Advertising or Educating?

This article on the "hidden influences that sway our medical decisions" examines how the presentation of evidence in advertisements for drug treatments affects what patients believe about the treatments. It cites two studies which clearly show that current drug ads do not effectively educate patients—but they do sell more drugs.

In one study a group viewed actual drug ads, and nearly two-thirds of the group overestimated the drug effectiveness: "They believed it was 10 times more effective than it actually was"! But another group was shown ads with information clearly presented in a simple "drug-facts box." Three-quarters of this group "correctly assessed the actual benefits of the treatment."

This study shows us a lot about how presentation of evidence can affect an argument. It appears that different arrangements of the same evidence can lead the audience to very different conclusions. It also suggests an interesting research topic for Unit 3. How should drug advertisements be regulated? Should they be designed to educate patients, or to simply sell product?

Illness as Metaphor, Chapter 9 Summary

In the final chapter of Illness as Metaphor, Susan Sontag describes how diseases have been used by people throughout history as a means to describe unsatisfactory states of society.
          Sontag wrote Illness  after being diagnosed with breast cancer in 1975 and realizing how the language of cancer, from the disease itself to treatments and patients, relies heavily on metaphors (Grauer). Sontag argues that these metaphors greatly influence, mostly in a negative way, how those with a cancer diagnosis view their condition and how the world views the disease as a whole.  Illness was released in 1978, a time where a cancer diagnosis came with a stigma. Therefore timing of Illness' release appeals greatly to the rhetoric device of kairos because one of Sontag's goal in writing the the book was to destigmatize cancer by unwrapping the metaphors society uses to describe it. 

           In the final chapter of the book Sontag starts out by arguing that although physical diseases can express themselves in a variety of ways, from ulcers to lesions and tumors, when disease is used to describe a situation it is the treatability of the disease that matters, with diseases either being painful but curable, or possibly fatal.

What type a situation a disease metaphor is used to describe depends on how disease is clinically described at the time. In the 19^th century a disease was described as something that opposes life, says Sontag, so during that time period institutions like Communism were described as a “bureaucratic cancer” because of the view that it limits the possibilities of living life freely (Sontag pg. 75).

             Sontag also describes how classic political philosophy draws upon the classic medical interpretation of disease being the result of the humors of the body being out of balance in order to help explain political models. She gives the example of Machiavelli describing state affairs like “tuberculosis” because if they are treated soon they are easily taken care of or “cured" (Sontag pg. 77).

            When politics turns radical, however, Sontag points out how revolutionary violence is often justified by saying that society has a “radical, horrible illness” that can only be remedied through equally extreme means or ‘treatment’ (Sontag pg. 81). The identity of the fatal disease is employed as a metaphor in these situations, with rhetoric painting the chosen cause of decline, whether it was Hitler casting the Jews as a “cancer that must be excised” to Stalinism being called a syphilis, as an illness (Sontag pg. 82).
            Sontag's many examples of illness metaphors being used to describe political situations throughout history appeals to the rhetorical device of ethos, because it demonstrates her far-reaching topic of the knowledge of the topic to the readers of Illness. 

            One of the most common illness metaphors that has been employed throughout history is that of a cancer, Sontag writes. Because cancer is perceived as a radical disease that can only be cured with aggressive treatment, it is a favorite for people in power to employ to cast a situation as serious and warranting action (Sontag pg. 85).

            However, Sontag ends her chapter predicting that the fear cancer instills will wane with time as better, less radical treatments are discovered and cancer moves into the realm of an overall treatable condition.  Just like how science informed the definition of disease and what was metaphorically described as such in 19^th century, the decline of the perception of cancer as a death sentence, will decrease its metaphorical clout, even as the conditions it was once used to describe continue to exist (Sontag pg. 87).
          The rhetorical device used in this closing prediction is logos because it draws on a past example (the influence of prevailing science on the application of illness metaphors in different social situations) to support the future prediction of the cancer metaphor losing its impact. 

           

Works Cited:

Sontag, Susan. “Chapter 9.” Illness as Metaphor. New York: Picador, 1977. Print. 72-87

Grauer, Tresa. "Susan Sontag." Jewish Women: A Comprehensive Historical Encyclopedia. 20 March 2009. Jewish Women's Archive. October 3, 2011 <http://jwa.org/encyclopedia/article/sontag-susan>.

