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Inflamed: Deep Medicine and the Anatomy of Injustice (Encore)

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Book cover of “Inflamed: Deep Medicine and the Anatomy of Injustice.” Credit: Macmillan Publishers

Book cover of “Inflamed: Deep Medicine and the Anatomy of Injustice.” Credit: Macmillan Publishers

Inflammatory diseases are on the rise around the world, and when left unaddressed can turn chronic. Now, doctors are finally starting to pay more attention. But why & when does a beneficial part of our immune system turn against us? Raj Patel & Rupa Marya think it has a lot to do with the world we live in. They talk about climate change, ecological devastation, & the collapse of our planet & what that has to do with inflammation. Their thesis: our bodies are a mirror of a deeper disease in society & the environment. But there’s still hope. They point a way back to health via Deep Medicine, which is the quest to reignite our commitment to the web of life and our place in it.


  • Tré Vasquez, Co-director/collective member at Movement Generation Justice & Ecology Project
  • Raj Patel, author, academic, journalist, activist
  • Rupa Marya, author, Professor of Medicine at the University of California, San Francisco, and a co-founder of the Do No Harm Coalition

Episode Credits:

  • Host: Salima Hamirani
  • Producers: Anita Johnson, Salima Hamirani, Amy Gastelum, and Lucy Kang
  • Executive Director: Jina Chung
  • Interim Executive Editor: Jessica Partnow
  • Web Editor: Sabine Blaizin
  • Engineer: Jeff Emtman 
  • Digital Media Marketing: Anubhuti Kumar


  • Frequency Decree – “Cenote”
  • Blear Moon – “Anto”
  • Broke For Free – “Juniper”
  • Frequency Decree – “Lithosphere”


Salima Hamirani: I’m Salima Hamirani, and on today’s Making Contact, we’re talking about the ways our health and the environments we live in are deeply linked.

Tré ambi: Cool. So this is the, our kind of compound area back here. We’re behind two, um, homes, and then there’s a Y structure that was built here by MG…

Salima Hamirani: I’m meeting up with Tré Vasquez in an outdoor office for a environmental organization called Movement Generation, or MG as Tré called it.

Tré ambi: And then cottage office space over here. You can hear the chickens, you can see the chickens here. You know, a lot of, um, native plants here and, and food and whatnot.

Salima Hamirani: The offices are in a small garden in Berkeley where Tré agreed to meet me. Tré does a lot of work around environmental justice and envisioning a collective future under climate change, which of course includes chickens and backyard food.

Tré Vasquez: Hello. Uh, my name is Tré Vasquez, and I am a collective member and co-director of Movement Generation Justice and Ecology Project. I live in Santa Rosa, California, which is occupied Pomo, Wapo and Coastal Miwok territory.

Salima Hamirani: Tré agreed to talk to me about his work up in Santa Rosa, where he lives, which was the site of some of the biggest fires California has ever seen.

News Clips

Salima Hamirani: And Tré was in the thick of it

Tré Vasquez: So the first year, I was actually working as an organizer was 2017. So that was the Tubbs Fire. I remember it was like two in the morning and my cousin was just down the road and sent me a text and was like what? And then I started to realize how intense it was when I looked outside in my neighborhood, which was mostly a working class Brown neighborhood, and everybody was packing their cars. We left at like three in the morning. I remember the lines for the gas station were like down the road. And it was like gridlock traffic. So that was like the huge wake up for me that was like, dang, we do not have the infrastructure in our communities to really know how to handle this.

News Clips

Salima Hamirani: a few days later because of the chaotic experience of evacuating during the fire, Tré began to organize in his community.

Tré Vasquez: And, um, basically that was like rapid response within, I believe two to three days of, of the fires starting up, we were already on the ground, working at a local churches, seeing anywhere from like 200 people a day coming in. And that, was beautiful, right? How people unified and came together and self-organized. Um, but also super high stress as you could imagine.

Salima Hamirani: As he worked at the mutual aid centers, Tré was exposed to extremely high levels of toxic smoke

Tré Vasquez: I mean, in 2017, we had that fire come down the hills, um, from what’s called Fountaingrove, jump across the 101 freeway and jump into town, hit a huge neighborhood called Coffey Park and also blew up literally like blew up, uh, the Kmart that was there. So when you think about all of the toxic materials that are burning and that we’re essentially breathing in, it’s horrifying.

Salima Hamirani: and it wasn’t just his one experience with smoke and high stress. He actually lived through multiple fires back to back.

Tré Vasquez: And then we have fires the next year. And then in 2019,  was the Kincaid Fire. So I have been in the North Bay for, I believe four consecutive fires and all that comes with it. And then in the years where there weren’t fires directly in the area, we were heavily impacted by the smoke coming from down south and from up north as well.

Salima Hamirani: Then one day Tré woke up with a strange shooting, overwhelming pain in his body.

