Is socially irresponsible science contagious?
July 27, 2007 § 5 Comments
I’ve been thinking about your comments on yesterday’s post about the obesity study, all of which expressed at least a hint of skepticism about the study’s conclusions, if not outright derision. While I am heartened by your response, I remain disturbed by the assumptions that lie at the heart of the research. A discussion follows.
To begin with, I feel compelled to note the incorrect usage of the term “epidemic” to describe patterns of obesity, which has become de rigueur among health professionals in recent years and which begs to be problematized. Although the term is often used figuratively, it nevertheless has a primary definition: “a widespread incident of a disease in a specific area at a particular time.” Usually, the term is used to refer to diseases that are spread virally, such as HIV/AIDS or smallpox, and whose transmission carries the risk of large numbers of fatalities, such as the influenza epidemic of 1918.
Although it is commonly associated with an increased risk of disease development, obesity is not in and of itself a disease, nor is it classified as such by responsible medical professionals. From an insightful scholarly article on the subject:
Obesity, defined as a body mass index (BMI, kg/m2) or percentage body fat in excess of some cut-off value, though clearly a threat to health and longevity, lacks a universal concomitant group of symptoms or signs and the impairment of function which characterize disease according to traditional definitions. While it might nevertheless be possible to achieve a social consensus that it is a disease despite its failure to fit traditional models of disease, the merits of such a goal are questionable. Labeling obesity a disease may be expedient but it is not a necessary step in a campaign to combat obesity and it may be interpreted as self-serving advocacy without a sound scientific basis.
Further, there is disagreement among health researchers about the relationship between increased body mass and disease comorbidity. For example, recent research has shown that people who are moderately overweight have a lower death rate than people who are thin; also, weight loss has itself been associated with higher death rates in numerous studies. Therefore, it would be premature to assume that increased body mass is directly linked to the outbreak of disease.
Despite this, the study’s authors (and virtually all subsequent media reports) use the term “obesity epidemic” to describe current obesity rates, and they frame their conclusions using this concept. Moreover, the authors speculate (but do not prove) that obesity may have an “infectious” dimension, a hypothesis their research appears to support. Since the study does not claim that obesity is a truly viral condition, the term is used figuratively to suggest a process of contagion that is as dangerous as that of true epidemics. For this reason alone, the study deserves to be read with a critical eye.
This leads us to a second and even more insidious assumption that the study is based upon, which is implicit in its findings: namely, that obesity is a health crisis that must be controlled at any cost. By framing obesity as an epidemic that spreads pseudo-virally, it legitimizes forms of medical intervention that would normally be reserved for outbreaks of highly fatal diseases such as smallpox. In this case, interventions are directed at social networks, which the study claims are directly implicated in the “spread” of obesity. As the study’s authors speculate, social interaction with obese friends “normalizes” the experience of obesity by reinforcing the notion that it is socially acceptable. From the article:
Having obese social contacts might change a person’s tolerance for being obese or might influence his or her adoption of specific behaviors (e.g., smoking, eating, and exercising).
Thus, it seems reasonable to infer that if obesity is an epidemic, and an epidemic that is linked to normalization within the context of social networks, then strategies of social denormalization are a legitimate and potentially effective way to reduce obesity rates and stop the transmission of serious disease.
Sound familiar? Let’s see where we’ve heard this before, shall we?
Social denormalization is one of the core strategies that is employed by the tobacco control movement, and has been adopted by health researchers, government bodies, and the World Health Organization as a justifiable means of reducing smoking rates. The Cancer Prevention Institute of Canada provides us with a working definition of the concept:
[S]ocial context builds on the ideas that the cultural norms and expectations in a society can exert a powerful influence on behaviour. Social denormalization is a related phenomenon which describes the point where attitudes match and reinforce behavioural change (which has been brought about by whatever means), so that the wide majority of a population has adopted a new dominant attitude, e.g., smoking in someone’s home without permission is unacceptable.
[ . . . ]
The application of denormalization to risk factor reduction within a population is clear and appropriate. It represents a call to create long-term public health messages within society that eventually produce a sea-change in public sentiment, that in turn might be more effective than any other intervention in changing personal behaviour. This shift in social atmosphere has the advantage of being at least temporarily self-sustaining, i.e., with little or no additional public investment. [Emphasis mine.]
In other words, the goal is to use various means of communication to transmit messages that stigmatize risky personal behaviours, such that the social “atmosphere” will actively reinforce the health industry’s efforts to eliminate them. As the CPIC notes, this is an extremely cost-effective way to combat health problems, since, unlike other prevention strategies, it does not require a significant outlay of public funds.
Despite the tobacco control movement’s association with social denormalization, the strategy was originally utilized for a somewhat different purpose. Disturbed by what they viewed was the “normalization” of recreational drug usage during the 1960s and 70s, the founders of the Partnership for a Drug-Free America embarked on a campaign to “denormalize” street drugs in the mid-1980s. With the enthusiastic support of the Reagan administration, the PDFA flooded the airwaves with public service announcements that linked drug use to brain damage, physical disability, and death, most notoriously in the “This is your brain; this is your brain on drugs” series.
The PDFA’s campaigns have since been widely criticized for disseminating misleading, and in some cases fraudulent information about the effects of specific drugs, and for inadvertently undermining the public health goals that it claimed to advance. Even so, the strategy legitimized the Reagan administration’s “War on Drugs,” which utterly failed in its efforts to eradicate recreational drug use but was nevertheless highly effective at stigmatizing drug users. As a consequence, a range of legal interventions which might otherwise have aroused political opposition, including increased sentences for drug possession, drug testing programs, and mandatory drug searches in schools, were implemented without protest.
In retrospect, this shows us that social denormalization campaigns are only partially effective, since to date none have eliminated the behaviours they set out to abolish. However, despite proponents’ insistence that such tactics are aimed at the offending behaviour and not at those who engage in the behaviour, they have been most successful at stigmatizing the individuals and communities whose health they seek to protect. Any drug addict who has been jailed for their addiction can attest to the veracity of this statement, as can any mother who has been threatened with having her children removed from her custody solely because she smokes cigarettes.
In the case of obesity, the threat acquires a unique character, since it is arguably the first time that social denormalization strategies have been targeted at a population that is not primarily defined by addiction. (I say “arguably” because the term could easily be used to describe the centuries-long campaign of discrimination against queer people, which often claimed a basis in health science.) In theory, one can say that the strategy stigmatizes the act of smoking, not the individual smoker (although in practice it amounts to much the same thing), but I wonder how it is possible to separate obesity from the subjectivity of an obese person? Fatness is not something that one does, but a condition of what one is–i.e., it is the body through which an individual experiences the world, just as possessing a female body is part of the subjectivity of those of us who are women. How do you denormalize the condition without denormalizing the person? I say that it is impossible.
In this sense, the strategy is recklessly cruel in its exploitation of social norms, which, as uberfrau writes about elsewhere, are already experienced as punitive and isolating by people who do not conform to our culturally constructed ideals about what a human body should look like. As with drug use before it, in a misguided quest to “save” those who are obese, the health industry will unthinkingly make life intolerable for those who remain so by rendering them outcasts in a society that believes that health must be achieved by any means necessary. The approach is not only scientifically unsound but ethically repugnant, and it is a clear violation of the Hippocratic Oath to never do harm. If we tacitly support its goals then we are complicit with them. Period.