Accommodations

November 2004

The sick role is a long documented part that almost all of us play at one point or another in our social lives. In American society, being sick brings with it both privilege and responsibility.

Being sick means that we are excused from many of our regular expectations. We are able to miss school, work and household chores in the name of "getting well." Being sick means that others are expected to wait on us, providing us with food, fluids, medicine, a place to rest, quiet time and whatever we request that might make us feel better.

However, this role cannot be played indefinitely without consequences. The main duty of the sick person is to do everything in their power to get well. This means taking medications, going to health care workers for assistance, remaining compliant to established regimens and making lifestyle choices that are considered "healthy."

If a person claiming the sick role is perceived by others to be responsible for their condition in some way or another, the privileges of the sick role can be withheld.

All this boils down to a negotiation between the "sick" and the "well" over the extent to which the sick person is allowed to claim sick privileges and the well person is expected to accommodate the sick. These negotiations are fraught with emotion, expectation and the potential for misunderstandings.

In the past forty years or so, with the rise of medical consumerism and alternative medicine in the United States, these negotiations have included the question of whether the person claiming the sick role "brought on" the illness through poor lifestyle choices. More than ever, individuals are expected to have done everything in their power to avoid getting sick in order to claim the role.

Almost everyone has felt the sting of a well-meaning person raising accusatory propositions about our illnesses. "You have to eat better to build up your immune system." "If you took zinc every day, you wouldn't get colds." "What were you thinking when you rode that bike?" "If you exercised more, you wouldn't be susceptible to injury." And so forth.

This way of thinking has led to one of the great oxymorons of our age: preventable deaths. Public health officials who want to make a name for themselves in the world of epidemiology can do so through identifying and examining preventable deaths, which generally include deaths attributed to medical accidents, preventable physical accidents and, of course, poor lifestyle choices.

The airwaves are full of the latest studies telling us what we must do to ensure that we stay healthy. These studies are often conflicting. These studies are often reported before they have been verified and replicated. These studies are often reduced to sound bites.

In the name of reducing preventable deaths, pharmaceutical companies, surgeons, attorneys, epidemiologists, public health officials and snake oil salesmen have taken short-cuts and ignored warning signs in order to promote a favorite procedure, product or regimen. These procedures, products and regimens usually make someone a lot of money. These procedures, products and regimens often stigmatize a particular group in order to make the sale. These procedures, products and regimens frequently lead to other kinds of illness, injury or, ironically, death. But the risks involved in these procedures, products and regimens are acceptable because they supposedly have the potential to reduce whatever preventable death is being targeted.

In the midst of this negotiation between the sick and the well, a number of things get labeled as medical in order to produce these products. Pharmaceutical companies especially have a built-in motive for creating and naming new illnesses. The patent process allows for a different patent for the same medication for each condition the medication is shown to treat. Thus, when a patent is about to expire, a new condition is found and the new patent is obtained, keeping the medication exclusive, expensive and highly profitable. When the patent runs out, other companies can reproduce the product, market competition sets in and prices (and profits) go down. Physicians and other health care workers also benefit from the creation of new illnesses because they rely upon diagnostic codes to justify payments from insurance or HMOs.

The consequence of this naming of new diseases is that a number of differences among humans get labeled as "sick." Given the negotiation between the "sick" and the "well," being labeled as sick can be both a blessing and a curse. Claiming the sick role can bring privilege, but many of the "preventable" illnesses bring stigma. Cancer is a bad thing. However, lung cancer is often regarded an indication that a person spent a lifetime smoking, making their disease an indictment of their lifestyle choices rather than a horrifying experience.

Naming a human difference as "sick" opens up the possibility of social control. In the name of helping the sick, a number of people assert control over the sick. Discrimination that would not be possible on the basis of mere difference becomes acceptable under the guise of helping.

It should not be surprising given the medicalization of many human differences and the justification that medicalization gives to attempts to social control, that the Center for Disease Control found it fitting to study the effects of weight on fuel consumption of airlines. A study publicized last week suggests that because, in 2000, Americans were, on the average, 10 pounds heavier than they were in 1990, air fuel consumption has risen along with the residual effects of air pollution.

Several problems exist with this so-called study.

First, little context was given to the practices in airlines to attempt to pack as many people as possible into an aircraft. The practices of airlines to limit or eliminate first class seating and to cram coach seating in their planes was not considered as a factor.

Second, this kind of study assumes that no other efforts could be made to make fuel consumption more efficient. Weight is one of hundreds of factors that affect fuel efficiency, including such things as better burning fuel, alternatives to petroleum-based fuels and more aerodynamic designs. Singling out one of these factors and giving it precedent over all these other ignores the interactive nature of these factors and the possibility that taking the full multivariable model and deriving the optimal model from it would have led to quite a different picture.

Finally, why the hell was the CDC doing this kind of study? The answer lies in the concept of preventable deaths. Justifying the spending of public funds on an impact study of an industry lies in the belief that all the resources available to convince people to lose weight must be explored in the name of preventing so-called "obesity-related" deaths.

This study will lead to prejudice and discrimination, not weight loss.

The Ample Traveler^© is sad to see this study getting publicity and attention from the travel industry. A number of studies have been done that suggest that it is activity, not weight loss, which leads to good health and well-being. We promote the idea that travel is an excellent way for people to become more active. Cutting off or stigmatizing a group of people from travel becomes a self-fulfilling prophecy. If fat people are excluded implicitly or explicitly from airline travel through double-fares and hateful rhetoric about "fat butts" having an environmental impact, then they will stay home and be less active.

Making room for everyone includes literally making room. The problems experienced by the airlines is not a matter of 10 pounds, it is a matter of engineering design and the will to accommodate difference in human bodies. By the CDC's own admission, one doesn't have to lose a great deal of weight to enjoy health benefits of eating well and exercising regularly. So which is it, do they want us to be skinny or do want us to be healthy? And what will they want tomorrow?

No matter where you stand on the question of intentional weight loss as a matter of health, you have to know that fat people will still be around. Excluding them from air travel is not going to make them healthier and, in fact, might be a detriment to a healthier lifestyle.

The Ample Traveler^© hopes that the airline industry will ignore this ill-informed study and will think about accommodation as the key to their future success. Human beings come in all shapes and sizes with all sorts of needs. Medicalizing these differences is not the answer. Celebrating them is.

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