A look back at the military’s influence on American nutrition

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Image of early 1940s poster by Office for Emergency Management, Office of War Information, Domestic Operations Branch, Bureau of Special Services

If you think of our military’s influence on food, you may picture MREs — meals, ready-to-eat — which are the main operational food rations for the U.S. Armed Forces. You may even have some MREs in your earthquake supply bin.

But according to Hannah LeBlanc, a history of science doctoral candidate at Stanford, the U.S. military has had a more fundamental and far-reaching impact on American nutrition than MREs. In fact, she argues, American nutrition was profoundly altered during the mid-1900s when the U.S. government poured funding into nutrition research. The legacies from this research include the food pyramid, recommended dietary allowances and much more.

LeBlanc’s dissertation reveals that the government hired nutritionists and issued propaganda films about nutrition because they needed healthy soldiers to fight in World War II at a time when many men were physically weakened from malnutrition during the Great Depression. And the government studied physiology in hopes of improving their soldiers’ physical endurance and food processing to preserve food longer.

Nutrition was also viewed as a national security issue during the Cold War — combating hunger as a means to protect our democracy. LeBlanc explained in a recent Stanford news release, “If you’re hungry, communism’s promises of food and well-being are going to be appealing.”

LeBlanc came to these conclusions by delving into a dozen archives throughout the U.S. for primary sources, such as military memos, government budgets and propagandistic nutrition films.

LeBlanc’s advisor, Londa Schiebinger, PhD, argues in the news release that this work can act as a reminder to pay attention to who is funding and directing our research: “Since the 1950s, there’s been this idea that science is merely objective. And, yes, we discover truth in science, but research priorities are very much determined by society.”

This is a reposting of my Scope blog story, courtesy of Stanford School of Medicine.

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How yellow fever shaped 19th-century New Orleans: A Q&A

Stanford historian explains how frequent yellow fever epidemics in nineteenth-century Louisiana generated cultural and social norms in its fatal wake.

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I was intrigued when I came across the Stanford profile of Kathryn Olivarius, PhD, a historian of 19th-century America. Her research primarily explores how epidemic yellow fever disrupted society in the antebellum South, generating cultural and social norms in its fatal wake. To learn more, I spoke with her recently.

As a historian, what got you interested in fellow fever?

“When I embarked on my PhD, I wanted to write about how slavery changed in Louisiana after 1803 with the Louisiana Purchase, as the region shifted from Spanish and French to American rule. But while sitting in Tulane’s archives and perusing letters, diaries, plantation ledgers and ship manifests, what impressed me the most was how much people spoke about disease. And the disease they feared the most was undoubtedly yellow fever  — a disease that struck antebellum New Orleans at epidemic levels nearly every third summer.

Yellow fever victims experienced a sudden onset of headache, back pains, jaundice, nausea and chills. Within days, they oozed blood through their external orifices, writhed in pain and vomited up partly coagulated blood. About half of all people who contracted yellow fever in the 19th century died, while the survivors gained lifetime immunity.

In my view, yellow fever played a critical role in Louisiana’s asymmetrical social organization, on the schedule and character of the cotton market, on capitalism itself and on the entire system and ideology of racial slavery. So I decided to focus on the disease for my PhD and my forthcoming book.”

How did the disease impact the social structure of 19th-century Louisiana?

“Antebellum New Orleans sat at the heart of America’s slave and cotton kingdoms. But it was also the nation’s necropolis, the city of the dead, with yellow fever routinely killing about 8 percent of its population between July and October. In some neighborhoods — particularly those with high densities of immunologically-naive recent immigrants from Germany, Ireland and the American North — yellow fever deaths could reach 20 or even 30 percent.

These repeated epidemics generated a hierarchy of ‘acclimated’ survivors who leveraged their immunity for social, economic and political power and ‘unacclimated’ recent immigrants who languished in social and professional purgatory. Until whites could prove they were acclimated, they struggled to find steady, well-paid employment, housing, spouses and a political voice. From the employer’s perspective, it wasted time and money to train someone for a detail-oriented job only to watch him sicken and die by the autumn.”

How did this affect slavery?

“Because of the disease, the commercial-civic elite of New Orleans argued that they required large-scale black slavery — publicly proclaiming that black people were naturally immune to the disease based on spurious and racially-specific visions of medicine and biology. It became a powerful proslavery argument with many whites claiming that black slavery was natural, even humanitarian, as it distanced white people from labor, spaces and activities that would kill them. Some even argued black immunity signaled divine sanction for widespread slavery, with God creating black slaves specifically to labor in the cane and sugar fields of the Mississippi Valley.

