Black lung: the social production of disease

Trade, uneven development and people in motion: Used territories and the initial spread of COVID-19 in Mesoamerica and the Caribbean

Mesoamerica and the Caribbean form a region comprised by middle- and low-income countries affected by the COVID-19 pandemic differently. Here, we ask whether the spread of COVID-19, measured using early epidemic growth rates (r), reproduction numbers (R _t ), accumulated cases, and deaths, is influenced by how the 'used territories' across the regions have been differently shaped by uneven development, human movement and trade differences. Using an econometric approach, we found that trade openness increased cases and deaths, while the number of international cities connected at main airports increased r, cases and deaths. Similarly, increases in concentration of imports, a sign of uneven development, coincided with increases in early epidemic growth and deaths. These results suggest that countries whose used territory was defined by a less uneven development were less likely to show exacerbated COVID-19 patterns of transmission. Health outcomes were worst in more trade-dependent countries, even after controlling for the impact of transmission prevention and mitigation policies, highlighting how structural effects of economic integration in used territories were associated with the initial COVID-19 spread in Mesoamerica and the Caribbean.

'The body says it': the difficulty of measuring and communicating sensations of breathlessness

Breathlessness is a sensation affecting those living with chronic respiratory disease, obesity, heart disease and anxiety disorders. The Multidimensional Dyspnoea Profile is a respiratory questionnaire which attempts to measure the incommunicable different sensory qualities (and emotional responses) of breathlessness. Drawing on sensorial anthropology we take as our object of study the process of turning sensations into symptoms. We consider how shared cultural templates of 'what counts as a symptom' evolve, mediate and feed into the process of bodily sensations becoming a symptom. Our contribution to the field of sensorial anthropology, as an interdisciplinary collaboration between history, anthropology and the medical humanities, is to provide a critique of how biomedicine and cultures of clinical research have measured the multidimensional sensorial aspects of breathlessness. Using cognitive interviews of respiratory questionnaires with participants from the Breathe Easy groups in the UK, we give examples of how the wording used to describe sensations is often at odds with the language those living with breathlessness understand or use. They struggle to comprehend and map their bodily experience of sensations associated with breathlessness to the words on the respiratory questionnaire. We reflect on the alignment between cognitive interviewing as a method and anthropology as a disciplinary approach. We argue biomedicine brings with it a set of cultural assumptions about what it means to measure (and know) the sensorial breathless body in the context of the respiratory clinic (clinical research). We suggest the mismatch between the descriptions (and confusion) of those responding to the respiratory questionnaire items and those selecting the vocabularies in designing it may be symptomatic of a type of historical testimonial epistemic injustice, founded on the prioritisation of clinical expertise over expertise by experience.

The science of spin: targeted strategies to manufacture doubt with detrimental effects on environmental and public health

BACKGROUND

Numerous groups, such as the tobacco industry, have deliberately altered and misrepresented knowable facts and empirical evidence to promote an agenda, often for monetary benefit, with consequences for environmental and public health. Previous research has explored cases individually, but none have conducted an in-depth comparison between cases. The purpose of this study was to compile a comprehensive list of tactics used by disparate groups and provide a framework for identifying further instances of manufactured doubt.

METHODS

We examined scholarly books, peer-reviewed articles, well-researched journalism pieces, and legal evidence related to five disparate industries and organizations selected for their destructive impacts on environmental and public health (tobacco, coal, and sugar industries, manufacturers of the pesticide Atrazine, and the Marshall Institute, an institute focused on climate change research, and other scientists from the era that associated with those in the Institute). These documents provided evidence for a list of tactics used to generate pro-industry spin and manufacture doubt about conferred harm. We then identified trends among sets of strategies that could explain their differential use or efficacy.

RESULTS

We recognized 28 unique tactics used to manufacture doubt. Five of these tactics were used by all five organizations, suggesting that they are key features of manufactured doubt. The intended audience influences the strategy used to misinform, and logical fallacies contribute to their efficacy.

CONCLUSIONS

This list of tactics can be used by others to build a case that an industry or group is deliberately manipulating information associated with their actions or products. Improved scientific and rhetorical literacy could be used to render them less effective, depending on the audience targeted, and ultimately allow for the protection of both environmental health and public health more generally.

