Photo: Keir Novesky
No less than a reckoning with modern medicine is what Rupa Marya and Raj Patel lay out in Inflamed: Deep Medicine and the Anatomy of Injustice, published last week. The healthcare system that many Americans interact with today, they write, is mostly focused on fixing the patient who presents with symptoms of an illness or infection. Instead, they argue, the future of medical treatment must be predicated on something larger: analyzing how society, culture, and the environment interact with people to affect health, and using that context to inform a richer understanding of how people stay well or become sick.
Marya is a physician, an associate professor of medicine at the University of California, San Francisco, and co-founder of the Do No Harm Coalition, which was started in 2016 as a response to police violence in San Francisco. Patel is an author and research professor at the University of Texas. The two are longtime friends, having met during a protest against genetically modified crops. (Marya was playing in a band; Patel was dressed as a gene-edited tomato.) The book itself began as a conversation during a taxi ride to the airport, after a talk Marya gave at the Dell Medical School at the University of Texas.
The book is both provocative and thought-provoking. Inflamed takes readers on a tour of human anatomy through our various systems: circulatory, nervous, respiratory, digestive, and so on. Yet this is not a medical textbook. At each physiological juncture, the co-authors relate the malfunctions of human biology to the inadequacies of our political and economic systems. Debt and repayment anxiety, for instance, is linked to higher levels of C-reactive proteins, inflammatory markers that are, in turn, linked to chronic heart disease.
Even something as simple as a pulse oximeter is a reflection of those inadequacies. The devices use light that passes through the skin to measure blood oxygen levels, so critical for monitoring the health of Covid-19 patients. A reading of 88 percent will prompt hospitals to put patients on supplemental oxygen to forestall organ failure. Never mind that the devices, since their advent in the 1970s, were tested predominantly on the skin tones of white people—which means they can falsely register higher blood oxygen levels for black people when the exact opposite is true, preventing them from receiving supplemental care when they need it most.
This type of shallow medicine, as Marya and Patel call it, treats a sick person as a broken machine-bearing symptoms. It’s a generalized form of medicine, one that assumes that what’s good for one sick person with a certain condition will be just as good for another sick person with that same condition. At the same time, they take aim at capitalism and colonialism, two forces that have made medicine a monopolistic enterprise, they say, instead of an imperative to public health for all.
Ultimately, the pair conclude that what’s needed is deep medicine, a term they coined that appears in the book’s subtitle. Rather than diagnosing a sickness and determining why it happens within the confines of the body, we need to recouple medicine with the rest of the web of life. How is the person with diabetes, for instance, going to survive if the price of insulin is so far out of reach? How is the person with heart disease ever supposed to get healthier if the communities where they live lack grocery stores with fresh produce?
“In order to have effective solutions, we have to have an effective way of thinking of things as interrelated systems. We can no longer think of medicine and health without thinking of our ecologies,” Marya says. “Whether those ecologies are political or biological or social, these things are phenomena that are acting on our bodies and creating either health or illness.”