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| Textes de conférences disponibles |
L'OMS la dimension culturelle de la santé et les droits de l'homme
Claudine Brelet | | Docteur en sciences sociales, ancien membre du personnel de l'OMS, lauréate de l'Académie française, Paris | Initiative multi-partenariale de santé publique urbaine à Libreville / Owendo (GABON)
Thierry Coffinet | | Maison de la santé publique et du Développement social, Gabon | Les trois tempêtes
François Dagognet | | Professeur émérite de Philosophie – Université Paris I Panthéon-Sorbonne | Les biotechnologies en médecine
Claude Debru | | Professeur de Philosophie des sciences, Ecole Normale Supérieure, Paris | Les défis actuels du droit médical face à l’éthique
Francine Demichel | | Professeur, agrégée des Facultés de droit, Université de Paris 8, France | La médecine entre «hubris» et «phronésis»
Dominique Folscheid | | Professeur de philosophie, Université de Marne-la-Vallée, France | Diseases of modernity and biomedical moralities
Anastasia Karakasidou | | Department of Anthropology, Wellesley College, Massachusetts, USA | Les méthodes prophylactiques et les pratiques soignantes des maladies d'ordre gynécologique (sans recours aux médicaments) chez les jeunes filles de la société moderne
Tatyana Kovalenko | | Université de Volgograd, Russie | Des espaces de réflexion éthique : pour quoi faire ?
Pierre Le Coz | | Maître de conférence en philosophie, Faculté de Médecine de Marseille, Membre du Comité Consultatif National d’Ethique pour les Sciences de la Vie et de la Santé (CCNE), Membre de l’Agence nationale de la biomédecine (ABM), Docteur en science de la Vie et de la Santé, Directeur de Rédaction de la revue d’Ethique « Forum » de l’Espace Ethique Méditerranéen de Marseille | Expérience de terrain. Confrontation inter et transculturelle : France - Togo - Guinée Conakry - Gabon
Gontran Pierre Marie Maka | | Médecin, Cabinet médical ANYAMBYE AKEWA, Libreville, Gabon | Initiative multi-partenariale de santé publique urbaine à Libreville / Owendo (GABON)
Gervais Mbita Truffault | | Médecin, Consultant Coordinateur de la Maison de la Santé Publique et du Développement Social / Projet de Santé Publique Urbaine - Libreville | Le Brésil - le Programme de Santé de la Famille: pratiques et enjeux
Maria Guadalupe Medina | | Médecin, Salvador de Bahia, Brésil | Les rebouteux : place de ces tradipraticiens dans la prise en charge des traumatismes de l'appareil locomoteur
Abdeljalil Moulay | | Médecin, Rabat, Maroc | Les rebouteux : place de ces tradipraticiens dans la prise en charge des traumatismes de l'appareil locomoteur
Khireddine Mourad | | Université El Cadi Ayad, Marrakech, Maroc | La santé comme authenticité
Patrick Paul | | Professeur associé H.D.R en Sciences de l'éducation, Université François Rabelais, Tours | Le moment est venu d'être modeste
Philippe Pignarre | | Éditeur des Empêcheurs de penser en rond, Paris | Diversité culturelle et médecine traditionnelle à Madagascar : Impasses et opportunités
Philippe Rasoanaivo | | Institut Malgache de Recherches Appliquées, Antananarivo, Madagascar | Ethique médicale interculturelle
Didier Sicard | | Président du Comité Consultatif National d'Ethique, Paris, France |
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| LES NOUVEAUX DÉFIS ÉTHIQUES DE LA MÉDECINE |
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| Diseases of modernity and biomedical moralities |
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Anastasia Karakasidou
Department of Anthropology, Wellesley College, Massachusetts, USA
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Linda is an American woman in her early 50s, and she has been suffering from Stage Four colon cancer for the past three years or so. After three major surgeries, many rounds of chemotherapy and other experimental drugs, doctors keep reminding her that her cancer, although metastasized to her lungs, liver, and the lymphatic system, is “insignificant” and can be controlled. When I visited her during one of her post-surgery recuperation, she spoke knowledgeably about different chemotherapy ‘cocktails,' but on her bedside table, I noticed a small laminated card printed with the ‘Prayer to St. Peregrine,' the patron saint of cancer patients[1].
