'Viral Chic': Propaganda of Health Care in the United States
Issue #21, September 1995
Newsweek calls them "commandos of viral combat" and "viral jocks," while Laurie Garrett (author of The Coming Plague) calls them "disease cowboys." Either way, doctors and scientists from the Centers for Disease Control (CDC) and the US Army Medical Research Institute of Infectious Diseases (USAMRID) have recently become big news. Over the past twelve months the names for previously obscure viruses that have appeared throughout the world, together with the names of research institutions which deal with them, have become household names, and stories about such diseases continue to circulate within the mass media.
It is not only the "real-life" epidemics of Ebola in Zaire earlier this year, or of Hanta in the United States in 1993, that have raised awareness about the threat of deadly viruses. Indeed, as anyone with even a passing familiarity with popular culture cannot fail to have noticed, the United States is currently experiencing what one journalist calls an "epidemic of viral entertainment." In the last two years, popular culture has been inundated with a wave of viral thrillers (and a smattering of movies) which capitalize on our fear of deadly and highly contagious diseases. Probably the best known of these is Richard Preston's 1994 non-fiction book The Hot Zone, which has been on the New York Times bestseller list for over a year. But other recently released books include William Close's Ebola, Patrick Lynch's Carriers, Graham Watkin's Virus, and John Nance's Pandora's Clock; films include Outbreak and the made-for-tv movie Virus.
Popular culture continues to claim that these new micro-organisms are the most deadly menace to face the human race. Writers have found, moreover, that such diseases provide lucrative and compelling fodder for mass-marketed entertainment. Yet, as many health workers argue, tuberculosis and AIDS present a far more serious threat than the more "exciting" Ebola or Hanta and the United States would do well to acknowledge instead the spread of these equally deadly but less "dramatic" diseases. Tuberculosis, for example, can be transmitted by airborne droplets from a cough or sneeze and can slowly work its way through a population for years before enough people exhibit symptoms and cause alarm. Similarly, AIDS spreads silently, with infected people often not showing symptoms for years. The fact that John Nance's Pandora's Clock is being marketed as "The Hot Zone meets Speed," however, suggests that while AIDS and TB remain serious but "unexciting" health issues, popular culture happily co-opts other viral narratives as fast-paced action adventures. Are AIDS and TB simply less marketable or is it more the case that the strategies of health care they require are simply less "entertaining"? Many of these recent best-sellers are based on fact, so it is clearly not the case that we will consume stories of horrific bodily disease and disfigurement only so long as we believe they are fictional. It is simply easier to consume narratives which pose totalizing solutions than to address the complicated and difficult problems associated with the incidence and spread of TB and AIDS in the United States
The line between "fact" and "fiction" within this emerging genre is further blurred by the way in which these biohazard thrillers blend scientific lab-speak with the dramatic trope of a social group on the brink of disorder. In other words, if news-stories about the outbreak of Ebola in Zaire seem too depressing, or the rise of tuberculosis in the United States too dull, these books tap into our fears of deadly viruses while simultaneously fostering a sense of security about our ability to deal with them. Indeed, by focusing on "real life" epidemics, these books function in a manner similar to historical novels: enabling the reader to feel edified by the subject matter while also being entertained by the compelling and dramatic story. After finishing The Hot Zone, for example, I felt I had learnt as much about Ebola as if I had read a dozen articles in medical journals. My knowledge and mastery of the subject was dependent, however, on a sense of fear that Ebola could strike at any time and that there was nothing I could do about it except trust government agencies to come up with a cure. These narratives teach us, in other words, to have faith in the possibility of quick and easy solutions to the threat of deadly diseases. This faith relies, however, on a disavowal of the social context within which diseases occur.
The spread and incidence of tuberculosis, for example, is directly related to social factors, and specifically to the (ine)quality of life associated with capitalist expansion and urbanization. Indeed, because many diseases thrive in densely populated areas, cities are frequently a haven for microbes, providing micro-organisms the opportunity to spread rapidly and effectively through human populations. Cities are, therefore, as Garrett calls them, "microbe magnets" which exploit urban ecologies to create new or more serious viral threats. The tuberculosis bacterium is, for example, a slow-growing microbe that flourishes in malnourished and immune deficient individuals, particularly in places where there is high-density housing and in areas of dirty and poorly circulating air. Tuberculosis is also, according to Garrett, an opportunist, silently "lurking" for decades and only striking when the victim's immune system is preoccupied with another serious disease. Since people living in densely crowded situations are continuously re-exposed to droplets of the bacteria, TB continues to be strongly linked to urbanization, in particular with homelessness and the overcrowding associated institutionalized living.