Illness as a Metaphor, Ch. 6-8 Summary

Susan Sontag wrote Illness as a Metaphor, in 1986. Sontag wrote this piece to help change the way society used language to describe illness and disease moving society away from blaming the person who is diseased or ill. Her writings primarily focused on cultural attitudes of illness as this had a serious impact on her life. Her father suffered from Pulmonary Tuberculosis (a disease that attacks the lungs), which is discussed in greater detail in the previous chapters. Sontag herself suffered from acute myelogenous leukemia and died on December 28, 2004.

Sontag summarizes the arguments about disease made over the years in this reading, “With the advent of Christianity, which imposed more moralized notions of disease, as of everything else, a closer fit between disease and “victim” gradually evolved.”

This reading starts out describing disease as intentional to the person as an individual. It argues that the person causes the disease because they do not express themselves emotionally. It’s not about the personality traits of the individual, but rather how abstract and dissociated the individual is with life. “The sick man himself creates his disease, he is the cause of the disease and we seek none other.” (46) It is insisted that because it is not pleasant in our society to look in ourselves internally for the cause, is why doctors prefer to attack the outer causes.

The second part of this reading focuses primarily on specific diseases. Sontag argues that specific emotions or characteristics within oneself cause specific diseases. An example of this is that with women, ”grief and anxiety are among the most frequent causes of breast cancer.” (56) Another example is found among businessmen and mothers of large families, since they tend to suffer from grief, stress and are overworked making them ideal candidates for cancer. The reading concludes by examining illness by a means of two hypotheses; #1) every form of social irregularity should be considered an illness and treated to the best of abilities; #2) every illness can be considered psychologically. In other words, people should believe that they get sick because they unconsciously want to, therefore they deserve it. They also have the ability to cure themselves by curing their mental “self”.

This next section focuses primarily on the meaning of disease. Disease was thought in terms of metaphors. When something was considered to be disease like, it was shameful and ugly. For example, in the last two centuries syphilis was looked down upon as a demeaning and horrible disease. Other metaphors were used such as, evil and foul. They used these metaphors to create an unequal environment among society. Syphilis was also thought to be a disease “that corrupts morally and debilitates physically.” (59) Other diseases have also contaminated the way people feel about strength, weaknesses, and energy.

In order to treat these types of diseases traditional medicines was used. While it treated the physical part of the illness they didn’t find it effective for the emotional and mental health. To cure psychological aspects of the illness it was suggested to use treatments such as, cheerful surroundings, isolation from stress and family, healthy diet, exercise, and rest. Doctors believed that treatment of both the psychological and physical aspects were essential to the treatment and recovery process.

The evidence presented in this summary shows the way society and doctors views toward treating illness has changed. In other words, their views of disease changed from thinking they were caused by “moral pollution” and “mismanaged emotions” (71) to a focus on psychological and physical aspects of the illness.

Works Cited:

Sontag, Susan. “Chapters 6-8.” Illness as Metaphor. New York: Picador, 1977. Print. 43-71.

Illness as Metaphor Page 5-26

Susan Sontag was born January 16, 1933 and died December 28, 2004. She was a patient suffering from Leukemia. Her father died of Tuberculosis (TB). She focused her work on cultural attitudes on illnesses. She wrote Illness as Metaphor in 1986. She attempts to speak with pathos primarily at audiences who use metaphors as illnesses.

Sontag argues that metaphors help us understand illnesses, but can only go so far. She uses TB and cancer as her examples. TB at the time was equivalent to the cancer-scare of her time or AIDs in modern era (7). Now the prevalent disease is cancer. We did not know the etiology of the TB disease back then, and we attempted to quarantine it. After advent of technological innovations, we soon found out the source of TB. In today’s society certain information is refrained from being disclosed to the patients – the methodology of disclosing information varies from country to country. The reason behind this was because it was thought to have had an indirect pernicious effect on the patients – it may have caused premature death. The metaphors of the illnesses provide some “horror” account for the patients. The patients were left to think of cancer (and previously TB) as “ill-omened, repugnant to the senses” (7). In other words, there were some sentimental values for these patients that the word cancer delineates a horrible feeling.