But in private, most slavers would not buy an unacclimated slave. The slave market essentially shut down in August, September and October in order to protect the health of potential buyers and their valuable slave property. This inconsistency suggests that the widespread belief in black immunity was less a reflection of biological reality but instead a social tool, a means to epidemiologically-justify racial slavery.”

Do you believe anything similar is happening today?

“Yellow fever still kills thousands of people each year. It’s endemic in 47 countries, mostly in Africa and Central and South America. The Intergovernmental Panel on Climate Change’s report released last year also suggests that Americans may become more familiar with this disease again as ecologies change and mosquito populations migrate. Zika, spread by the same mosquito as yellow fever, has been an increasing problem in recent years.

In terms of the social impact of disease, there are certainly modern analogues of societies in the midst of terrifying epidemics rationalizing mass death or singling out certain marginalized groups as the cause. The most obvious comparison in the U.S. is probably HIV/AIDS in the 1980s with gay people, intravenous drug users and Haitians who were blamed for the disease’s spread and who faced severe discrimination on the basis of their alleged-vulnerability.”

This is a reposting of my Scope blog story, courtesy of Stanford School of Medicine.

A look at the cigarette epidemic in China

Image by Dimhou

The imagery of a cuddly panda bear has often been used to sell tobacco products in China. So a new book that examines China’s cigarette industry seems aptly titled: Poisonous Pandas: Chinese Cigarette Manufacturing in Critical Historical Perspectives.

The book brings together an interdisciplinary group of scholars — including Stanford editors Matthew Kohrman, PhD, a professor of anthropology, and Robert Proctor, PhD, a professor of history. Together the team has investigated how transnational tobacco companies have worked to triple the world’s annual cigarette consumption since the 1960s. They focus on the China National Tobacco Corporation, which currently produces forty percent of cigarettes sold globally.

In a recent Freeman Spolgi Institute Q&A, Kohrman discusses how he got involved in this work. “When I began my ethnographic fieldwork on tobacco in China, I initially studied mostly consumer behavior. But I quickly realized that focusing solely on cigarette consumption, without considering the relationship between supply and demand, was like studying obesity while ignoring food,” he says.

Kohrman explains that cigarettes have become the single greatest cause of preventable death in the world today and the problem is getting worse. “Instead of declining as we would expect based on our impressions living here in California, the number of daily cigarette smokers around the world is projected to continue climbing,” he says. In particular, he explains the big tobacco companies are targeting less-educated people from lower- and middle-income countries.

Kohrman does offer some hope in light of the Chinese government’s recent initiatives to restrict tobacco advertising and smoking in public places. But he says that there is a lot more work to do.

“The road towards comprehensive tobacco prevention in China is going to be a long one,” Kohrman concludes.

This is a reposting of my Scope blog story, courtesy of Stanford School of Medicine.

What history can teach us about medicine: A Q&A with a Stanford medical student

Photo by Shivam Verma

When I think of history, I think of the famous quote: “Those that fail to learn from history are doomed to repeat it.” This is often brought up in reference to politics, but what role does history play in science and medicine? To learn more, I spoke with Julie Barzilay, a second-year medical student at Stanford who has studied the history of science.

How did you first become interested in the philosophy and history of science?

“As an undergraduate at Harvard, I took an incredible course on the history of Darwin and evolutionary theory that introduced me to the world of history and philosophy of science. It was fascinating and powerful to think about scientific knowledge as something that was created by humans in particular contexts and as something that was constantly being evaluated and re-imagined. I was especially drawn to the history and philosophy of medicine, where complex issues of identity, power, stigma, hope, fear and biopsychosocial dynamics all seemed to intersect. Once I began thinking like a historian, I could never see science and medicine the same way again — and I think that is a very good thing.”

How can this enrich the everyday practice of science and medicine?

“All knowledge has a history. Analyzing the ways that humans constantly create and revise their understanding of scientific processes makes us more innovative and critical when it comes to challenging assumptions in our fields. I also believe that thinking historically and sociologically builds empathy. Sociologists, historians, philosophers and anthropologists of science have made us think hard about concepts like the power dynamics in the doctor-patient relationship, or how a patient’s identity changes when given a diagnosis. And thinking about medicine in these terms adds so much depth to the care a physician can give a patient.”

What motivates you to still pursue this interest as a busy medical student?

“I think history is incredibly colorful, fun and important. I am also curious about the history of the profession I’m joining, and often find the questions that excite me the most live at the intersection of history, ethics and sociology of medicine.

I want to share these frameworks and passions with my peers. This is what motivated me to develop the upcoming lunch series on the history of science and medicine, which I created with the support of the Biomedical Ethics and Medical Humanities Scholarly Concentration, particularly Audrey Shafer, MD, and my advisor for this course Laurel Braitman, PhD. The class will introduce students to an array of talented historians, sociologists, anthropologists and bioethicists at Stanford as we rotate through a new speaker each Thursday at 12:30 pm. I hope the speakers inspire students to think historically and ask tough questions about our assumptions in all scientific fields.”