Interdisciplinary Perspectives on Breath, Body and World

Breath, the ephemeral materialization of air at the interface of body and world, engages with and alters the quality of both. As a process of inhalation and exhalation that signals its physiological universality, breath is an invisible prerequisite for life, an automated and functional necessity. Yet it is more than simply a reflexive action and can at times be controlled or manipulated. It can also affect or be affected by experiences, environments and relationships. In this essay, like the contributors to the special issue it prefaces, we aim to address the lacuna that exists in the examination of the meanings and embodiment of breath as a central theme in the humanitics and social sciences. Interdisciplinary perspectives that explore breath as a multifaceted phenomenon, both intrinsically shared and contextually distinct, open new directions in the field of breath and body studies.

Distract, delay, disrupt: examples of manufactured doubt from five industries

Manufactured doubt describes the efforts used by organizations or individuals to obscure the harmful effects of their products or actions by manipulating science. Although approaches to do so are widely used, relevant stakeholders are often unaware of these tactics. Here, we examine the strategies used in five cases of manufactured doubt: tobacco and adverse health; coal and black lung; Syngenta and the herbicide atrazine; the sugar industry and cardiovascular disease; and the Marshall Institute and climate change. By describing the tactics used in these cases, effective methods for identifying and countering instances of manufactured doubt can be generated.

'X-rays don't tell lies': the Medical Research Council and the measurement of respiratory disability, 1936-1945

During the first half of the twentieth century, the mining industry in Britain was subject to recurrent disputes about the risk to miners' lungs from coal dust, moderated by governmental, industrial, medical and mining bodies. In this environment, precise measurements offered a way to present uncontested objective knowledge. By accessing primary source material from the National Archives, the South Wales Miners Library and the University of Bristol's Special Collections, I demonstrate the importance that the British Medical Research Council (MRC) attached to standardized instrumental measures as proof of objectivity, and explore the conflict between objective and subjective measures of health. Examination of the MRC's use of spirometry in their investigation of pneumoconiosis (miner's lung) from 1936 to 1945 will shed light on this conflict and illuminate the politics inherent in attempts to quantify disability and categorize standards of health.

Elemental analysis of occupational and environmental lung diseases by electron probe microanalyzer with wavelength dispersive spectrometer

Occupational and environmental lung diseases are a group of pulmonary disorders caused by inhalation of harmful particles, mists, vapors or gases. Mineralogical analysis is not generally required in the diagnosis of most cases of these diseases. Apart from minerals that are encountered rarely or only in specific occupations, small quantities of mineral dusts are present in the healthy lung. As such when mineralogical analysis is required, quantitative or semi-quantitative methods must be employed. An electron probe microanalyzer with wavelength dispersive spectrometer (EPMA-WDS) enables analysis of human lung tissue for deposits of elements by both qualitative and semi-quantitative methods. Since 1993, we have analyzed 162 cases of suspected occupational and environmental lung diseases using an EPMA-WDS. Our institute has been accepting online requests for elemental analysis of lung tissue samples by EPMA-WDS since January 2011. Hard metal lung disease is an occupational interstitial lung disease that primarily affects workers exposed to the dust of tungsten carbide. The characteristic pathological findings of the disease are giant cell interstitial pneumonia (GIP) with centrilobular fibrosis, surrounded by mild alveolitis with giant cells within the alveolar space. EPMA-WDS analysis of biopsied lung tissue from patients with GIP has demonstrated that tungsten and/or cobalt is distributed in the giant cells and centrilobular fibrosing lesion in GIP. Pneumoconiosis, caused by amorphous silica, and acute interstitial pneumonia, associated with the giant tsunami, were also elementally analyzed by EPMA-WDS. The results suggest that commonly found elements, such as silicon, aluminum, and iron, may cause occupational and environmental lung diseases.

SOCIOLOGICAL THEORY AND PHARMACY PRACTICE RESEARCH: (3) How relevant is Marxist sociology for pharmacy practice research?