However, she’s not saying that these metaphors are all bad. She provides us with many comparing and contrasting metaphors to help describe both TB and cancer. She attempts to “aestheticize” both TB and cancer; and realizes cancer, with our current understanding of technology, cannot be “aestheticized” (20). She illustrates this by suggesting “Cancer is rare and still scandalous subject for poetry; and it seems unimaginable to aestheticize the disease” (20). She emphasizes that in no way can cancer be beautified like TB. She illustrates one of many examples by describing a patient’s body with TB as becoming “consumed”, or “burned up” or experiencing a sudden spurt of energy through his/her last days of life; as opposed to a cancer patient’s body becoming “shrivel(ed)”, dying a slow painful death (14). In addition, she provided many positive connotations geared towards TB, but many negative connotations geared toward cancer. Positive metaphors could hardly characterize cancer. Moreover, Sontag addresses how TB and Cancer were also viewed as a “passion for love”. Again, the connotations of this metaphor points to TB as “too much passion”, the positive, and points to cancer as the complete opposite, “insufficient passion”, the negative (20-21). Using metaphors in certain situations help us better understand the diseases and where our current information is at in current society.

Works Cited:

Sontag, Susan. “Chapters 1-3.” Illness as Metaphor. New York: Picador, 1977. Print. 5-26,.

Illness as Metaphor

In Illness as Metaphor, it’s author, Susan Sontag, argues that we cannot think or interpret something without the use of metaphors and seeing that “something is or like something-it-is-not is a mental operation as old as philosophy and poetry”. (93) He acknowledges that some metaphors are very useful in helping others understand how something works or acts, however, in this reading he persuades us to abstain or retire the many metaphors regarding health and the body.

He begins his article with examples of other metaphors that we use in our daily life and understanding. He talks of how we contrast social moments with being “left” or “right” and how this particular metaphor can be traced all the way back to the seating arrangements during the French Revolution when the republicans sat to the presiding officer’s left and the monarchists sat to the right. He argues that the idea of using terms such as “left”, “right”, “up”, and “down” work well when describing social conflict but it was Plato and Aristotle’s metaphor of government being like a body, “which is ruled by a head” (94), that made authoritarian governments seem inevitable and even justified repression. Sontag also includes the history of Western medicine when “metaphors for the unity of the body were adapted by the arts” (95); these included, harmonic and rhythmic living. It was these metaphors and their use that was the first to be argued against. Sontag references Lucretius, “who argued that it could not do justice to the fact that the body consists of essential and unessential organs” (95). Lucretius believed that not all the organs are equally important and to “let the musicians keep that [harmony] term” (96).

After metaphors regarding the arts and the body came to be, architecture and the idea of the body being “like a fortress”, “like a factory”, or like “a temple”, a term coined to Saint Paul, was now very popular. Each of these metaphors has a specific purpose and idea associated with it, but in the reading, Sontag focuses very heavily of the “body like fortress” metaphor. She notes that itself is a metaphor for the morality and human frailty. She quotes John Donne in his 1627 article Devotions upon Emergent Occasions, during which he describes illness as an enemy that “lays siege to the body-fortress” (96), a metaphor that Sontag would argue against the use of. However, it wasn’t until the “invader was seen not as the illness but as the microorganism that causes the illness…did the military metaphors took on new credibility and precision” (97). Since then, Sontag argues, has disease been seen as an alien invasion and the body is perceived to put up it’s own natural “military defenses” with medicine being “aggressive” warfare.

Sontag argues against this prominent use by saying how war-making is “one of the few activities that people are not supposed to view ‘realistically… In all-out war expenditure is all-out” and no sacrifice is excessive (99). Military metaphors contribute to the “stigmatizing of certain illnesses” and those who are ill (99). It was this stigmatization against Sontag herself, when she was diagnosed with cancer that led her to write Illness as Metaphor. What enraged her the most was how the sheer reputation of the disease added to the suffering of those who have it. She observed how the patients showed disgust at their disease “and a kind of shame” toward themselves for having it (100). Cancer is regarded as a disease in which the “physically defeated” and the “repressed” are prone and it was very similar to tuberculosis throughout the nineteenth century before a cure was found. It was the differences between myth and fact regarding tuberculosis that gave Sontag the main strategy of her book regarding the “mystifications surrounding cancer” (101). She says how she wanted to tell a useful story different from those that came before hers. The purpose, she wanted, was to calm the imagination and to work away from the ideas that the medical metaphors had implanted.