Tré Vasquez: It felt like I had just like thrown out my back and that’s what I assumed that it, that it was. And so I was trying to do all the things that you would do, you know, for when you throw out your back, uh, chiropractor, massage,… and nothing was addressing, nothing was fixing it. and I went on like in that level of, of flare up for about six months and then it subsided

Fortunately, I had access to healthcare, right? But I wasn’t getting very many answers. They were telling me to take epsom salt baths. And I started to realize like into that like six months of explaining the situation over and over and again, and getting bounced around in circles between doctors and rheumatologists and, other, you know, specialists, I started to realize that a lot of what was happening is that they were assuming that I was seeking, opiates, you know, that I was seeking painkillers.

But it went on for, it went on for six months. It, it stopped, and I had like a remission of the symptoms, and then it came back six months later.

I continued to go through the same thing, just getting bounced around, um, told again, to take salt baths and stretch and exercise. Actually, they were telling me, you just need to exercise. And I was like, I can’t even walk. Like, I don’t know what’s going on with my body. And finally, after that was about a year and a half, the second flare up was a year and a half long. I was finally diagnosed with fibromyalgia.

Salima Hamirani: There’s no direct proof that his illness was actually caused by the fires, which is sometimes a problem with inflammatory diseases. You can’t prove causation, but he feels certain that it is linked.

Tré Vasquez: Because I don’t know that it was a one time event. I do know that it flared up in that high time of stress and toxicity of the fires, you know? And so I, I do feel like there’s a direct connection there, that level of, of trauma and burnout and on top of the toxicity from the smoke, I feel like there’s a direct linkage there.

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Salima Hamirani: Tré’s experience is actually the topic of today’s show. His illness mirrors something that’s happening in many communities across the US: sickness arising out of the environment, or because of social conditions, race, class, gender conditions under which a person lives.

Tré Vasquez: You know, I’ve grown up in pretty, toxic communities, for a lot of my life. Like I grew up in a copper mining town, um, and then have lived in low income neighborhoods the majority of my life. So I think there’s a certain level of being accustomed to seeing the signifiers of toxicity around me. But I don’t think I knew how, how bad it was.

Salima Hamirani: For a long time these kinds of stories were mostly anecdotal and it’s still difficult for people like Tré to get compassionate care from their doctors who often don’t even believe their symptoms. But some people in the medical field are beginning to pay attention to people like Tré Vasquez. And that’s because the kind of disease that he developed is on the rise – an inflammatory disease.

Rupa Marya: We’re seeing chronic inflammatory response present in a lot of the diseases I treat as a hospital medicine doctor from cardiovascular disease to cancer, to diabetes to even depression and anxiety.

Salima Hamirani: That’s Rupa Marya. She’s a professor of medicine at the University of California in San Francisco. Globally, diseases caused by inflammation have grown somewhere between three to 10 times from their levels just 40 years ago. And that includes illnesses we don’t usually think of as being inflammatory in nature like cancer.

Rupa Marya: I am helping 35 year olds die of colon cancer. Colon cancer is an inflammatory disease. It is a disease where local tissue inflammation in the colon is driving carcinogenesis. This is not a genetic phenomenon. But the way that we’re taught about these things in medicine is there’s this over emphasis on precision therapies and genetic, you know, let’s go look at the individual as opposed to looking at why are 35 year olds now dying of colon cancer?

Salima Hamirani: So in order to answer that question, Rupa Maria, along with Raj Patel, wrote a book called “Inflamed: Deep Medicine and the Anatomy of Injustice.”

Raj Patel: “Inflamed: Deep Medicine and the Anatomy of Injustice” is a story about how our bodies and our planet and our communities are inflamed. And we’ll talk about what inflammation is in a second, but the idea is essentially that our planet is on fire, but our bodies are also subject to a range of diseases that are associated with immune response called inflammation and our communities are at each other’s throats.

Salima Hamirani: Raj Patel studies food systems, and he’s a writer and a teacher. He’s previously written books on nutrition and food deserts.

Raj Patel: And what we suggest in this book and the argument that we make is that the reason that our planet is on fire is the same reason that there are fault lines in society. And it’s the same reason that some people more than others are subjected to the kinds of stress and exposures that generate in our bodies inflammatory disease. So our story is not a story about metaphor, but it’s a story actually about how disease spreads in through our body and out into the world, through our communities, into our planet, and then back again.

Salima Hamirani: the link between the outside environment and how they cause illness within us is called inflammation.

Rupa Marya: Inflammation is the body’s ancient response, the immune system’s response to damage or the threat of damage. And it’s the way in which the body heals. So when you have a paper cut, that’s an acute inflammatory response. The cells in the body detect that there’s been a breach of the skin. All these biological mediators are mobilized to help heal that wound. When the wound is healed, the inflammatory response goes quiet.

When damage or the threat of damage keeps coming. you know, something like being afraid to be evicted from your home. Whether you are encountering, you know, exposure to toxic pesticides in your work as a farm worker, the damage that is experienced in that way if it is ongoing, the body never has a chance to heal. And the inflammatory response never goes quiet. And you can think of that as a smoldering fire that then go on to create collateral damage in the tissues of our bodies.

Salima Hamirani: Rupa, there’s a case study that sort of illustrates what you’re talking about and it was a really sad story. Can you talk to me about who, I think her name was Sheila McCarley was, and what happened to her?