O great St. Peregrine, you have been called ‘the Mighty,' ‘the Wonder Worker,' because of the numerous miracles… For so many years you bore in your own flesh this cancerous disease that destroys the very fiber of our being…You were favored with the vision of Jesus coming down from His Cross to heal your affliction. Ask of God and Our Lady, the cure of the sick whom we entrust to you….[2]
My friend noticed me reading the prayer card. “You cannot lose hope,” she said simply. Undeterred, and driven perhaps by a ‘bare life' instinct for survival, she continues to search for information about the disease and therapeutic options. She went on a complimentary medicine regiment, and although she does not make plans for the distant future, she “battles” the “dread disease” (Patterson, 1987) everyday and attempts to lead a “normal” life.
Linda is one of the millions of Americans suffering from all sorts of malignancies. Today the American cancer patient can be regarded as the quintessential modern patient: the rational individual who, more or less, accepts the authority of the trained oncologist, whom in turn is an authoritative source of information, and some explanation, or even comfort and solace. Excluding the few cases of “rebellious” patients who seek alternative treatments, the vast majority of Americans have faith that our medical specialists will heal us. In modern society, science has usurped a sacred place more dominated by religion, while bio-medical research and health care have come to command a large share of the economy. Modern bio-medical science promises to free us from the fetters of primitive fear of disease through modern rational therapies. We are finding ourselves being less and less afraid of cancer. Their therapeutic techniques, however, entail their own processes of discipline and compliance that render the model modern cancer patient ever more dependent upon biomedicine. “The modern American,” noted the French medical historian Dubos, “boasts of the scientific management of his body and soul.”
The model modern patient is based on ideas of the Enlightenment, on notions of rational knowledge, empowerment, control over and liberation from nature. As Foucault observed, (p.x) the sovereign power of the empirical clinical gaze dispelled the shadows of ignorance, as “doctors described what for centuries had remained below the threshold of the visible and the expressible.” Through the clinical experience, the concrete individual is opened to the objectivizing language of rationality, and the patient becomes a field of scientific investigation. But, as Taussig (1980) has argued, modern biomedicine manipulates the ‘language' of our bodies, and hides the human (i.e., political) relations embodied in definitions of symptoms, and in therapeutic strategies. In this sense, biomedicine mystifies the power relations of the modern social order through the ‘reification' of the patient's consciousness “in the guise of a science of physical things.” Taussig maintained that “in this way disease is recruited into serving the ideological needs of the social order, to the detriment of healing and our understanding of the social causes of misfortune.” Cancer illustrates this recruitment: it causes the “reification” of the patient, but it also conceals the material and ideological structures of modern society that cause carcinogenesis.
In the United States, ever since President Richard Nixon declared 'war' on cancer in 1971 (Rettig 1971), the metaphor of 'battle' has provided the dominant paradigm for popular understanding of the disease. Cancer is perceived as an enemy invasion that attacks and besieges the body as “uncontrollable, lethal, and deceptive traitor that destroys the person from within” (Hunt 1998:30). Biomedicine promises to empower individuals with scientific knowledge to fight cancer, but the ‘battles' of this ‘war' tend to be fought on the basis of individual engagements (see Whiteman and Slevin 1996). Today, the search for "a cure for cancer" has become a pervasive part of contemporary global culture. Since the development of ‘germ theory' in the last quarter of the nineteenth century, western biomedicine has been profoundly shaped by the doctrine of specific etiology of disease. But therein lays the rub with cancer. It has become increasingly apparent that cancer's causality cannot be explained through specific etiology.
