Survival odds mortality in corporate time

Current Anthropology

Volumn 52, Issue SUPPL. 3, 2011, Pages

  Jain, S Lochlann ^a  

^a STANFORD UNIVERSITY   (United States)

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EID: 79953141062     PISSN: 00113204     EISSN: None     Source Type: Journal    
DOI: 10.1086/656795     Document Type: Article

References (20)

1. Initially the term "survivor" was pegged to cancer in order to ensure that the medical system recognized the specific medical issues of people who had endured cancer treatments. However, in the past decade, the notion of survivorship against the odds-the enumeration of survivorship- has come increasingly to matter in popular accounts of the disease. That is what I want to focus on here.
2. "Survivor" takes the sting out of the stigma, but the rhetoric may also be understood as part of a broader cultural cancer management technique. Recall, for example, sociologist Talcott Parsons's (1981) still relevant description of "sick role" from the 1950s. Parsons hypothesized that the break from responsibility required by illness was rendered legitimate when the ill person followed culturally determined conventions of being ill, such as seeking health care and trying to become healthy (Parsons 1981:70).
3. Interview with surgeon, American Society of Clinical Oncology, 2009.
4. I take this up in detail in "The Mortality Effect: Counting the Dead in the Cancer Trial" (Jain 2010).
5. It's no coincidence that a scholar of Donne, Professor Vivian Bearing, would be the protagonist of a play contrasting versions of death and survival. In Wit, Bearing discusses the comma-the slight pause that separates life from death-between life and life everlasting in the Holy Sonnet X, "Death Be Not Proud." As Bearing had learned from her professor: "Nothing but a breath-a comma-separates life from life everlasting. It is very simple really.With the original punctuation restored, death is no longer something to act out on a stage, with exclamation points. It's a comma, a pause" (Edson 1999:14).
6. Different though they are, both Donne's and Cannetti's versions of survival predate the rise in population statistics and the use of those numbers to manage questions of political and economic power. According to the philosopher Michel Foucault (1977), this shift toward numerical aggregation and explanation arose with a political shift away from God and the sovereign as the primary sources of governance and toward the state and corporation. Thus, Canetti (1984:232) could write that the "true subject" gives up his or her life for the ruler and that the ruler needs these deaths to maintain and demonstrate his or her power over death and life. In other words, in Canetti's view, the sovereign could pick out individuals who might live or die. The ability to let live or make die distinguished sovereign power and marked his or her position as sovereign. Cancer makes one a subject through survival (not kicked out like the leper). Foucault (1977) considered subjects as populations. The individual is no longer of interest to political power. Foucault requires a different notion of death. He writes that notions of death for citizens familiar with population aggregates differ drastically from what Donne would have called death. According to Foucault, our notion of death could not be more different from Donne's, in which death is necessarily a collective and political endeavor. In contrast, in the age of population statistics and aggregates, death is a limit on political power; death becomes "the moment when the individual escapes all power, falls back on himself and retreats, so to speak, into his own privacy. Power no longer recognizes death. Power literally ignores death" (Foucault 1977:248).
7. Oxford English Dictionary Online, s.v. "survivor," http://www.oed.com/view/Entry/195113?redirectedFrompsurvivor# (accessed June 21, 2010).
8. One could turn to many places to find the uniqueness and historical specificity of this way of understanding time and death. Marcus Aurelius (1992), in Meditations, for example, wrote, "Always remember then these two things: one, that all things from everlasting are of the same kind, and are in rotation; and it matters nothing whether it be for a hundred years or for two hundred or for an infinite time that a man shall behold the same spectacle; the other, that the longest lived and the soonest to die have an equal loss; for it is the present alone of which either will be deprived, since (as we saw) this is all he has and a man does not lose what he has not got" (10). Thanks to Derek Simons for the quote.
9. Indeed, physicians bear these statistics in mind in vastly different ways. In San Francisco, California Pacific Medical Center's Dr. Bertrand Tuan says that he does not do hands-on exams that involve feeling for swollen nodes, skin irregularities, or other abnormalities for his breast cancer patients because he believes that "if someone has metastatic disease, they will know it" (June 2008). On the other hand, Dr. Garrett Smith does a close manual exam because he thinks the 3 months potentially gained in early detection of recurrence can offer the opportunity to save a life, and "that's the fun part" (August 2008). Both approaches and physical exams (one lasting about 2 minutes and the other about 30) fall under the current acceptable limits of standards of care both medically and legally.
10. "What Is Gardasil?" http://www.gardasil.com/tv-commercial- forgardasil.html (accessed June 5, 2008).
11. Misdiagnosis project, interview with cancer survivor, June 10, 2008.
12. For patients who died in 2001-2005 in the United States, rates for white women were 2.3 per 100,000 women and for black women 4.7 per 100,000 women, based on November 2007 Surveillance Epidemiology and End Results (SEER) data submission posted to the SEER Web site, 2008. Median age at diagnosis was 47, and the average number of years of potential life lost from cervical cancer was 25.3 (Ries et al. 2007).
13. Dr. Diane Harper, a professor of medicine at Dartmouth Medical School; Dr. Harper was a principal investigator on the clinical trials of both Gardasil and Cerverex (Rosenthal 2008).
14. As Jan Hoffman writes, there is an individuated form of responsibility here: illness is not understood as a communal responsibility (girls' sake), and the sexual transmission of disease is not underwritten by responsibility of both parties (Hoffman 2008).
15. "The American Cancer Society launched an effort to promote the Pap smear in 1957, fifteen years after the test had been shown to save lives, and nearly three decades after it was first developed" (Davis 2007: 132).
16. "Breastcancer.org Helps Young Girls Put Breast Cancer Fears into Perspective," http://www.breastcancer.org/about-us/press-room/prevention. jsp (accessed June 21, 2010). Girls who had been through breastcancer.org's educational lecture came out knowing that they should "drink less diet soda" and that the main risks for cancer are "just getting older." Nothing on the breastcancer.orgWeb site indicated anything about rising cancer rates, links to common toxins, how to raise concerns with a physician, or the politics of treatments.
17. This study was widely reported in the press and on multiple blogs (Kim and Goldie 2008).
18. Their assumptions are optimistic, assuming lifelong protection, no replacement with other strains of HPV, continued screening, and natural immunity to HPV is unaffected (Haug 2008).
19. Additionally, though many people find it abhorrent to put a number on years of abstracted life, many people are worth much more than $100,000 in terms of how much money they make themselves or their employers and in terms of how much they would be willing to spend or have someone spend on their behalf. A classless democratic calculation that drives oncological protocol and drug development leaves those people out of luck, because certain drugs will simply not be developed. The less value accrued to the "average" life, the less will be accorded to every life.
20. Livestrong.com is a for-profit created by Demand Media in alliance with the Lance Armstrong Foundation, which seems to epitomize the characteristics of cancer culture that I describe.