David Buchanan / The Campaign in Public Health and Health Sciences / Deans' List / School of Public Health Home Page
AYBE
BECAUSE HIS FIELD has the word "public" in it, David Buchanan of
the faculty of Public Health and Health Sciences uses few words that confuse
the layperson. But here's one that sent us to the dictionary: "iatrogenic,"
as in "iatrogenic harm." This turns out to refer to efforts to help
that inadvertently damage the patient. For instance, in nineteenth-century
America, addiction to opiates "exploded," says Buchanan, with per
capita rates over six times higher in the 1890s than in 1842. One explanation
has been the invention, in 1850, of the hypodermic needle, which was widely
used to treat the Civil War wounded.
Now, Buchanan has other ideas about nineteenth-century
opiate abuse, which was actually most prevalent among women. He thinks
alienation, not medically induced addiction, was its cause. But the principle
of well-intentioned harm is profoundly important. Buchanan, whose central
interest is adolescent substance abuse, worries that our favorite strategies
to discourage such abuse may reinforce attitudes that encourage it.
Buchanan is a strapping, sandy-haired
Californian who grew up in Los Angeles in the `60s and `70s and had friends,
he says with disbelief, "who died as a result of drugs."
And yes, under the rubric of "drugs" he does include alcohol,
which as a legal substance is popularly thought of as something else. When
Congress recently appropriated $175 million for anti-drug-abuse ads, public
health advocates "lobbied as hard as we could," Buchanan says,
to have alcohol included. "The alcohol industry was stronger."
Yet in all the patterns of pathology that
undermine communities, from domestic violence to entrenched poverty, "alcohol
is just there," says Buchanan. He's observed this connection
firsthand; as a young scholar he repeatedly interrupted his studies to
do community work, and as a doctoral student at Berkeley he immersed himself
in the subculture of stock-car and drag-racing as part of a study eventually
published as "Beer and Fast Cars: How Brewers Target Blue-collar Youth
through Motor Sport Sponsorships."
Today, at UMass, Buchanan fits volunteer
service on the Amherst Board of Health and work on a community-based health
project in Holyoke around his more formal research and teaching duties.
"I love that kind of work," he says. And he rues the effects
of substance abuse, and distrusts the attenuated sense of community, that
he sees in every sphere.
On campus, it's as plain as a giant inflatable
beer can that the same companies who target blue-collar youth through motor
sports events are targeting college students through other venues. In Holyoke,
citizens identify substance abuse as a primary threat to their children.
And at Board of Health hearings, Amherstonians invoke individual rights
with a certitude that confirms some of Buchanan's most interesting views
on the culture of abuse.
These views are rooted in his reading
of history. Three times in the past, he notes, American society has undergone
swift and convulsive change: change that both weakened the sense of community
and strengthened the sense of individual entitlement. These periods of
national upheaval what historian Robert Bellah calls "our times of
trial" coincided with the Revolutionary War, the Civil War, and the
Vietnam and culture wars of the 1960s. And following each of these cultural
storms, substance abuse rose sharply.
For instance, in colonial America, alcohol
appears to have been fairly well integrated into community life, Buchanan
says. Then came the politically salutary, but socially traumatic, Revolutionary
War. And between 1800 and 1830, per capita consumption of distilled liquors
jumped from 2.8 gallons a year to more than 5. Some estimates make it 10.
Consumption decreased again under the influence of the temperance movement
in the decades before the Civil War. It showed yet another increase, and
another decline, in the post-Civil War and Prohibition eras.
While he acknowledges that many other
changes were afoot in the early nineteenth century, Buchanan is especially
interested in the way that alcohol had become associated, during the Revolution,
with the breakdown of traditional authority and class deference. "All
men were equal before the bottle," one scholar writes, and taverns
"were certainly seed beds of the Revolution." Drink became a
talisman of equality, and ultimately of individual liberty.
As Americans, we see the democratic dispersal
of authority as a good thing. But among its by-products were the existential
anxieties of freedom, and alienated individuals. Both anxiety and alienation
find solace in drink, and alienation may pride itself on its right to do
so.
This community perspective on the meaning of drink is what persuades Buchanan
that we're going wrong, not just in abusing intoxicants but in understanding
why we're so prone to do so in a post-traumatic era, and how we can best
protect young people against the dangers of excess.
"One of my interests has been in
looking at moral reasoning about drug use," he says. "For my
dissertation I talked to over a hundred kids about how they make up their
minds on these issues. And I was able to develop a typology in terms of
whether they saw drugs as an individual choice, or a social choice, or
a moral choice.
"Basically, what I found is that those who see issues primarily in
terms of rights are most likely to get into substance abuse. Those who
feel more embedded in a web of social bonds are likely to stay out of trouble."
It's interesting to think, says Buchanan,
how this relates to what he calls "the whole mythology of peer pressure
that's out there." To his mind, the "Just Say No" approach,
with its focus on strengthening the self against social bonds, partakes
of an ideal that has been all too much with us since the most recent of
our great times of trial. He would have us think less about resisting social
bonds, more about improving their quality and strength.
"I'm not the first to say that we need to come back to some sort of
equilibrium," says Buchanan. "What we need is a conversation
about rights and responsibility."
-PW
|
"ISN'T THAT NEAT?" exclaims Dean Stephen Gehlbach, his dark eyes sparkling, when he sees he's sparked a visitor's interest in two new initiatives that are a focus of Campaign UMass in the School of Public Health and Health Sciences. the Center for Research and Education in Women's Health - created last year - and the Center for Nutrition and Sport in Human Performance - announced this May - "just makes so much sense," says the Dean.
As for fitness and nutrition, researchers such as Stella Volpe, who will direct the second new center, and Robin Levine, who works extensively with athletes, are already in high-octane alliance with other exercise science and nutrition faculty and with the athletic department. Supplements, soreness, dehydration, weight control, and eating disorders ("especially in the 'appearance' sports," says the Dean) are a few of their interests. |
| PHHS: biostatistics and epidemiology . communications disorders . community health studies . exercise science . nutrition |
These
centers make sense in two ways. A concentration of intellectual resources
to fuel them already exists at UMass, and the problems they address
are highly topical. Women's health, for example, is under-researched
in comparison with men's. More than a dozen research projects are underway
on campus (including at least one, "Alcohol Use and the Etiology
of Breast and Ovarian Cancer," that is relevant to the theme of
this issue), and the center is expected to spark additional efforts.