She concludes that, in a way, metaphors kill. They “make people irrationally fearful of effective medical measures such as chemotherapy, and foster credence in thoroughly useless remedies such as diets and psychotherapy” (102). She urges terrified people who are ill to consult doctors or change them to those who would give proper or better care, and to regard cancer as if it was just another disease; not a curse, punishment, without meaning, and certainly not a death sentence. Cancer is now seen, as tuberculosis once was, the illness that society had identified with evil. The society’s disease gives blame to its victims but its hard to have more than one at a time.

Works Cited

Sontag, Susan. “Regarding Illness as Metaphor.” AIDS and its Metaphors. New York: Picador, 1988. Print. 92-104

Racism and Research: The Case of the Tuskegee Syphilis Study

Summary of Allan M. Brandt’s “Racism and Research:
The Case of the Tuskegee Syphilis Study”

“In retrospect the Tuskegee Study revealed more about the pathology of racism than it did about the pathology of syphilis; more about the nature of scientific inquiry than the nature of the disease process. The injustice committed by the experiment went well beyond the facts outlined in the press and the HEW Final Report”(27) writes Allen M. Brandt. In his 1978 article, Racism and Research: The Case of the Tuskegee Syphilis Study, Brandt is extremely critical of the Department of Health, Education and Welfare’s (HEW) Final Report of the Tuskegee Syphilis Study that was released in 1973. Brant contends that the report fails because it failed to examine the experiment in the broader sociological context.

In 1932 the U.S. Public Health Service (USPHS) began a study in the town of Tuskegee in Macon County, Alabama. The USPHS intended to examine the effects of untreated syphilis by observing 600 men (400 who had syphilis and 200 who were not infected). The experiment was originally supposed to last only six months, but it actually lasted for 40 years. During this time the 400 infected men were deceived and lied to, they were told that they were receiving treatment for “bad blood.” In actuality the men were receiving no such treatment, even after 1947 when it became widely know that penicillin was a very effective treatment. Instead these 400 men were being given ineffective tonics and ointments along with aspirin. To make matters worse, not only were the doctors withholding treatment, they were also effective in getting other local doctors and even the U.S. Army to not treat these men. Brandt cites example after example of how the USPHS, from day one, sought to intentionally deceive and mislead the black population in Tuskegee. The failed to inform the participants of the true facts and intentions of the experiment, and therefore could not have received proper consent. The USPHS told the study’s participants that they were receiving government issued medical treatments, they promised hot meals and even monetary assistance with burial costs in order to keep the men coming back. It is difficult to see how such deceptive practices could have been allowed to occur without looking at the influence of racism.

In the early twentieth century Social Darwinism was a commonly held belief that justified and rationalized American racism. “Essentially primitive people, it was argued, could not be assimilated into complex, white civilization. Scientists speculated that in the struggle for survival the Negro in America was doomed. Particularly prone to disease, vice and crime…” (Brandt 21). It was thought that blacks were particularly susceptible to venereal diseases because of their natural propensity for lust, promiscuity and immorality. Many scientists and doctors also argued that blacks were by their nature unlikely to seek medical care and treatment for syphilis. This racist undercurrent is what allowed the Tuskegee Study to occur. The scientists and doctors involved saw the black participants and genetically inferior to themselves. They justified what they were doing by telling themselves that the men they were withholding treatment from, and using as guinea pigs, would not have sought treatment anyway. The continued suffering and spread of the disease and death among this population was an evolutionary inevitability.

Brandt effectively argues, that one cannot truly examine much less understand the Tuskegee Study without acknowledging the commonly held racist beliefs of the time. “Failure to place the study in a historical context also made it impossible for the investigation to deal with the essentially racist nature of the experiment” (Brandt 27).

Work Cited

Allan M. Brandt. 1978. Racism and research: The case of the Tuskegee
Syphilis study. The Hastings Center Report 8(6): 21-29.