In the same vain, the etiology of cancer in the United States is understood primarily in terms of the statistical concept of risk (especially hereditary), with the individual patient at the center of a localized treatment process that begins at the moment of diagnosis (Lock 1998; Checker 2000). This discourse on “risk” is distinct from that of “danger,” as Margaret Lock has observed, for it foregrounds the responsibility of the individual's own subjective rational consciousness in managing diet, exercise, and life-style choices that may influence one's risk of developing cancer (Clinton and Giovannucci 2001). It seems we all live in what Ulbrich Beck (1992) called, “risk society.” Hereditary genetics has encouraged many Americans to regard cancer in more familial terms, as a sort of 'indigenous' disease ("we have it in our genes"). But, we can ill afford to ignore or downplay exposure to other external carcinogenic factors that usually contribute to the onset of cancer, if we are to understand the epidemiology of the disease.
We can identify carcinogenic agents, but not a single causal agent. What we understand is that exposure to a constellation of circumstances, a multiplicity of factors may increase the risk of carcinogenesis. As Margaret Locke observed, what we get from modern biomedical science is “risk assessment,” not causality[3]. The protection of one's ‘bare life' is thus the responsibility of the individual, not the state, the national body, or the social collectivity. The social order itself, our modern ‘quality life,' is not in danger; as individuals, we make choices that exposure ourselves to relative levels of managed risk.
It comes, therefore, as no surprise that issues of medical ethics of cancer concentrate around issues of early detection and treatment. That is, the ethical discourse of carcinogenesis centers around the scientific management of the human body, and not on the ethics of allowing carcinogenesis to happen to begin with. It debates and asks for universal availability of the management of the cancerous body, for all peoples of all cultures and socio-economic status. The example of the town of Wellesley and the increased death rates from prostate cancer among the tiny African American minority men of the town (the vast majority of the town's male population being white affluent men with access to the best biomedical system in the country. While the prostate cancer incidence in the town of Wellesley is increasing every year and many white men undergo early detection, and live with prostate cancer for years, the ethics of public health officials are not evolve around the question of what causes and how it can be prevented, but whether the scientific management of the cancerous body should be universal.
For anthropologists, theorizing about cancer is a challenging task. As our understandings of cancer are both socially and culturally constructed, we, as anthropologists, seek a definition of cancer that offers better prospects for a social history of the disease (Ranger 1992). It is almost a truism to claim that disease is not only a biological event, and that one finds it situated at all the major intersections of world history and politics, whether in endemic (infectious), epidemic, or pandemic manifestations (Hayes 1987; McNeill 1977; Crosby 1986). Cancer, like other potentially fatal diseases, challenges and puts to the test all cultural assumptions of our species. It is situated at the intersection of the politics of the modern industrial nation-sate, and the biomedical system that accompanies it. Cancer might have a long duree, (as I will discuss below), but at the start of a new millennium, cancer seems to be embedded in modern life in a way that it was not in 5th century B.C. Greece, where it was first diagnosed. It is still a terrifying disease, a pervasive part of the global scene, afflicting men and women, young and old, rich and poor alike.
For myself, I wanted to approach cancer pace Aristotle's Politics: to see things grow from the beginning, so to speak, both the disease as well as our thinking about it. I wanted to understand cancer from its origins, and to contextualize knowledge of the disease within our highly chemicalized generation of life. Cancer, it seemed to me, had become a fundamental human condition, and a mimic of modernity.
Historians of medicine tell us that cancer is an old disease, and an old people's disease. It was not regarded as a “monster of infection” that revealed itself quickly, like the plague. It revealed itself slowly, often over a span of years, becoming increasingly aggressive. Experts today tell us that prior to the nineteenth century, one was far more likely to die of such infectious diseases, malnutrition, or accident before cancer had time to develop within the body (Weinberg 1998). When cancer did appear, it was attributed to an 'act of God,' or to ill will, tragic fate, or poor fortune.