Yet popular culture focuses instead on the swash-buckling possibilities offered by diseases that strike and kill in a matter of hours or days, rather than those which can only be understood when social and historical conditions are taken into account. Indeed, as the catchy names for the doctors and scientists suggests, fighting these newly emerging (or at least newly acknowledged) viral enemies is not only a heroic and deadly occupation, but also a quintessentially masculine and military one. Gone are the nerdy scientists in lab coats. Instead it is cowboys, jocks, and commandos who save the world from devastation with their hermetically-sealed space suits and technological hardware. As The New Yorker put it in a review of Outbreak, these new viruses are silent, cunning assassins "carrying out the orders of the most formidable enemy power of all, Mother Nature." Or, as Preston suggests in The Hot Zone, "hot" viruses are actually less like parasites and more like predators since they make themselves invisible to their prey during the stalk that precedes the deadly attack. Certainly, there is nothing new with the natural world being given consciousness or subjectivity in this way, but the stealth and motivation with which these viruses are perceived to attack is worthy of note. No longer the benign, self-sustaining, and protective Gaia figure of the 1970s and 80s, Mother Nature of the 1990s is vengeful and deadly in her quest for doom and destruction, requiring not caution and respect but a tough and militaristic strategic offensive.
Since diseases can and do transcend national boundaries, thereby linking the United States with the rest of the world, the current preoccupation with viruses and the threat of epidemics is in some senses both justified and necessary. Indeed, as Preston has suggested, the popularization of viral entertainment might be useful because it promotes a sense of awareness about the relationship between politics, economics, the environment, and healthcare. What is striking about this sense of awareness, however, is the fact that the relationship is perceived to be an essentially coercive rather than cooperative one. Specifically, since viruses travel quickly and easily across national, social and economic borders, many writers propagate a perception of the biological world as essentially predatory and dangerous. It is now the "natural" world, in other words, rather than a specific country or region, which is perceived to threaten the United States. From this perspective the military response becomes entirely coherent and plausible. If the United States is under attack from a deadly virus, something must be done to defeat it. This position, however, is one that relies upon a denial of the kinds of social relationships that create, or at least exacerbate, the spread of many diseases. It is a view, moreover, that promotes a form of health-care based upon large-scale scientific or military knowledge, rather than localized and personal health care.
Like tuberculosis, the spread and incidence of AIDS is affected as much by social factors as it is by biological ones. Unlike viruses such as Ebola, Hanta, or Marburg, which attack at random, AIDS hits specific human targets and is associated with particular social activities: unprotected sex and IV drug-use. Like tuberculosis, moreover, AIDS is associated with poverty and homelessness: first, because those people who are currently homeless are at a higher risk for contracting HIV due to lack of health education and accessible protection, and second, because those who have AIDS are more likely to become poor and/or homeless due to the high costs of medical care. However, as an administrator for Ark of Refuge, a nonprofit agency in the Bay Area which provides housing for people living with AIDS, argues, "It costs $700 a day to hospitalize someone, whereas it costs a minimal $70 a day to provide a person infected with AIDS with shelter, constant medical care and other support services." Since there is evidence to suggest that clean and adequate housing facilitates the stabilization of T-cell counts, it is remarkable and depressing that such programs continue to be underfunded. Since marginalized individuals and groups typically have less access to information about self-protection, it is not only poverty that contributes to the spread of disease, but also social alienation. Focusing on the social, as well as biological, aspects to disease is crucial, therefore, to reaching any kind of a cure.
The emphasis on scientific rational knowledge rather than social context within which diseases occur is reiterated in the literary structure of these bestsellers, many of which are fall within the genres of the scientific mystery or detective story. The biohazard thriller typically opens, for example, with the appearance of an unknown disease or virus that is disrupting the existing social order, with the task being to then locate, identify, and destroy it. Indeed, "real-life" CDC epidemiologist, Arthur Reingold, said of his job, in a recent interview, "I liked the puzzle-solving, detective-work aspect. Epidemiology was the closest I could get to being a cheap, sleazy detective and make a living." Like the detective story, virus action-mysteries such as The Hot Zone foster a myth of the knowable world, and cling to the fantasy of being able to map out — and control — social space. Instead of the urban spaces of the typical detective novel, however, it is the microscopic world of viruses and parasites that must be conquered. Maverick scientists abound, and it is the loner "cowboys" who are able to restore the social (and microscopic) order by combining science, clinical medicine, and good old-fashioned detective work.