The Disease of Masturbation

The Disease of Masturbation

In his text, The Disease of Masturbation, Tristam Engelhardt puts fourth the notion that vice and virtue are not the exact same thing as disease and health, but instead they bear a direct relation to these concepts. When we apply this idea to the topic of masturbation it means that the act of masturbation itself is not a disease, but rather by having this vice one is failing to cohere with the norms of society and can be viewed as “ill”.

Throughout the text Engelhardt uses numerous historical sources and references to show us three views on masturbation related to being a disease. The first is the 19^th century view that masturbation led to the development of an “authentic disease”. The second view is that guilt, not excitation, was what led to the occurrence of masturbation. This position was what led to the third view on masturbation as a disease. The third view is that people believe in the idea that masturbation does have negative effects on one’s health, but that those effects come from society’s condemnation of masturbation as opposed to coming from a disease.

Based on the first view that Engelhardt presents to the audience, we are led to believe that masturbation was a serious disease that led to numerous illnesses such as blindness, vertigo, epilepsy, impotency, and even death. A few deaths were recorded and the killer was said to be masturbation.

The second view shows the audience that the masturbators were not performing the act of masturbation because of a sense of euphoria but from a sense of guilt. Engelhardt refers to an outside resource and mentions that “the masturbator feels that his act degrades his manhood, while the man who indulges in legitimate intercourse is satisfied that he has fulfilled one of his principal natural functions” (16).

The third view shows us the most modern belief: that the negative effects of masturbation aren’t necessarily from the “disease” of masturbation but rather from the guilt of performing an act that is condemned by society and does not follow the norm.

Engelhardt proves his point that disease and health have a direct relation to vice and virtue by showing us these three models of masturbation as a vice and how it has been turned into a disease based on a society’s beliefs.

Works Cited

Engelhardt, Tristram. "The Disease of Masturbation: Values and the Concept of Disease ." Sickness and Health in America. n. page. Print.

Revisions:

In his text, The Disease of Masturbation, Tristam Engelhardt reflects on the idea of masturbation being viewed as a disease through out history in order to put fourth two of his arguments. The first argument Engelhardt makes is that vice and virtue are not equivalent to disease and health, they bear direct relation to these concepts. When we apply this idea to the topic of masturbation it means that the act of masturbation itself is not a disease, but rather by having this vice you are diseased. His second argument is that “one chooses concepts for certain purposes, depending on values and hopes concerning the world”. When we apply this idea to the topic of masturbation it means that people in society believe certain things are diseases based on their values and beliefs.

To accredit his first argument, Engelhardt provides us with three views on masturbation. The first is the 19^th century view that masturbation led to the development of an “authentic disease”. This argument was first put fourth by an anonymous writer in 1700 but later S. A. Tissot published a book on masturbation as well. In his book, Onanism, Tissot states that “If one examines the world with a tacit presupposition of a parallelism between what is good for one’s soul and what is good for one’s health, then one would expect to find disease correlates for immoral sexual behavior”. This concept is what supports Engelhardt’s belief that “vice and virtue are not equivalent to disease and health, they bear direction relation to these concepts”.

The second view is that guilt, not excitation, was what led to the occurrence of masturbation and this position is what led to the third view on masturbation as a disease. The third view shows us the most modern belief: that the negative effects of masturbation aren’t necessarily from the “disease” of masturbation but rather from the guilt of performing an act that is condemned by society and does not follow the norm.

Engelhardt’s second argument is that “one chooses concepts for certain purposes, depending on values and hopes concerning the world” and he supports this argument by presenting evidence from the past. The idea that people in the 19^th century believed masturbation was a disease is due to their beliefs and what they valued. People in the 19^th century saw masturbation as being “unnatural” and “less satisfying” than intercourse with a partner. Engelhardt presents to us the disease that appeared in the South known as “Drapetomania, the disease causing slaves to run away”. At the time, society viewed the idea of slaves running away from their land as going against their system of value and belief and invented a disease for it.

Engelhardt’s text The Disease of Masturbation is a very complex work with many arguments but his two main arguments were that “vice and virtue are not equivalent to disease and health, they bear direction relation to these concepts” and “one chooses concepts for certain purposes, depending on values and hopes concerning the world”. He proves his points by showing us three views on masturbation being considered a disease and historical evidence that demonstrates how crucial a system of beliefs and values can be.