Yet there is also widespread consensus that, prior to the twentieth century, it was quite rare, although the “master narratives” of the history of cancer trace it to Neolithic times. “Evidence of primary malignant tumors in ancient bones is rare” (Sandison and Tapp, p.51)[4]. Hippocrates (c. 460-377 BCE), commemorated in professional oaths as the forefather of modern medicine for his rational approach to disease, diagnosed women's breast cancer in his treatise, ‘Carcinosis.' He offered no explanation as to the causes of the disease, nor prescribed any of his characteristic therapeutic diets, noting that such patients tend to die quickly (Hippocrates 1939). It was him who gave the ailment the name of the ‘crab,' alluding to the distended veins radiating from the lumps of the breast. Galen (c. 130-210 CE), who like Hippocrates eschewed divine agency for natural causes of disease, found breast cancer among melancholic (i.e. black-bile) women, which he attributed to ‘miasma' or ‘pestilential atmosphere,' referring to external influences that induced imbalances in the body's four ‘humours:' blood, phlegm, and yellow and black bile[5].
Paracelcus at the turn of the 16th century 1493-1541), an early pioneer in disease etiology, pathogens, and occupational disease, introduced the use of chemical compounds as therapeutic medicines, emphasizing ‘proper dosage.' But even he regarded cancer as a chemical imbalance, attributing it to excess of mineral salts in the blood.
Until the late nineteenth century, cancer was generally regarded as a concentration of black bile, which migrated to various organs in the body. Cancer has been a long feared and often unmentionable illness, highly stigmatizing and surrounded by a silence and secrecy, once not even mentioned on death certificates in nineteenth century America. Some people feared the physician or surgeon as much as the disease itself, and took to walking backwards and throwing objects over their shoulder, or to wearing their clothes inside-out, to ward off cancer. There were few 'remedies,' perhaps a puppy's head powdered with honey, or maybe morphine to ease the pain. To this, biomedicine in the second half of the twentieth century offered radiation and chemotherapy, and some began to hope for a cure (Patterson 1987:20).
But the scientific transformation of medicine also prompted a medicalization of perceptions of cancer, facilitated in no small way through advances in microscopic technology, anesthesia, cell biology, and other fields. Tumors were no longer seen as black bile but as solid masses, and by the early twentieth century, a number of new theories had been proposed to explain cancer. It was attributed alternatively to germs, contagion, heredity, and mental or emotional stress. Some saw it as a 'random' killer, while others described it as a disease of civilization, noting that cancer seemed to be absent among primitive societies, suggesting industry had destroyed the balance between humans and the natural environment (Patterson 1987). Owing in large part to the growing influence of bio-medical science, by the 1920s and up to the present, four principal theories attempted to account for the causes of cancer: 1) old age and somatic degeneration; 2) hereditary predisposition; 3) viral or bacteriological infection; and 4) external 'irritation' (see also Cope 1932).
While researchers searched for and argued about causes, the number of cancer deaths in the United States continued to rise. In the 1840s, 15-20/100,000 people died of cancer. By 1900, however, this number had more than tripled to 64/100,000 (Patterson 1987:22-3). By 1976, it had doubled again to 100-150/100,000. The American Cancer Society reports now that the number is well over 200. (www.acs.org). In this sense, the conquest of cancer presented one of the greatest challenges to bio-medical science (Ewing 1992). The first "alliance against cancer" within the medical establishment was forged in the 1920s, which the government joined in the 1930s with the establishment of the National Cancer Institute (Patterson 1987). Special investments were made in cancer research hospitals and other facilities, and the public was warned to seek medical help before it was too late. Early detection, surgery, and an educated patient were said to hold the best promise of successful treatment. While the pace of research increased, a 'cure' seemed to remain elusive. At the start of the twenty-first century, cancer has become a global phenomenon, afflicting people throughout the world. The geographical space of cancer incidence appears to be both transnational and ex-territorial. In unexpected ways, the spread of cancer seems to have reinforced notions of a ‘global village,' reminding us of our common frail humanity. The availability of such techniques and treatments to everybody in the global ‘village” has been the bio-ethical discussions regarding cancer. But bioethics cannot be separate from biopolitics. The biomedical paradigm frequently decontextualizes cancer from its environmental and social milieu, individualizing it within a specific body. Illness, accordingly is an entirely “biological phenomenon” and its treatment a “technical intervention to a mechanical problem.”