What are your career plans?

“After completing my MPhil in history and philosophy of science at the University of Cambridge and finishing my premed courses in a post-baccalaureate program at Johns Hopkins University, I worked at ABC News as a production associate in their medical unit in New York. I love communicating about health and medicine, and hope to integrate health communication into my career one day. In terms of clinical practice, I am most interested in pediatrics, but am open to exploring other fields during my upcoming clerkships. I hope to teach, write and practice, in some combination.”

This is a reposting of my Scope blog story, courtesy of Stanford School of Medicine.

Using history as a guide to end tobacco addiction

Photo courtesy of Robert Proctor

The public’s opinion of tobacco use has dramatically changed over time. Gone are the days when cigarette companies advertise using slogans like “fresh as mountain air” or “more doctors smoke Camels than any other cigarette.” We now know that cigarettes cause blindness and tuberculosis, among many other conditions, and are highly addictive.

But in the era of nicotine e-cigarettes that are touted as cool and harmless, have we really changed our ways? I spoke with Robert Proctor, PhD, a professor of history at Stanford, to learn about his work.

What inspired you to research the history of cigarette design?

“Cigarettes are the world’s leading preventable cause of death, killing about 6 million people worldwide every year.  A physician might hope to heal a thousand or perhaps ten thousand people over a career, but what if we could save these 6 million people annually?  It was this hope of saving lives that led to my exploring how cigarettes have been designed, and how they might be stopped.”

Where do you find your research materials?

“The Legacy Tobacco Documents Library is a real treasure.  I use it to explore the industry’s myriad secret projects — like Project Subculture Urban Marketing, a secret Reynolds campaign from the 1990s to target gays and the homeless in San Francisco.  I also use it to find out what they’ve been adding to cigarettes—like diammonium phosphate, a free-basing agent used to boost the potency of the nicotine molecule. I also use it to find out who has been working for the industry, as grantees or expert witnesses. Historically that included dozens of Stanford professors, but I don’t know any still working in that capacity today.”

What do you think about the FDA’s plan to reduce nicotine in cigarettes?

“As I explained in a recent op-ed for the New York Times, the Food and Drug Administration will try to mandate the reduction of nicotine in cigarettes to a sub-addictive level. However, they will encounter ferocious resistance from the industry, which sees nicotine as the indispensable ingredient of their business. For beginning smokers, nicotine is actually a negative in the smoking experience. Once addicted, most smokers regret having started. It will be crucial for the FDA to reduce nicotine sufficiently to make sure new users don’t become addicted. De-nicotinization is easy. Multiple techniques are available to achieve this, including genetic technologies and some of the same techniques used to de-caffeinate coffee.”

Have you also studied e-cigarettes?

“I have studied e-cigarettes but not as intensively. Many of the same techniques once used to market traditional cigarettes have been revived for e-cigarettes and other vaping devices, as Robert Jackler, MD, and his colleagues have shown so beautifully. E-cigarettes may help some smokers quit, but they are more likely to renormalize smoking and act as gateways to regular cigarettes. They also serve as bridge products to keep smokers from quitting nicotine entirely, which is why the big cigarette makers have all launched new vaping devices.”

What more can be done?

“Physicians often know the right thing to do, but may not have the power to make that happen — that is medical impotence.  A third of all cancer deaths, for example, are caused by cigarettes. Just knowing that, though, isn’t enough to do any good, since there are powerful forces dedicated to making sure we keep pulling smoke into our lungs. Much more could be done to solve such problems — the new age minima for purchasing cigarettes should help. I also believe we need to explore what I call ‘the causes of causes.’  Cigarette smoking causes disease, but what causes cigarette smoking?  Too often we end with the individual, rather than going upstream to the source of the problem in the first place. Stop the manufacture of cigarettes, for example, and you stop having to yank out tumors from lungs or putting people on oxygen. We need more upstream thinking in the practice of medicine.

We also need to think more about health in our own community. For instance, Stanford got a failing grade from the Santa Clara County Public Health Department in 2011 as the most cigarette-friendly campus in the Bay area — for allowing the sale and use of cigarettes on campus.  We did finally manage get the sale of cigarettes in the student union stopped, after years of painful protest.”

 

Editor’s note: Stanford has a smoke-free environment policy that prohibits smoking in all buildings, facilities, vehicles, covered walkways and during indoor or outdoor athletic events. Smoking has been banned on the School of Medicine campus for a decade. 

This is a reposting of my Scope blog story, courtesy of Stanford School of Medicine.