Inflammation is the most common health problem in the world today. A way of responding to an object, threat or infection, immune cells release powerful antibodies, proteins and other substances that destroy invading microbes or heal wounds. However, if this response persists for a long time, it has the potential to become chronic inflammation, which increases physical stress and damages body tissues. In other words, inflammatory processes that are helpful to the body in the acute phase can become detrimental in the long run, and are associated with heart disease, diabetes, asthma, irritable bowel syndrome, rheumatoid arthritis, other autoimmune diseases, cancer, Even Alzheimer's is closely linked.
The Covid-19 pandemic has exacerbated the dangers of inflammation. Those with common medical conditions such as heart disease, obesity, cancer, diabetes, etc., contract the new coronavirus, which triggers a further response in the body, leading to an escalation of inflammation. So while the virus itself does not cause cloudy lungs and breathing difficulties, the inflammation caused by the body's response to the virus makes it inevitable.
For the prevention and treatment of chronic inflammation, the mainstream solution in the medical community is to recommend a healthy lifestyle, such as regular physical activity, no smoking, limiting alcohol consumption, getting enough sleep, controlling weight, eating more fruits and vegetables, and avoiding processed meats and fried foods. , sugar-sweetened beverages and snacks, and more. The subtext of this solution is to attribute poor health to individual weakness or failure, however, according to American scholars Rupa Marya and Raj Patel, this view of health as a personal responsibility, Actually blaming the victim, the cause of inflammation is not under the control of the individual, and when the market is flooded with junk food and there is no land to grow more traditional food, it is certainly difficult for the poor to eat healthy. The problem that causes inflammation is systemic, and the solution must be systemic. In their book Inflamed: Deep Medicine and the Anatomy of Injustice, they argue that systemic inequality and injustice are the root causes of chronic inflammation, and that medicine should shift its focus from treating inflamed individuals to Transforming into a world of healing inflammation.
The authors take readers on a human medical journey through the digestive, endocrine, circulatory, respiratory, reproductive, immune, and nervous systems, shedding light on the hidden relationships between the human biological and political and economic systems. Inflammation is related to food, air, and microbial diversity in the human body, to traumatic events a person experiences as a child, and even to the pain of their ancestors, to the likelihood of access to medical care, and to physicians' treatment patterns .
The prevailing diseases in the human body today are caused by a larger system out of control. For example, there are more than 144,000 human-made chemicals in the world, most of which are not regulated, and regulations are only created after they have caused considerable damage and caused a public backlash. The human body, formed through natural evolution, certainly cannot adapt to the daily onslaught of unnatural chemicals. The "exposome" is a scientific term for all environmental exposures to which a body is exposed, which this book describes as "the sum total of a person's lifetime exposure to non-inherited causative agents, from conception to death" . In industrialized countries, the exposed group is riddled with inflammatory triggers, with members of the poor or minority groups bearing the brunt.
In the United States, triggers for inflammation are very unequally distributed among different ethnic groups. Compared with whites, blacks and Native Americans have lower incomes, higher debt, higher levels of stress, live in areas with limited choices of affordable healthy food, struggle to maintain a healthy diet, and are more likely to be exposed to environmental hazards, such as drinking water It contains lead and is therefore susceptible to various inflammatory effects, such as the chronically high incidence of cardiovascular disease. Inflammation also makes them far more likely to die from the coronavirus than whites.
Therefore, it is necessary to locate the causality of disease within the dynamics of history, ecology, ideology and power outside the individual body. This requires overcoming the limitations of mainstream medicine. Mainstream medicine is actually a kind of biomedicine in a narrow sense. Doctors are not trained as real healers, but only act as "biomedical technicians". The individual is treated as a broken machine, a dysfunctional and occasionally disobedient robot, and treatment is equated with repair. Medical schools require students to memorize complex biochemical reactions that do not need to be mastered in medical practice, but neglect to teach them to listen and build trust with patients. When making a diagnosis, doctors mainly look at the computer screen, record symptoms and transcribe codes. Most doctors do not ask the patient's appeal, and they only listen for an average of dozens of seconds before interrupting the patient's speech. Physicians are increasingly acting as widget producers for profit-making products that are not health but a charge code, a pill or procedure that can be billed to a patient or insurance company.