Foucault's influential studies of the relationship between science and modernity saw the two linked in a civilizing project that sought to order the world through knowledge and power (Foucault 1973, 1980). Although the foundations of scientific knowledge are distinctive, the metaphor of biomedical war on cancer is a moral discourse of modernity, and in this sense shares certain affinities to other moral discourses, even those that attribute the disease to adultery, hedonism, domestic violence, and promiscuity (Hunt, 1998). The immediate goal seems to be to control, tame, and domesticate cancer into a mere chronic illness. Like the parable of blind men each describing one part of a large elephant, we have not discerned all pieces of the cancer puzzle. And the most important piece that is still missing is that of the causality of carcinogenesis.
In Politics, Aristotle posited his famous dictum that man is a political animal: a living animal with the additional capacity for political existence; a cultural animal. Human nature, Aristotle suggested, was based on a fundamental juxtaposition between zoe (i.e., a ‘bare life' animal-like essence within us; and bios (that is, ‘quality life' derived from our cultural capacities). The polis, or political unit (i.e., the culturally based social formation), derived its legitimacy, indeed its definition, largely on its distance from an animal-like ‘base' life existence in nature. Culture, in a sense, makes life good; it civilizes nature to add quality to life, thus distinguishing our species and human experience from that of other (non-political) animals. Modern society rests the basis of its political legitimacy on the degree to which its culturally-based ‘quality life' seems to distance itself from the base nature of our ‘bare life' biological existence.
One may look for this distinction in our dealings with disease, the primitive instinctual concern with the preservation of our selves and species manifest in the ‘bare life' of our zoe, on the one hand, and the culturally-derived ideological formations that support the ‘quality life' social collectivities in our historical bios, on the other. For Foucault, however, biological modernity meant that both the individual organism and the species became the focus of a society's political strategies. The life of our species, he argued, is wagered on our political strategies, with bio-power among the most fundamental paradigms of modern society. Agamben suggests the politicization of ‘bare life' (the decisive event of modernity) occurs in a ‘zone of indistinction,' where living beings are transformed from the objects to the subjects of bio-political power. Whereas Agamben applied this theoretical framework to the empirical context of Nazi concentration camps, one may observe this ‘zone of indistinction' in bio-politics of cancer: a site of both subjective individuation (where the modern cancer warrior is situated, who wages war against his own body) and objective totalization (in which western medical technology is regarded as the only effective treatment of the disease)[6].
For all its nuances, absent from Foucault's influential work on bio-politics was any critical questioning of the dominant belief in the superiority of Western biomedicine. I would argue that the efficacy of scientific medicine played a strong role in the fusion of these two distinct modalities of power in the West. Agamben has argued that this process of convergence, which defines notions of biological modernity, occurs in a ‘zone of indistinction. It is here, he argues, that modern man, Homo sacer (or ‘sacred man'), may be killed but not sacrificed. As I will argue, people may die of cancer, or be killed by cancer, but it seems antithetical, or sacrilegious to suggest that the bio-politics of the modern scientific and industrial state would permit modern ‘sacred man' to be sacrificed to cancer.
The strong alliance between state and industry, and the role of science and biomedicine in the service of national interests, has played a major role in the history of chemistry, and in the chemicalization of material culture. The chemicalization of modern life began early in the history of the cultural accomplishments of homo sapiens, but it begun in earnest during the age of industrialization and with the use of chemical fertilizers and pesticides in food production[7]. There seemed to be boundless prospects for converting nature to the needs and demands of modern society. Although some academic scientists voiced suspicions about the new chemical industries, there were many chemists who devoted their work to their national cause, to protecting and improving the ‘quality life' of modern society. For example, Haber's pioneer synthetic production of ammonia to be used as fertilizer was put to further use in the production of explosives: by oxidizing ammonia, it was easier to produce the nitric acid used in munitions[8]. Working to save the world from starvation and disease, by producing fertilizers, pesticides and pharmaceuticals, the chemical industries also produced lethal weapons to protect their modern social order. These were happy, optimistic times. ‘They were the best of times, and the worst of times,' to borrow from Dickens. Scientific “prometheans in the lab” helped to create a modern world based on these new chemical compounds, ushering in an era of intensive industrial development that became global in its scope and reach.