As a genre, the detective story has traditionally been a showcase for masculinity, and a form of storytelling that privileges rationality and order over those forms of knowledge based on personal experience or social context. This kind of "phallocentric" or traditionally male point of view is further evident in the ways in which family and work relationships are mapped out in these books and movies. Outbreak, for example, features a divorced couple (played by Rene Russo and Dustin Hoffman) both of whom work for the CDC and who inevitably end up working together to conquer the fictional Ebola-like virus. Following a clumsy accident with a scalpel, Russo catches the virus when it leaks into the gaping hole of her biohazard suit. She is obviously no longer able to perform as a doctor, and instead must lie in bed while her ex-husband takes the glory. As an army doctor, however, Hoffman finds he is forced to battle with military bureaucracy to do his job, and he ultimately takes the law into his own hands to save the United States. It is Hoffman, suited up in army fatigues who confronts the evil general (Donald Sutherland) and saves the day with true military style. Similarly, in the non-fiction The Hot Zone it is only Nancy Jaax, not her husband Jerry, who wrestles with the choice she must make between working at the USAMRID (where they both work) and her family's needs. Neither catch the virus, but Nancy's commitment to the USAMRID is constantly being questioned (by Preston) because of her work and family obligations.
There are precedents to these kinds of narratives, however. Indeed, Michael Crichton's 1969 fictional The Andromeda Strain (one of the first biohazard thrillers) most clearly exemplifies the gender politics of the genre. The Andromeda Strain features a group of biologists, technicians, and doctors scientifically chosen to be the best possible team in the event of a viral attack. The "odd man" on the team (and they are all men) is assigned the position of carrying out command decisions involving chemical and biological threats. Based on tests designed to evaluate who can best make decisions in the event of an emergency, the "odd-man" must always be an unmarried male scientist and it is he — not his team of co-workers — who makes the final decision on strategies to address biological hazards. Married men and all women, in other words, bring too much emotional baggage and gender confusion with them to their jobs as doctors: baggage that disables, rather than enables, their attempts to administer medical care. Since personal relationships hinder his quest for knowledge, the odd man, like the "detectives" and "cowboys" of the hot zones, must remain separate and detached from the social world he seeks to control and heal.
This fear of feminization is not only acted out in the gender sub-plots of these books, but is also evident in the very descriptions of the viruses; the etiologies of which are, by now, fairly well know. Ebola, for example, undermines and devastates large populations of people by breaking down the very structure of the human organism, transforming virtually every part of the body into digested slime. Internal organs become liquefied until the body implodes, leaking out through every possible orifice until death inevitably ensues (what Preston calls "Crash and Bleed Out"). The virus is, moreover, highly contagious and has a high fatality rate. Reading descriptions of such diseases recall the ways in which women and femininity have often been characterized. Jean-Paul Sartre's infamous description of femininity as a "gaping wound" that is full of sticky slime, for example, or Stephen King's classic horror-story Carrie which is essentially about male fears of women's bodies, and particularly of menstruation, are just two examples of the pejorative ways in which the female body is frequently characterized. Indeed, The Hot Zone reads in places like a deadly menstrual nightmare, suggesting a paranoid fantasy of a lethal femininity acted out by an invisible enemy which turns its victims into bleeding pariahs. What could be more masculine, therefore, than viral warriors fighting their enemy with strategies of containment, sterilization, and technological mastery?
What we see going on here is not simply the familiar theme of women and families disrupting the workplace — and specifically the scientific workplace — but that any kind of human social relationships are counter-productive to questions of health care. Just as cowboys and detectives typically operate as outsiders, so too, these narratives promote a belief in the debilitating and destructive effects of human interactions. Certainly, social relationships do play an important part in healthcare issues, but, I would argue, not in the manner these scenarios suggest. Indeed, focusing on the disabling effects of gender operates as another form of denial and deferral about the kinds of social and economic conditions which do create diseases. As Laurie Garrett convincingly argues in her recent book The Coming Plague: Newly Emerging Diseases in a World Out of Balance, social relationships should be examined when investigating viral outbreaks since they frequently foster and exacerbate the spread of plagues. Garrett points out that microbes, viruses, and bacteria have always existed but they are intensified by poverty, hunger, warfare, poor housing, inadequate health care, and environmental destruction. It is social conditions, in other words, not natural ones, which foster and perpetuate many viral and bacterial diseases and epidemics. Believing that women and families are responsible is just a form of denial about the ways in which diseases are spread. Similarly, believing that disease is a purely biological phenomenon is merely a form of propaganda to deny questions of economic need and social injustice. Indeed, as Garrett argues, the rise in epidemics is one price we pay for social irresponsibility and rampant industrialization.
