Green women, fat livers, and the cultural side of disease

Once upon a time, there was apparently a disease called chlorosis. (There is, still, a plant disease of the same name, but we're talking about human chlorosis, here.) It existed in young women from the U.S. and Europe. It turned their skin turn green. The diagnosed cause: Excessive virginity. Prescription: A husband and, for best results, babies.

The thing with chlorosis is that the actual biological parts of it — the green skin — really did exist. It was the culturally influenced medical interpretation that was all off. In 1936, researchers proved it was actually just a type of anemia — an iron deficiency that could happen in males and females. The greenish tinge to the skin happened because the red blood cells were suddenly a lot less red.

Medicine isn't just anatomy and biology. It's also how we cultural interpret the importance and meaning of what we see in anatomy and biology. That's the point made by Druin Burch in a really interesting piece at Slate.com, where he compares chlorosis to a modern scourge — fatty liver disease.

Fatty liver disease affects up to a quarter of us. Its harms—a significantly increased risk of death among them—are taken seriously by hepatologists and other doctors. But it may not be a real disease at all ... Those with fatty liver disease won't know for certain they have the disease without a scan, be it ultrasound or some other modality. Usually fatty liver disease causes no symptoms. Yet those who have it are more likely to suffer heart attacks and strokes, more likely to develop liver cirrhosis, more likely to have high blood pressure and diabetes. Their health is improved from lowering their blood pressure and cholesterol levels, from dieting and exercising, and even (if they're particularly obese) from having a gastric bypass or similar surgery to help them lose weight.

The problem comes into focus when you realise these same hazards and recommendations can be invoked for any other manifestation of being overweight. Take fatty elbow disease. As far as I'm aware, I'm the first to describe it, but I think it could take off. It's associated with being overweight and underactive and it carries with it the same range of real risks. Sufferers are often asymptomatic, unaware of their illness, although I admit that it can be picked up without much use of an MRI scanner. Shortly I'll be writing to the New England Journal of Medicine to expose the problem. I'll demand action to raise the profile of fatty elbow disease, with programs to screen elbows nationwide and make patients aware of their affliction. I'll accept lucrative posts advising drug companies and seek out a celebrity patient or two. I'll attend so many lavish conference dinners I may develop the disease myself.

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Image: Sean & Sarah, a Creative Commons Attribution (2.0) image from duncanh1's photostream