Amid such heady scientific entrepreneurialism, clean air, pure water, workers' safety, and pollution control “paled in importance[9].” Entrepreneurial chemists perhaps had no idea that the chlorinated byproducts they were producing would come to be labeled as potentially ‘carcinogenic' in the second half of the twentieth century. But they certainly were aware that some of their workers were beginning to develop cancers, and even had concerns that this might be due to exposure to chemicals in the work place. The first serious cancer clusters observed at the end of the nineteenth century were among working-class peoples employed in the dye industries[10].
In 1895, a surgeon in Frankfurt-am-Main reported that three of the forty-five laborers working for Hoechst in the section of fuchsine production had developed bladder cancer[11]. Others had bladder ailments. The company's surgeon, however, maintained that the disorders could not be related to the production process, since the number of cases was so low. It was not until more cases were reported from Basel, Switzerland (another principal dye-producing region), that the German scientific community confirmed a causal relationship between the chemical dyes and bladder cancer, establishing the latter as a ‘compensable occupational disease' category for dye workers. And, here, I emphasize “compensation” as a replacement for “punishment.” Thereafter, German factories collected and maintained data on cancers among dye factory workers.
When American companies acquired German patents after WWI (the ‘chemical war'), they suppressed these data, and continued to expose American workers to significant health risks. It's all perfectly safe, we are told, again and again. The production process was regarded and declared as safe - until American workers developed cancers. In all these cases, bladder cancers began to be diagnosed roughly fifteen years after workers' initial exposure to carcinogenic chemicals (particularly benzidine) in the production process – precisely the typical latency period that epidemiologists would expect before the first indications of carcinogenesis become apparent in the body. The first bladder cancer incidents among the workers in the ‘infamous' Chambers Works were reported by the DuPont Company's physicians in 1932. Yet within only a few years, DuPont stopped releasing such data.
This, too, is another familiar story, versions of which we continue to hear today. Each time a claim, charge, or suspicion is raised about the toxicity of a chemical compound and its potential as a catalyst in carcinogenesis, scientists working for companies and governments raise objections. Those who voice concerns are labeled as critics, doomsayers, or eco-fanatics. There is no proof these chemicals are harmful to you, we are told. There is no scientific evidence, the authorities tell us. These inventions are good for us. They are intended to improve our quality of life, our ‘quality life.' And, this is at the heart of Agamben's theory of homo sacer who may be killed, but nor sacrificed, and yet nobody gets punished for the homicide.
From the historic moment of carcinogenesis induction to laboratory animals, I wonder why we are still not certain what causes cancer. It was as early as 1915 when a Japanese laboratory researcher (Katsusaburo Yamagiwa), was able to induce carcinomas in rabbits by repeatedly rubbing coal tar into the animals' ears. He hypothesized about the carcinogenic effects of coal tar, based on the very first epidemiological observation of cancer, made by London physician Percival Pott in 1775. Pott, regarded today as the ancestral founder of cancer epidemiology, described scrotal cancers among men whom had worked as chimney sweeps in their youth.
But how does coal tar induce carcinogenesis? Coal tars were a complex mixture of thousands of distinct chemicals. British chemists and cancer researchers tested these constituent compounds and found some of them to be very potently carcinogenic in animal experiments. Then, in the 1950s that it was discovered that these cancer-causing agents act through their ability to induce mutations in the genes of exposed animals: carcinogens are mutagens. Today, the carcinogens are in our genes; we have evolved carcino-genes.
And so goes the story of the sacred men of the modern world, those who “may be killed but not sacrificed.” Those whose ‘bare life' (zoe) is lost in the process of creating a ‘qualified life' (bios), a life for the modern population in general. Today, however, cancer is not an occupational disease, in the strict sense of the term. It is a growing epidemic that threatens the entire human species.