This is not to say that mainstream medicine has not brought progress, such as an increase in life expectancy, a decline in maternal mortality, and a dramatic reduction in the rate of child stunting, among its great achievements. However, due to habitual disregard for social background, mainstream medicine assumes that all people with a certain disease are the same and can be treated in the same way, which has caused many serious problems in reality.
Pulse oximeters, for example, use light that passes through the skin to measure blood oxygen levels, and when the reading reaches a certain threshold, the device will alert doctors to give patients supplemental oxygen to prevent organ failure. This is critical for monitoring the health of Covid-19 patients during the Covid-19 pandemic. However, since its introduction in the 1970s, the device has primarily been tested on white skin, making it error-prone in measuring blood oxygen levels in blacks, preventing black patients from receiving critical care.
To this end, this book proposes the concept of DeepMedicine. Etymologically, the English diagnosis "diagnosis" comes from the Greek words dia (to disassemble) and gignōskein (to know, to know), the original meaning of which is to take apart the object to know. Deep medicine is the exact opposite of that, putting the pieces back together to understand and heal. In other words, deep medicine does not separate an individual or a community from the network of social relationships that lead to disease, but brings together various types of narratives that reveal the social relationships and historical context behind disease. In-depth medicine is a synthesis of medicine and social sciences.
If the mainstream medical model includes paying attention to symptoms, confirming the diagnosis and providing treatment, deep medicine is not to diagnose the disease and determine the cause of its occurrence in the body, but to try to identify and solve the potential "exposure group" problem and systemic inequality. For example, if the price of insulin is out of reach for the general public, how do people with diabetes survive? How can people with heart disease be healthier if they live in communities that lack access to fresh food?
On the other hand, deep medicine can also reconstruct the relationship between humans and ecosystems. The human body has evolved from the intricate relationship with the sun, soil, water, tides, seasons, bacteria, viruses, animals, plants, fungi, etc. the ecology in, on, and around humans. Good health is based on good ecology, those indigenous communities that maintain a good ecology, such as the Yanomami in the Amazon rainforest, some hunter-gatherer tribes in Tanzania, are free of various inflammatory diseases and cancer or senile hypertension.
In fact, prior to colonization, the lifestyles of Indigenous communities worldwide focused on keeping the surrounding biome and the microbiome within the human body thriving, thereby maintaining a healthy ecological environment. Colonial conquest led to the demise of biodiversity.
An example is the Pacific coast from Alaska to northern California, which is a migratory area for wild salmon. It used to be rich in salmon resources, but in the past 100 years, due to the frenzied fishing of American and Canadian fishermen's fleets, wild salmon resources are on the verge of death. Depleted and gradually replaced by farmed salmon. Originally, wild salmon died after spawning, and countless corpses were left in the upper reaches of the river, which contained nitrogen, phosphorus and other elements, as well as a large amount of protein and fat. More than 80 kilograms of nitrogen and 11 kilograms of phosphorus are obtained from the carcass of salmon, thereby realizing the transfer of nutrients from the ocean to the land. If there is no migration of wild salmon, the nutrients in the land will be lost to the ocean. Wild salmon, which act as a nutrient pump in the local ecosystem, are being destroyed by indiscriminate fishing by fishermen's fleets, and the incidence of diabetes, cardiovascular disease and depression in the local Aboriginal community has risen sharply.
Colonialism is not just about occupying lands and resources in invaded areas and changing the ecological structure, it is also the total destruction of local cosmology and worldviews, changing the connection of indigenous peoples to nature and traditional culture, as well as their identities, communities and even language.