In our previous paper on the relevance of sociology to pharmacy practice research, we discussed the ideas of Talcott Parsons and his work on the sick role.1 We explained that his consensual depiction of how health care relationships functioned within society came under sustained attack during the 1960s and beyond. Much of this criticism emanated from scholars influenced by the work of Karl Marx. The sociological perspective most heavily influenced by Marx's ideas has come to be known as the political economy critique (although for simplicity we refer in this paper to the ideas of Marx rather than the political economy critique). No sociological textbook would be complete without a major section devoted to Marx. The same applies to this series on the relevance of sociology to pharmacy practice research. What we will show in this paper is that sociologists influenced by Marx have produced a compelling critique of the relationship between capitalism and health in Western societies and this critique continues to be germane to understanding contemporary health care systems, health issues and the role of pharmacy within society.

Political coalitions for mutual advantage: the case of the Tobacco Institute's Labor Management Committee

In 1984, the tobacco workers' union and the Tobacco Institute, which represents US tobacco companies, formed a labor management committee (LMC). The institute relied on LMC unions to resist smoke-free worksite rules. In a review of the internal tobacco industry documents now publicly available, we found that the LMC succeeded for 2 primary reasons. First, the LMC furthered members' interests, allowing them to overcome institutional barriers to policy success. Second, the LMC used an "institutions, ideas, and interests" strategy to encourage non-LMC unions to oppose smoke-free worksite rules. While public health advocates missed an opportunity to partner with unions on the issue of smoke-free worksites during the era studied, they can use a similar strategy to form coalitions with unions.

Conceptualizing sports medicine as occupational health care: illustrations from professional rodeo and wrestling

The purpose of this article is to propose a sociological model of sports medicine that conceptualizes it as occupational health care. All occupational health care systems can be summarized according to three types: elite, managed, and primitive. These types reflect the quality of health care provided, the social class membership of workers, and workers' value to employers. The author presents ethnographic data to illustrate the social dynamics of primitive occupational health care delivered to rodeo cowboys and local professional wrestlers. This care is primitive because these athletes have relatively low economic value as workers, and the rugged individualism of their sports' subcultures supports a system of health care that is inexpensive, nonmedical in its philosophy, personalistic in the structure of its practitioner-patient relationship, and incidental in its delivery.

Applying Aristotle's doctrine of causation to Aboriginal and biomedical understanding of diabetes

Aristotle's doctrine on causation identifies four distinct types of cause: formal, efficient, material, and final. Science is said to have differentiated itself from philosophy by concentrating solely on efficient causes. Nonetheless, when applied to narratives of causation, Aristotle's doctrine provides a useful heuristic to explore the issues such as Aboriginal and biomedical perceptions of causal factors for non-insulin dependent diabetes mellitus (NIDDM) on Manitoulin Island, Ontario. This paper also outlines two divergent causal stories for NIDDM and the associated moral positions regarding the 'righteous' pursuit of health. Biomedical narratives emphasize the role of lifestyle factors, particularly the impact of obesity, in causation. In the case of diabetes, the moral course of action is pursued through lifestyle choices. In contrast, Aboriginal narratives emphasize the role of genetics in causation. These narratives describe diabetes as collectively affecting Aboriginal people - thus identifying Aboriginal people as different. Aboriginal frameworks for health venture beyond the 'efficient' cause of biomedicine and thus the moral pursuit of health within this framework involves returning to an initial state of health and purity through traditional knowledge.

Women uranium workers: a case study of perceived hazardous exposures and health effects

An exploratory study of seventy-four women uranium workers employed in the western United States (miners, millers, truck haulers, and office workers) was conducted. These uranium industry workers were employed primarily during the 1970s and 1980s. It was found that approximately 60 percent perceived overall moderate to high levels of dust during their employment, and about 50 percent reported the likelihood of having past, present, or future health problems related to their uranium work. Two of the most-often-identified health problems were respiratory symptoms or illnesses and cancer. Issues regarding public policy, research, and worker rights are discussed.

