.com/pipeline/archives/2005/10/24/hype_or_hope.php)
"It's well behind that of lung cancer in the female population, which moved into first place nearly 20 years ago (see the graph on page 5 of this PDF), but it gets easily ten times the press, and surely generates ten times as much worry. Lungs, though, are not visible manifestations of femininity, and come with no cultural or political meaning attached. I'm sure that there's a ribbon color for lung cancer, although I don't know what it is, and I don't know when their Awareness Month might be. This is especially odd when you consider that most of the high incidence of lung cancer is from a completely avoidable cause. . ."
j. fielek
you state one of the most common misconceptions about cancer. a growing body of evidence is demonstrating that the runaway growth of cells that typifies malignant cancer is only a shared symptom of many different diseases. this appears to be analogous to how we once viewed "fever" as a disease, but now realize that it is a symptom of infection, and is actually part of the body's defences against infection.
while some cancers respond to common medicines, they are really separate diseases, some of which are, or are likely to be, caused by infection. Cervical cancer and a form of stomach cancer are linked to infection (by HPV and helicobacter, respectively), with many others as candidates.
Heart disease may even be caused by an infectious vector. It is actually likely many different diseases with similar expressions, given the range of apparent causes. Dr. Helen is one example of someone with heart disease not expressing what is normally thought of as a high risk profile.
For demonization of men: I worry about kids in public schools (private school is much more understanding and tolerant, especically single sex schools) and about men in bad relationships. When you're faced with someone who is emotionally disturbed and only weighs 95 pounds, you can very easily find yourself in a heap of trouble.
Cancer is cancer. asdvances in the treatment of once form of cancer often positively affect treatment of other forms of cancer.
Not so much, really. There might be cross over, but no two tumors are the same much less every form of cancer. Derek Lowe has more on this.
As for breast cancer, I think awareness is good, but we've long since gone past that into hype. My girlfriend found a lump in her breast back in May (she's 21), and that gave us quite a scare. They did a biopsy and it turned out, of course, to be some benign growth that, so long as it doesn't get bigger, poses no threat at all. If I'd known that stat about 900 women under 30 in 2001, I'd have felt much less freaked out.
Don't believe the hype, I guess.
I'm a radiologist in private practice, and I get to deal with both the paranoia and denial ends of the breast cancer spectrum. When I talk to women about their mammograms and ultrasounds, I show them the pictures, explain what and why, and tell them that even though I recommend a biopsy there is only a 25% chance that it will come back with cancer. I hope this is comforting, but Duvall's Law is that "Minor procedures happen to other people, any time they happen to you it makes them major."
Prostate cancer comes in two flavors -- the kind you die with, and the kind you die from. I believe that breast cancer will be found to have a similar hetergeneity, in that some of the DCIS we find would be inconsequential if left alone, while high-grade DCIS will develop into a killer. Ultimately, that's not my call though -- I just find it and tag it for removal, though some day soon I imagine that small lesions more than a centimeter or two from the skin surface will be killed in situ with RF ablation, and many breast cancer patients won't even have a scar to show for their troubles.
There is in some patients an unreasonable expectation as to the sensitivity of imaging. Mammography is far from perfect, it's just the best method we have right now to find breast cancer. Ultrasound and MRI have their places in selected populations, but mammo is still our main tool. I'm hoping that genetic research will get the cost of gene screening down to the point where we can risk-stratify women appropriately and use our imaging tools better, but at the moment it's too expensive for wide usage.
To Michael,
Which disease is a bolt of lightening from heaven and which is related to personal habits? Breast cancer has been linked to lack of exercise and too much fat in the diet and heart attacks can happen like a bolt of lightening, believe me. When I had a heart attack at 37, I was an avid athlete, light and a vegetarian (really stupid, acutally) and it was and still is, a horrible jolt--the limitations and disability are hard to describe unless you live through it.
To J.Pike,
Your doctor is wrong--most breast cancer happens to women over 50. Heart problems are more prevalent in younger women. Believe it or not, even doctors buy into the myths about illnesses from the media. I had to beg for months for an echocardiogram when I had a heart attack because the three hospitals and two doctors I saw could not believe a slim woman in her thirties could have a heart attack. This length of time resulted in the formation on aneurysm and other problems which could possibly have been addressed if I had gotten proper care ASAP. While it is not good to be a hypochrondriac, it is also beneficial to question your health care provider at times.
If I remember correctly, lung cancer kills more women, and men, than breast cancer does. But you'd never know it from their respective public profiles. Nor would you know that the Susan G. Koman Foundation is friendly enough with Planned Parenthood to look the other way rather than research possible links between abortion and breast cancer.