Okinawa is the largest island in the Ryukyu Islands and was annexed by Japan after the Meiji Restoration. Once upon a time, the island's inhabitants were known for long and healthy lives, with more residents over the age of 100 than any other region in the world. After the end of World War II, Okinawa was under the control of the United States for a long time, and its governance was not transferred from the United States to Japan until 1972. During American control, Okinawa established dozens of U.S. military bases, stationed tens of thousands of U.S. soldiers, and introduced a variety of American food and lifestyles that persisted after the U.S. handed over control to Japan. As a result, thousands of Okinawans have left their land and traditional way of life, and the fat content of Okinawan diets has risen from 10% in 1960 to over 30% today. Currently, Okinawans have the highest obesity rate in Japan, the death rate among young people is rising, and overall life expectancy is falling. The effects of successive rounds of colonization by Japan and the United States have eroded every aspect of Okinawa's diet and culture, leaving local residents no longer living long.
The flip side of colonialism is capitalism. Capitalism is characterized by the extraction of resources without regard to the cost to the community or the environment. For example, a family of chemicals called perfluorinated/polyfluoroalkyl substances (PFAS), found in items ranging from textiles to firefighting foam, are known as "forever chemicals" because they never degrade, despite this Production of these chemicals in the United States has largely ceased in the early 2000s, but according to the US Centers for Disease Control, they are ubiquitous in food and drinking water, accumulate in the human environment and body over time, and are associated with cancer, thyroid Disease, high cholesterol, ulcerative colitis, and birth defects are closely related.
The microbiome in the human body is also a victim of capitalism. The human body is the ecosystem, evolving with thousands of single-celled animals, bacteria, viruses and even parasites. Most microbes are not pathogenic pathogens, but are vital to human survival, affecting how the body digests food, how the immune system functions, how it responds to medications and treatments, and even mood, sleep patterns and stress levels. Indigenous communities defend biodiversity through conventional wisdom and therefore have the most diverse microbiomes, making them highly resistant to inflammation. However, capitalism has transformed traditional agriculture into intensive agriculture, destroying the microbiome in the soil, causing a chain reaction of vegetation and livestock, which in turn affects the microbiome in the human body, so that the ecological The system cannot be healthy.
In addition to physical conditions, psychological stress is also a major cause of inflammation. Under capitalism, debt is the most common source of stress. Even the mere anticipation of future debt activates chemicals in the body and sets off alarms in cycles. C-reactive protein (CRP) is an acute phase synthesized by liver cells when the body is stimulated by microbial invasion or tissue damage. C-reactive protein is a highly sensitive indicator of inflammation, and debt and repayment anxiety can also lead to elevated levels of C-reactive protein, which can lead to inflammation and even chronic heart disease. When chronic stress becomes the background noise of life, not only are the cells of the body deeply affected, the genetic code is altered, and the stress experienced by one generation can become a physical defect and disease in the next.
Structural inequalities of colonialism, discrimination against disadvantaged groups, and post-traumatic stress disorder make the inflammation even worse. In the U.S., many blacks and Native Americans live in the shadow of racial inequality and have no way to be healthy. This is not a personal failure, but is rooted in the social fabric. If colonialism is a single event, such as an invasion, its effects may fade over subsequent decades, but colonialism is a long-term, ongoing process of consolidating and exercising power and making it possible through violence, coercion, and consent-making Normalizing relations, therefore, will not be an easy task to eliminate the harm that colonialism posed to human health.
The authors point out that as long as a subset of the population suffers from inflammation, everyone cannot be healthy, as the new crown epidemic has amply demonstrated. Communities with a high incidence of inflammation are easily overcome by the new coronavirus, and new mutant strains are constantly being produced. From the standpoint of deep medicine, the key to treating inflammation is to change the political, economic and social environment, to reorganize and reconstruct the flow of resources and the way of decision-making, and to rebuild the relationship between humans and the earth, and between humans and each other.
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