The “New Economics” and Industrial Health: A Reply

Our article called attention to two logical conclusions from the “rational worker” model: first, that firm safety investments can induce such carelessness that accidents will actually increase; second, that increased compensation payments can also induce such an increase. This leads directly to the conclusion that accidents can be reduced by reducing firm safety investments and by reducing compensation payments. Our contention was that this model, when used to draw policy conclusions, is conceptually flawed, empirically flimsy and dangerous in the sense in which the “accident prone” hypothesis has been called dangerous. If we understand James Chelius's reply (1), it serves to strengthen our contention.

Chelius offers no empirical evidence for the first conclusion that firm safety investments can induce an increase in accidents. He ducks conceptual issues, and, in particular, ethical questions. When he comes to the second conclusion, he shifts his ground, ignores considerable direct evidence that contradicts what he is trying to prove and relies again on regression coefficients from aggregate statistics. He then draws the same type of “blame the victim” policy conclusions that earned for the “accident prone” hypothesis its label of dangerous.

He has responded in three areas: 1. The theoretical model and methodology; 2. The empirical evidence; 3. Policy implications.

Capital sectors and workers' health and safety in the United States

The dual or segmented economy perspective suggests that the U.S. production system within a capitalist world-system can be divided into distinct sectors based on elements such as levels of industrial concentration, foreign involvement, and unionization. The differing organization of these sectors is argued to influence worker health and safety (WHS) outcomes. An economic segmentation model was applied to national occupational health data to examine the relationship between structural divisions in the economy and occupational hazard exposure, injury, and illness. Workers in more global industrial sectors had only average levels of hazardous exposure but a greater likelihood of occupational injury and illness than workers in other sectors of the economy. These differences are related to the structure of work in the various sectors. The findings suggest the need for (1) greater surveillance and reporting of WHS problems through the general health care system; (2) planning of economic and productive activity that takes WHS issues into account; and (3) greater worker organization and power within and between nations to improve WHS.

Workers' perceptions, knowledge and responses regarding occupational health and safety: a report on a Canadian study

This paper presents data from interviews with 492 rank and file workers. It examines aspects of workers' perceptions, knowledge and actions regarding workplace hazards and views these as indicators of the potential strength of labour in improving occupational health and safety. Respondents had a strong consciousness of ways in which their work might damage their health and they or their fellow workers had experienced half of the symptoms they mentioned. However, they lacked information on the results of environmental and medical monitoring, their core legal rights and the more effective strategies for reducing hazards. Few respondents sought information and few were persistent in dealing with their worries about hazards. Knowledge of their rights under the current occupational health and safety legislation was linked with taking such actions. It is suggested that workers' pursuit of their health and safety concerns might be facilitated if they had better access to information about their legal rights and mechanisms for dealing with hazards in the workplace.

The genesis of fear: AIDS and the public's response to science

The AIDS (acquired immunodeficiency syndrome) crisis has aroused scientists to major research efforts and the public at times to near-hysteria. The media and their audience eagerly await the latest scientific reports, yet the public seems to respond selectively, embracing the most frightening interpretation of the data and discounting attempts to place those data in perspective. One might be tempted to conclude that questions of public health policy are best dealt with by expert judgment unsullied by lay opinion. Yet such an attitude supposes scientists to be governed by pure reason and to be beyond influence by narrow self-interest or by political or moralistic considerations, a self-serving assumption belied by an examination of the record. The erosion of public confidence in science has indeed bedeviled health authorities in their efforts to generate consensus on the policies they wish to implement, but the public response—including the response of scientists to AIDS—is a far more complex phenomenon.

Compensation for occupational disease with multiple causes: the case of coal miners' respiratory diseases

Many diseases associated with occupational exposures are clinically indistinguishable from diseases with non-occupational causes. Given this, how are fair decisions made about eligibility for compensation? This problem is discussed in relation to the federal black lung program. Conflicting definitions of terms--coal workers' pneumoconiosis as defined by the medical profession, pneumoconiosis as defined by the United States Congress, and the popular term, black lung--are important considerations in this discussion. Each is embedded in different logical interpretations of the causes of occupational disease and of disability. Alternative views are presented and critically discussed.

The worker as teacher

The worker is the major source of information about job hazards. Frequently, workers themselves discover new occupational diseases. Physicians need to regard the worker as a member of the occupational health team.