I find your statistics interesting, Dr. H., I had no idea these disparities existed. No doubt most people are unaware of the comparatives that you have mentioned.
I agree with your observations (and Glenn's too) about the reasons for the huge support of breast cancer research by big business, media, et al., but I also think that the breast cancer advocacy movement has had many years of outstanding effectiveness in their advertising. We've been hearing about breast cancer issues since the late 60's, I believe, while many of the other diseases mentioned have either not been "hot" that long, or have just not achieved the momentum or notoriety it takes to attain and maintain a position in the spotlight. The Muscular Dystrophy Association is another long-standing advertising success, I think. Even AIDS advocacy seems to have less overall public interest today than it did in the mid-90's. I think some of the reasons we hear so much about some illnesses and so much less about others has more to do with Madison Avenue than it does with real medicine.
I agree somewhat with the heart disease comments; I think there is a ton of stuff out there about how you need to exercise and eat fruits and vegetables, but its not specifically targetted to women. However, I'm a 25 y/o woman who's definitely gotten the message that I need to exercise to be healthy and ward off heart disease; but, I have high blood pressure so maybe i've gotten more reinforcement than most. As to the sitcoms, they are ridiculous and I really can't believe people watch them. All I watch on tv is HGTV, TLC, some sports, Law & Order, and the news channels.
I lost a friend because she asked me to sign a petition asking the government to spend more on breast cancer research. I put her clipboard down and wrote a check for two hundred dollars explaining that I didn't think it was the government's place but I would gladly help support the cause myself. For some reason, she took that as an insult.
It is the politicization of medical care and research that led me as a physician to study some economics in the past 7 years.
The use of politics in medicine is certainly anti-scientific, but imagine what would happen if we adopted a single payer approach. Then politics will determine everything, subject to fads, irrationality, power struggles, corporate donations, and the rest. Now, the NIH favors breast cancer; just imagine when all of medical care is under the governmental thumb.
Dr. Tony,
Red did get used for heart disease. Women's heart disease, in the Red Dress approach.
Maybe a mauve, or really dark red?
First, the ribbon. Half red, half blue to represent the traditional colors of the circulatory system.
Second, breast cancer research versus heart disease. There is a tremendous quality-of-life benefit to come out of advances in breast cancer treatment in just the past 10-years.
My mother is a survivor (twice!) and a technique adpoted from melanoma treatment spared her a great deal of pain and suffering. Instead of a radical mastectomy she had a sentinal node biopsy followed by a lumpectomy. No radical surgery requiring a long post-operative recovery and probable reduction in limb efficiency.
Men get breast cancer too. Richard Roundtree (aka "Shaft") is probably the best known example. That notwithstanding, breast cancer is a very personal and self-esteem destroying affliction for women. Our society teaches women to put great stock in their appearance--otherwise the silicon implant industry would not be so productive--and breast cancer strikes at the core of that construct. It strips women of an elemental part of their identity. (I realize that I am generalizing, but I think it a safe generalization.)
Additionally, advances in knowledge about breast cancer may cross-pollinate other cancer specialties. These types of discoveries are often serendipitous and applicable to other forms of cancer.
Now, you can make the argument that heart disease does not present identically in men and women and that there are different risk factors depending on gender. You can also state that race (i.e., genetics) has a great deal to do with whether or not one is disposed to heart disease. It does require additional research and attention. However, a great deal of the developments in--at least--surgical intervention will apply equally to patients of either gender.
Heart diseases strikes both genders at a high ratio of the afflicted versus the general population. We do know that a great number of those cases are preventable--or at least identifiable--through diet, exercise, and simple blood screening tests (my wife and I used a blood-based home test kit to determine our cholesterol levels).
I know (from the Instapundit) that Dr. Helen was considered fit and not overtly at risk for heart problems. The vast majority of heart disease patients out there are at risk because of poor lifestyle habits. Obesity, smoking, and sedentary hobbies complicate the larger segment of heart disease patients. They are contributing factors.
If we can eliminate those factors, the obscure, occult cases like Dr. Helen will jump to the fore.
It's like the revolution in the treatment of high blood pressure (yet another element that predisposes one to heart disease). Once upon a time "high" blood pressure was categorized as any chronic systolic (the higher level, when your heart is at peak contraction) pressure over 150 mm/Hg (millimeters of Mercury). Once doctors achieved large scale reductions of pressure in the patient population, they realized that patients that were considered "marginally high" (say 140-145 mm/Hg) benefitted from treatment. (By the way, treatment largely consists of blood pressure-lowering medications combined with dietary restrictions.)