The majority of the worlds' tuberculosis victims have always been poor, for example. While tuberculosis has never been completely eradicated in the United States, its prevalence declined steadily from the 1880s on, particularly after the introduction of antibiotic treatment. While the incidence of tuberculosis declined steadily until the 1970s, in 1986 cases of TB in the United States increased for the first time in over three decades. Approximately 10,000,000 people are currently infected with tuberculosis in the United States, and several surveys in the 1980s documented the link between the rise in homelessness and the rise in adult TB. Indeed, a 1980 survey found a 98% incidence of the presence of the tuberculosis bacteria among men living in emergency housing in New York City. By 1986, moreover, nearly half of all cases of TB in the United States were among non-white groups, and significantly among African-Americans. The CDC also noted that HIV was almost certainly responsible for the massive spread in TB in New York City and Florida.
Just as tuberculosis was re-emerging in the United States, however, in 1986 the federal government reduced the budget for federal and state surveillance programs. It was only when new strains of tuberculosis began to be transmitted from homeless and prison populations to the health workers who looked after them that panic broke out, and in 1992 a study released by the CDC documented that by 1989 New York City had been the nation's epicenter for four major outbreaks of TB. Indeed, according to Garrett, the United States is the least efficient nation in the world in identifying and treating the spread and incidence of tuberculosis. The appearance of multiply drug resistant (MDR) strains of TB further emphasized the threat of a serious epidemic of tuberculosis in the United States, since previously successful antibiotics could no longer be used. Studies revealed that tuberculosis spread rapidly among homeless shelters and that individuals could become carriers of chronically active, and drug-resistant, tuberculosis bacteria. By 1993 the tuberculosis epidemic had made its way to the suburbs, was rampant in prison populations, and new outbreaks were reported in Los Angeles, Chicago, Dallas, Detroit, and Miami. According to Garrett, Reagan's 1980s war on drugs (which called for mandatory imprisonment for a range of drug-related crimes) coincided with a rise in heroin, crack and cocaine usage in New York and was largely responsible for the rise of the MDR-Tuberculosis epidemic in New York City. Indeed, 80% of MDR-TB sufferers were drug-users, many of whom spent some time in prison. While many of these individuals were incarcerated for only a short period of time — while on arraignment or for a short jail term — the urban jail ecology provided a perfect environment for the spread of microbes, leading to a full-scale epidemic within the city's prison system. As Garrett argues, however, rather than address the reasons why heroin and crack usage was so high among urban populations, deal with the housing shortage for low-income residents, or confront the cycle of poverty that meant so many of the city's population were permanently vulnerable to microbial disease, the health community looked instead to science for a magic cure for MDR-TB.
As consumers of biohazard thrillers we also look to science for "magic-cures" for diseases. Most books and films require a suspension of disbelief in order to be compelling and interesting, but the layers of deferral required by many of the recent biohazard thrillers are considerable. Since denial typically requires expending huge amounts of energy in order to avoid examining an issue at hand, if that energy could just be redirected into more constructive uses the spread of diseases could be reduced. As Garrett argues, moreover, corporations often ignore diseases which promise small profits. While books and movies about viral disasters may be big sellers, in other words, money for research is drying up. The rise of what Entertainment Weekly has called "viral chic" is alarming, therefore, primarily because it blows the risk of exotic diseases out of proportion — thereby deflecting attention away from more pressing health issues in the United States — and poses solutions that are overly simplistic and individualistic. The danger of viral chic is that it asks us to place our faith in the loner cowboy who solves our biological problems while simultaneously allowing us to deny our own responsibility for social ills. Having faith in our ability to deal with the spread of diseases may not be as "exciting" as fast-paced viral thrillers, but health is always better than disease, and life is always better than death.
Jillian Sandell is a graduate student in the Department of English at UC-Berkeley and Co-Director of Bad Subjects. She occasionally writes for Asian Trash Cinema, and has articles on forthcoming in Bright Lights Film Journal and Film Quarterly. She can be reached at firstname.lastname@example.org.