Reading DoubleX on Slate led me to this post* questioning the merits of screening mammograms, which led me to this post about how wishful thinking, especially in the form of just world theory, seems to underpin the narrative about breast cancer that the Susan G. Komen foundation promotes.
A couple of things struck me with their similarity to weight loss narratives:
The science oversimplified in favor of zippy “empowerment” narratives, especially in magazines:
We still can’t distinguish an aggressive one from a harmless one, except in retrospect. Some early stage cancers will come more aggressive and harmful with time, but others will never progress.
Yet that’s not the message you hear in so many of the news stories that proliferate like cancer each October. A large number of these stories promote the now-debunked relentless progression model, with a twist of self-empowerment thrown in. Their message — all breast cancers will kill you, unless you’re vigilant enough about screening and catch that cancer “early.” It’s up to you, ladies.
Glossing over the risks of treatment [for fat: weight loss]:
I’m not anti-mammogram. But I believe that medicine should be based on science, not wishful thinking. Women who want mammograms should have access, but only after they’ve been fully informed of the risks as well as the benefits. If my experience interviewing oncologists and radiologists is any indication, most of these doctors don’t understand the risks. More often than not, when I interview a radiologist, breast oncologist or gynecologist they tell me that the only risk from a mammogram is a false alarm. I think it’s the job of journalists to challenge these false messages.
Ignoring the role of factors beyond one’s control [for fat: mostly genes and socioeconomic status] in favor of a narrative where you’re in control of your destiny, and the promotion of an intervention that is generally not effective [for fat, diets; for breast cancer, breast self-exams] to help give that illusion of control:
Which gets to the ugly, ugly truth that no one wants to talk about. There is no certainty with breast cancer. Once you have it, there is always a chance of recurrence. There is nothing a woman can do today —not even cut off her breasts — to completely eliminate her chance of dying of breast cancer. Despite the headlines in those women’s magazines, there are no foods that “fight” breast cancer. Exercise, a healthy diet, limiting your alcohol consumption might reduce your risk, but only a little. Breast self-exams do not reduce breast cancer deaths, no matter how well you do them.
This touches on something else I’ve been thinking about: yeah, sure, being fat (or an inbetweenie, anyway) means that I have some incentive to think that it’s not my fault. (My naturally skeptical and contrarian personality also goes a long way towards questioning the fat and weight loss orthodoxy.) But I’m also giving up a lot of just world theory and the illusion that I am in control of my fate, that if I just do the right things I’m guaranteed to live to 100, maybe 110, with no health problems to speak of and then die quickly and peacefully in my sleep. It means admitting just one more way that life’s not fair. And of course it means giving up the idea that I am better than “the really fat people, the ones who eat at McDonalds every day, who use those Rascal scooters at the grocery store just because they’re lazy,” the ones I haven’t actually met but I’m sure are out there because I’ve seen Wall-E. In other words, giving up on the idea that I’m not like those other people with a BMI over 25, I am an inbetweenie/small fat and not supersize because I’m more virtuous than other people, or am doing things right that they aren’t. And I give up being seen as “reasonable” and accepting conventional wisdom and instead hear people say that my point of view is wishful thinking and denialism. That’s part of what bugs me about the “denialism” charge that FA gets hit with. I guess what I’m saying is, “Same to you, buddy.”
Then there’s the Carl Sagan quote that I came across today:
“One of the saddest lessons of history is this: If we’ve been bamboozled long enough, we tend to reject any evidence of the bamboozle. We’re no longer interested in finding out the truth. The bamboozle has captured us. It’s simply too painful to acknowledge, even to ourselves, that we’ve been taken. Once you give a charlatan power over you, you almost never get it back.”
There’s other stuff that I could say about the unwillingness of human beings to accept facts that contradict their opinions (some fat acceptance bloggers have already said some of it before, but I don’t have a link handy), but that’s enough for today.
Also, I hope that I don’t come off as too insensitive about breast cancer in this post. I do understand that its importance is not limited to how it relates to my pet issues or its rhetorical utility, even if I might not have sounded like it.
*At the bottom of the first post there’s also a link to Barbara Ehrenreich’s awesome and classic** piece, Welcome to Cancerland. If you haven’t already, go read it! But only if you want to, of course.
**2001 is old enough to be “classic” in Internet years.
Update: The Well-Rounded Mama has a good, comprehensive post about the benefits and drawbacks of screening mammograms during your 40s.