Once the "marginal" cases were taken care of research showed that "minimally high" pressure patients (130-140 mm/Hg) benefit from treatment too. ("Normal", "textbook" BP is considered 120/80 mm/Hg for a haelthy male...about 10-15 points lower for women.)
I've even seen a university presentation on educational TV (loove that Dish) where a professor in cardiology from the University of California system (It was either UCLA or UCSD, soryy...I can't remember.) said that there's anew drug that lowers "bad"--or LDL--cholesterol while leaving "good"--or HDL--cholesterol high. He suggested that the new standard for acceptible levels is 100 mg/dl of HDL or higher and no more than 50 mg/dl of LDL. (He said the LDL is like trash and the HDL is like trash collectors. As long as you have more collectors than trash--you're good.)
Another presentation suggested treating any blood pressure over "normal".
The doctor actually suggested that we could see the end of heart disease if the HDL drug proves to be as promising as it appears right now.
Good grief, I've rambled. Sorry so long.
Good health to everyone and I'm just happy that we can get a bunch of folks out to support any medical research.
For what it's worth, I (56-year-old male) was recently diagnosed with an enlarged heart muscle (cardiomyopathy, currently ideopathic, but more tests pending) that pumps out about 10 to 15 percent of the left ventricle volume. I have been told (and read web-info) that normal EF ranges from 50 to 75 percent. My sister died nearly 20 years ago of a similar problem, which was attributed to a viral infection of her heart muscle. I am slender, an ex-runner, and relatively health-conscious. Thanks to an angiogram two weeks ago, 'we' know that the arteries near my heart are 'normal', that is, they are not the source of my 'lazy heart' problem.
The symptom that started the medical inquiry was sporadic tachycardia-heart 'palpitations' or elevated heart rate. Of course, that never occurred during any EKG monitoring, and it was only during a month-long period of carrying a portable monitor that enough data were recorded to merit further inquiry. Only then was I scheduled for an echocardiogram, and that is when the more serious problem with pumping volume was identified.
I suspect that genetics (probably via susceptibility to infectious vectors-both viral and bacterial) has something to do with my circumstances. But I would encourage anyone with symptoms, whether paranoid or not, to get a sonic video done. I expect there are more Dr. Helens and Jim Fixxes (and mixedmeta4s) among us than we assumed or suspected.
To Mixedmeta4,
I am so glad they found the source of your problem and you are getting treatment. People want to believe that heart problems strike people out of their own sloth, laziness, drug use etc. but almost everyone I have know with heart problems has very few of these traits, if any. When someone dies of Sudden Cardiac Death from a rhythm problem, even athletes, the cause of death is rarely discussed or is said to be unknown so people do not realize how many of us are affected by heart problems. I wonder if these deaths are even counted as heart deaths. Good luck to you.
hmmm. what exactly does that mean--your "emotional makeup" is more "masculine"?
and gee, i really hate to give you any more ammunition for this attitude of yours but....
perhaps you already know this... there is a Medicaid category which provides coverage for "Women with Breast and/or Cervical Cancer". What about lung, liver or pancreatic cancer? And if for some reason, the government is only interested in the "naughty bits and pieces" of the populace, what about testicular and prostate cancer?
Why someone hasn't filed a suit challenging this I don't know.
To anonymous,
By "masculine" emotional makeup--I meant that I showed anger more directly to other people than typical women did in the south. I realize that women feel anger just as readily as men but they tend to show it in different ways such as passive-aggressive techniques such as not wanting to be your friend etc. Many junior high age girls were terrified of this rejection (still are) whereas I would just say, "fine, don't be my friend, what friend would say that to me?" I think men in our society are more direct with their anger (although that is changing). Some girls/women use power plays of human relationships to get what they want. I neve would play this game and as a result, was never in the girl club. However, the display of direct anger is not always a good thing and I have had to learn to temper myself.
As for the info on the medicaid category for Breast and Cervical Cancer, I did not know that, thanks---I don't know why no one has challenged that.
Allicent,
Thanks for the compliments.
Dr. Helen said: "I showed anger more directly to other people than typical women did in the south. I realize that women feel anger just as readily as men but they tend to show it in different ways such as passive-aggressive techniques such as not wanting to be your friend etc. Many junior high age girls were terrified of this rejection (still are) whereas I would just say, "fine, don't be my friend, what friend would say that to me?" I think men in our society are more direct with their anger (although that is changing)."
I don't live in the south, but my sister is like this and sometimes I think she does it to be mean. I am a very timid guy and I would never want to marry someone with this type of personality.
希望大家都會非常非常幸福~
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