A few highly publicized cases notwithstanding, when homo sacer is killed by cancer, typically there is no perpetrator arrested, charged, or brought to justice. There are no indictments against the carcinogenic agents that killed him; no attempts made to bring to justice those deemed responsible for creating the conditions for carcinogenesis. There is no responsibility directed toward those who promised to manage his health and to cure his diseases, or who disciplined his cancer-stricken body into docile posturing for (costly and generally ineffective) therapies. There is little accountability for those who politicize issues of life and death within the mantle of science, or whom try desperately to persuade homo sacer that his life is not “in danger” but rather merely “at risk” depending on a range of personal life-style choices and behaviors. Rather, the ‘bare life' of homo sacer is sacrificed in the quest to preserve the modern social order, and the very conditions that have made cancer such a catastrophic epidemic in the world today.
Cancer's threat, from the perspective of molecular biology, is that the creation of a tumor takes just one ‘renegade cell,' running on an uncontrolled growth program directed by damaged genes. This new ‘alien' life-form or ‘mass' then invades the body, disrupting biological order and mechanical function, causing chaos, breakdown, and destruction in pursuit of unlimited expansion. It seems ironic that our modern global society, based on an economic system of unsustainable development, has come to be threatened by a disease that follows a similar logic. Cancer cells seem to be immortal.
Modern biomedicine cannot really help with cancer; it can only help to prolong one's life. Yet in the process, we struggle to maintain a sense of human dignity in the face of the devastating effects of both cancer itself as well as the chemical and radiological therapies modern science directs into our vulnerable bodies. We highlight cancer ‘survivors' like war heroes, encouraging our comrades-in-carcinogenesis to keep up the good fight, to not waver in the face of adversity, to maintain a positive psycho-emotional perspective. But, to better understand how a disease of the masses can creep up on people of all ages, classes, creeds, and genders in an age of modern individualism, we need to look at the movement of disease between the social and individual levels.
Man, in what John Stuart Mill famously called “the maturity of his faculties,” created the modern world, but with it also disturbed the ecosystem by industrial development and created the very miasmatic conditions that promote carcinogenesis. Today, modern homo sacer perpetuates those conditions in the blind faith that the ‘maturity of our faculties' will lead us to a cure for what we have wrought. The pervasive and systemic penetration of cancer throughout the modern world elusively threatens to subvert the sacred order of modernity, posing a threat to the ‘bare life' and ‘quality life' survival of both individual patients as well as the species in general. The paleontologist Richard Leakey has warned that we face a crisis of our own making, a coming sixth mass extinction, and if we fail to act appropriately we will “lay a curse of unimaginable magnitude on future generations. But the ‘bare life' of the species is not of overriding concern to the modern social order, as we hold to the conviction that modernity shall overcome all challenges[12]. In such a context, as Foucault suggested, “it become possible both to protect life and to authorize its holocaust.”
Notes
[1] Born to a wealthy family in thirteenth century Italy (Forli), Peregrine Laziosi is said to have become afflicted by cancer of the foot, which was miraculously cured following a night of prayer on the eve of a scheduled amputation. He died at the age of eighty-five in 1345, and was canonized by Pope Benedict XIII in 1726.
[2] From http://www.catholic.org/saints
[3] Cancer epidemiology generally attempts to calculate risk, often by manipulated data, leading to extended methodological debates. Yet even the most sophisticated cancer epidemiologists conclude its all a matter of “chance.”
[4] The celebrated specimen of the Fifth Dynasty ancient Egyptian femur was, some contend, wrongly diagnosed as osteosarcoma (by Elliot Smith? CHECK ON THAT).
[5] Until the late nineteenth century, cancer was generally regarded by Western medical specialists as a concentration of black bile, which migrated to various parts (especially organs) of the body.
[6] Does zoe become a base alterity that defines the progress of our bios?