The diagnostic status of homosexuality in DSM-III: a reformulation of the issues

In this passage, Spitzer justifies his reasoning behind removing homosexuality from the DSM in 1973. He first begins by specifying how to define a “disorder”. He explains that in the process of determining disorders, it is less of a “Is condition X a disorder?” and more of a “Is it useful for condition X to be a disorder?” and “What are the consequences in society of an individual with condition X?” More specifically, a disorder can be defined as a condition that causes distress to the individual and general impairment in social effectiveness or functioning. Regarding homosexuality, it is obvious that these individuals are not distressed by their homosexual arousal or suffering major social impairments (unless it is due to negative societal attitudes).

Other sexual “conditions” such as pedophilia, fetishism or voyeurism are listed as a disorder because of the impairment in sexual functioning. These individuals differentiate from the “human norm” by becoming aroused at atypical objects/images. Although these individuals may not necessarily be distressed, the consequences in society are on a much larger scale. Homosexuality differentiates from this in the fact that there is no norm, because heterosexuality cannot be morally designated as the norm. Spitzer states that disorder must be defined by facts- not value judgment. He also states that there is no heterosexual “sexual disorder” category that implies that there is no distress or consequences in the heterosexuality community, which is obviously untrue.

One argument that advocates homosexuality being a disorder is that because as humans we have “built-in genetic mechanisms” for heterosexual reproduction, homosexuality obviously is an atypical disorder. Spitzer counters this argument by providing the example that as humans we possessed a gene for aggression that has since been repressed by society and the decrease of instinct to compete against others and hunt for food. Also, he states that the presence of homosexuals is not a recent occurrence and if they were truly a threat to human reproduction, we would have suffered by now.

Spitzer’s next argument is that if homosexuality had an effective treatment, more people might consider it as a true disorder. However, there is also the possibility of misdiagnosis. For example, if a person is depressed because of their homosexual arousal, why not diagnose only depression?

In conclusion, Spitzer presents many different arguments and counter arguments to his claim that homosexuality is not a disorder and does not belong to the DSM.

The Doctor Patient Relationship

According to an article in the New York Times, one patient is making a huge difference in medical education. Carolyn Bucksbaum is donating $42 million to the University of Chicago Medical School to fund a new institute devoted to training doctors in bedside manner and "compassion and empathy." Apparently patients who have better relationships with their doctors actually heal better. But most medical schools don't teach medical students to cultivate that relationship. This might be an interesting controversy to research: What should be the role of the doctor-patient-relationship in training for future doctors?

The Prayer of the Wandering Womb

The Prayer of The Wandering Womb

The article Wandering Womb was told by an unknown person praying, that lived somewhere around 400 B.C. The prayer was being spoken to a woman who was diagnosed as having hysteria. This prayer was influenced by Hippocrates idea that hysteria “was a physical condition rather than a mental affliction” (Thompson). It was thought that when a woman was diagnosed with hysteria that it was caused from a demonic spirit entering the womb of the body. Hippocrates made up the term Hysteria based off the Greek word uterus (Thompson). Hippocrates was born in the year 460 B.C., in Kos, Greece. Hippocratic therapy was heavily engulfed in the inherent healing power of nature (Famous People).

The beginning sentence of the prayer suggests that the womb contains a demon, which is causing pain. The prayer asks God to cure the grief of the violently trembling womb. The prayer asks God in the end of the prayer that he not allow the demon to possess parts of the body such as the head, neck, throat, breasts, ears, teeth, eyes, noses, and etc. The article ends with the sentence “May he, who lives in one and one in three, deign to fulfill this, and may God rule through all the ages of ages” (Thompson). This sentence suggests that the prayer believes in the three dimensions of space, time, and matter.

Works Cited

C. Oden, Thomas. "Three Dimensions." The Rice Holy. N.p., n.d. Web. 20 Sep 2011. .

"Hippocrates." Famous People. N.p., n.d. Web. 20 Sep 2011. .

Thompson, Lana. The Wandering Womb. Prometheus Books, 1999. Print.