Inflamed: Inspiring But Insufficient

A Book Review by Ellen Isaacs, October, 2021

The popular new book Inflamed, by Rupa Marya and Raj Patel, is both enlightening and enraging.  It has several dominant themes. One is that inflammation is behind most disease processes in all parts of our bodies, an idea that is more and more accepted by conventional medicine. However the authors carry the idea farther, showing how the environment, both physical and social, is deeply entwined with inflammation and how even heredity is affected by these processes. The second main theme is that modern medicine has detached bodily systems from each other and the body from the world it inhabits just as modern humans have fallen out of harmony both with each other and the world around them. In contrast, there are many indigenous cultures that are better synchronized with their environment.

However, what is sorely lacking is any prescription for how we can right all this imbalance, described as colonialism or occasionally as capitalist colonialism, in the modern industrialized world we live in. Instead the remedy is seen as emulating non-industrial cultures of the past or the few that survive at present. As is quoted on the next to the last page, the lesson is a bit of Maori wisdom “walking backward into the future” (p351). But the real challenge, which the authors do not address, is not to return to pre-capitalism but to consider what comes after capitalism and how to get there.

The Role of Inflammation

Acute inflammation may result from an infection, injury or psychological stress and initiate healing mechanisms like fever, bacteria-hunting macrophages, wound healing, and the fight and flight reflex. An important lesson from the book is that the stress response is the body’s response to any threat of damage, and it activates the nervous, endocrine and immune systems to produce inflammatory signaling proteins (cytokines) and hormones to respond in the short term. Chronic stress, however, may generate a chronic reaction from which the body never heals, be it from ongoing pollution or the mental stress of racism, sexism or poverty. Chronic stress leads to age-related chronic diseases such as diabetes, heart disease, kidney disease, osteoarthritis, chronic obstructive lung disease, and Alzheimer’s dementia. Even aging itself, manifest as a decrease in length of the ends of our chromosomes called telomeres, is accelerated by chronic stress (p68).

The authors detail the ways our circulatory, digestive, respiratory, reproductive, endocrine and nervous systems and connective tissues are all affected by inflammation. Stress activates an axis from the brain, via the hypothalamus and pituitary to the adrenal glands, that releases hormones like cortisol and adrenaline that in turn activate immune cells to release C-reactive protein and other proteins. Normally there is a feed back loop that stops this cycle as the threat passes, but in the face of chronic stress this mechanism is disrupted, resulting in constant. activation of low -grade inflammation. The response to new threats is then lessened and the body is less able to defend against infections, such as Covid (p92). Along with the fact that other chronic diseases like diabetes and chronic obstructive lung disease result both from inflammation and toxins like air pollution that are more prevalent among the poor and nonwhite residents of urban ghettos, we have an explanation for the higher prevalence and mortality of Covid that goes beyond blaming the poor health habits of individuals.

The example of Covid is just one of many that explain how modern medicine both ignores the higher toll of disease on people of color and poor people in general. In all societies where there is racial discrimination, the members of minorities have higher C reactive protein, a marker of chronic inflammation. This is true of blacks in the US, Muslims in Burma, Dalits in India and many more(p232).  For example, long term exposure to particulate matter increases the production of inflammatory cells which target insulin sensitive tissues, which leads to diabetes(p164), in addition to the  massive sugar load put in foods to increase profits. Compared to whites, US blacks have higher rates of chronic diseases like heart disease and diabetes that occur at an earlier age and have a shorter life expectancy – all conditions related to inflammation.

The authors spend about half of the book giving examples of how indigenous cultures around the world have avoided high stress levels and poisoning their environments. From the Native American tribes of the Pacific Northwest to Australian Aborigines, planting and grazing were managed with sophisticated crop and clearing rotations that preserved productivity for generations. Okinawans, the inhabitants of an island off Japan, have the greatest longevity in the world. A diet low in fat, sugar and salt, good medical care and sleep habits, and a robust social and spiritual life are largely responsible. These are but a few of many examples, but when any of these societies were disrupted by colonization and the imposition of modern industrial agriculture and production for profit, disease and social disruption followed.

What Is To Be Done

There is very little space in the book devoted to specific remedies for capitalist colonial harm that is so well documented. Beyond increasing the awareness of health workers about the interconnectedness of our bodies and our habitat, how can we alter that world? Although we can learn many lessons from studying indigenous societies, we are not really eager or able to recreate that life for the mass of the world’s population.

One of the few places where the authors consider current movements for change is in support of abolishing the police, since the police so disproportionately target and kill black, queer and other marginalized communities. The demand is that the huge police budgets be redirected to improved housing, schools, job creation and other community resources(p258). Even further, the authors say, “Abolishing the modern private corporation doesn’t mean ending coordinated enterprise but rather holding it accountable to the people it serves”(p334). However, the authors’ own evaluation of the hunger for profits, the cruelty of capitalist exploitation, and the violence perpetrated in world conquest illustrates the illogic of this demand. A system based on the repression of the few by the many needs a repressive force to quell dissent and the disorder resulting from poverty and discrimination. A system based on profits, the definition of capitalism, cannot sacrifice profits to maximize the good of workers.

In actuality, the only way to end capitalist colonization, indeed capitalism itself, is to build a movement with capitalism’s destruction as its aim. This will require a violent, massive, international struggle that will be built on the basis of reform struggles that focus on multiracial worker-led movements and do not build illusions about reforming capitalism. It may also be inspired by the worsening cataclysms that capitalism will bring – climate disasters and world war. As a new post-revolutionary worker-led society is constructed, then many of the insights about medicine and the connection of the physical and social environments to our health and wellbeing can be put into place on a large scale. But only then.

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