[7]At the turn of the twentieth century, Europe was facing the prospects of a threatening famine. The President of the British Association for the Advancement of Science declared that “it is through the laboratory that starvation may ultimately be turned to plenty.” To fertilize their fields, Europeans had been using nitrogen compounds produced from marine bird manure (guano), imported from Peru, Chile, Bolivia, and the Pacific Islands. “By discovering how to convert nitrogen from the air into ammonia for fertilizer, Fritz Haber saved millions of people from starvation,” according to a historical biographical narrative of the man who invented the first chemical fertilizers.
Haber discovered that it was possible to produce ammonia from nitrogen and hydrogen. BASF, one of Germany's three largest chemical companies, opened a nitrogen-fixing ammonia factory in 1913, and the new chemical fertilizer was quickly adopted for use on wheat, corn, and other plants. In recognition of his miraculous-like making of bread “out of air,” Haber was knighted, and went on to accumulate riches, prestige, laboratories research teams, and even a Nobel Prize in 1918.
Haber (1868-1934) was a young inventor who had a deep love for his country, for rank and discipline, and was driven by a religious-like sense of unquestioning nationalism and science at the service of society.
[8] Haber also worked on poison gases deployed by combatants in the First World War. The efficacy of his creations were manifest in the Battle of Ypres, in Belgium, where chlorine gas was used to corrode the eyes, nose, mouth, throat, and lungs of its victims, eventually leading to asphyxiation. Decades later, the ‘Zyklon B' gas used in Nazi death camps was an offshoot of work done by Haber's laboratory.
[9] Waste was dumped into the North Sea, or piped secretly to be discharged into rivers, which changed colors. Workers were said to enter the Ruhr valley at “their own risk,” as many suffered from nose, lip, and throat ulcerations. But the consumer public demanded ever more from the fabulous rainbow of colors produced through the miracle of industrial chemistry, and production continued unabated.
[10] The example of the production of dyes is an illuminating one. It was iIn 1856, that an eighteen year-old Londoner named William Henry Perkins, working in an outdoor shed, was able to take black coal tar (a byproduct of the distillation of coal to produce gas for lighting) and first transform it into a beautiful purple dye, which came to be known as ‘mauve.' His discovery brought him fame and fortune. It effectively democratized the color process for the first time in human history, heralded by historians of science as an “enormous revolution” for the world's dye and pharmaceutical industries. The process Perkins devised provided the booming textile industry (then the largest employer of chemists) with cheap dyes to replace expensive natural ones.
This was an age of pioneering work and great discoveries, when anything seemed possible. Within six years of Perkins's discovery, the London International Exhibition of 1862 featured a marvelous display of coal tar colors, including mauve, aniline blue, yellow, and imperial purple. Inexpensive colorful cottons were produced on a mass scale, and quickly gained market dominance over luxurious silks worn only by the aristocracy and the wealthy. The fashion world, it was said, was “swept by a craze for the natural purple dye” made from such an abundant resource as coal tar, and the “mauve measles” epidemic spread across Europe.
[11]The development of the dye industry took place amid intense competition, accompanied by bribery, industrial espionage, patent fights, and court suits in the second half of the 19th century. While natural dye producers, such as indigo farmers in India, were financially ruined, Germany soon emerged as the new leader of the world's dye industry. German factories hired chemist-managers under attractive profit-sharing arrangements, and provided them with well-equipped laboratories for researching new chemical substances. Many German dye companies diversified into pharmaceutical chemicals, as well as explosives and munitions. The coal dye industry was to play a major role in the First World War.
[12] The civility and sanitation campaign that seeks to make Kunming a ‘Civilized City of Spring' attests to how such sacred beliefs invisibly subvert the ‘bare life.' Modern sanitation practices involve the chemicalization of everyday life, the long-term consequences of which contribute to the disruption of the natural balance of both the individual body and the body politic.
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| Conférence prononcée le 8/4/2005 | | Colloque «Pratiques soignantes, éthique et sociétés : impasses, alternatives et aspects interculturels», organisé sur l’initiative du PPF RISES de l’Université Lyon 3 en collaboration avec l’Université Lyon 1 et les Hospices Civils de Lyon, avec la participation de l’Université de Marne La Vallée. |
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