Rupa Marya: Yeah, Sheila McCarley was one of my patients, and she was in you know, her sixties when she came to our hospital. She had been born and raised in Muscle Shoals, Alabama, where she pulled catfish from the most polluted watershed in the United States, the Tennessee River Valley watershed. And by the time she moved to the Central Valley of California at 40, her hair was falling out. She had a rash across her face. Her joints were swollen. And the doctors who saw her there thought, you know, okay, this looks like lupus.

For five months, she was in and out of the ICU with what looked like sepsis. So overwhelming inflammation that’s usually caused by a virus or a, you know, fungal, bacterial infection, but we couldn’t find any evidence of infection. We couldn’t even find any evidence of lupus. All the tests that we sent up were negative. What we did see in her was just off the charts levels of inflammation in her body. And we put her on antibiotics and we put her on pressers to keep her blood pressure off, and she’d come outta the ICU and as soon as those were off for a couple days, her blood pressure would drop again. And she’d become, again, this systemic, inflammatory response. She’d go back into the ICU in and out, in and out.

Her situation was quite severe. And after five months of being poked and prodded and not given any real hope of improving, she asked for to be withdrawn and she passed away shortly thereafter. And when we did an autopsy, what we found is that all of her bone marrow had been replaced by activated macrophages. So her body was just racked with inflammation.

It was very clear that her childhood and where she grew up as a poor white person in Alabama was a part of what we were seeing manifest now in her later decades of life. The river where she was eating catfish from had, you know, the 3M factory was there, putting their forever chemicals in the water. There was a chlorine factory that was losing about 150,000 pounds of mercury every year before it was shut down.

And so her situation to me really brought together the inflammation of a body, the inflammation of a social condition, the inflammation of a planet and the, and seeing how these things are completely inextricably linked.

Salima Hamirani: The linkage between the outside world and our internal body systems isn’t just a metaphor. It’s a real relationship that can have massive repercussions on our health. And we’re gonna hear more about that connect. Right after the break.

BREAK – We’re just jumping to remind you that you’re listening to Making Contact. If you’ve liked what you’ve heard so far, please visit us online at, where you could find out more information about the book, “Inflamed: Deep Medicine and the Anatomy of Injustice.” We’re also on Facebook, Twitter, and Instagram. If you’d like to find us there instead. And now back to the show.

Tré Vasquez: I mean, it was, it was and has continued to be totally life changing. I went from living a life of, of being able bodied, you know, having the privileges that I didn’t even realize were just so accessible to me to go where I want, do what I want, you know? And then all of a sudden it just changed like overnight.

Salima Hamirani: That’s Tré Vasquez again, who we met at the beginning of the show. Since his first flare up, Tré’s fibromyalgia has escalated. He now feels pain everywhere.

Tré Vasquez: Uh, neck back head face, like everything, every part of your body that you can feel in I’ve experienced pain in.

Salima Hamirani: And on, on a scale from one to 10, how would you rate that pain?

Tré Vasquez: Uh, at its peak points? Definitely like between 9 and 10. Yeah. And with no explanation, it was, it was scary. You know, I was like, what is, what is wrong with me? Like, do I have some kind of like, terminal illness? Like I had no idea and I was really not getting far with any kind of testing.

Salima Hamirani: What is the long term diagnosis? Like what, what did the doctors tell you what happened now that you’ve been diagnosed with this? Does it ever go away? Are there ways to manage it?

Tré Vasquez: Mm-hmm, it doesn’t ever go away according to them, and really what you’re told is that you’re basically left to just manage it, right. And so, even just a, a walk around the block or, you know, I’m trying to think, like washing dishes sometimes is like too painful. It’s it’s essentially, to me, what I felt like I was like, dang, I just got this life sentence of pain. That’s what they told me.

Salima Hamirani: And do you worry that staying there for a fire is gonna continue to impact this diagnosis and make it worse?

Tré Vasquez: Absolutely. But at the same time, it’s like, it’s gonna be there either way. And that’s part of a, a reckoning that I have to do all the time now, dealing with this inflammatory condition, disabling condition and, and so many folks are dealing with disabilities on an entire spectrum.

Salima Hamirani: In some ways Tré’s body is a direct mirror image of the world he was organizing in. It was on fire and in pain. That link is a huge part of the book Raj Patel and Rupa Marya wrote, which for those of you who are just tuning back in is called “Inflamed: Deep Medicine and the Anatomy of Injustice.”

Raj Patel: We, we talk a lot in the book about systems. And how it is that in fact the, the systems that operate inside our body are not contained within our bodies that the ways that we sort of imagine the edge of ourselves is something that’s much more porous and extends much further out into the world than we imagine.

Salima Hamirani: One place that really highlighted this aspect in the book to me was when Rupa and Raj talk about the salmon run and the ancient waterways that once supported the fish and the Indigenous people who depended on them.

Raj Patel: Now under capitalism, of course, salmon is the sort of thing you buy at the deli. You know, don’t have to worry terribly much about what it is or where it comes from, other than apparently it tastes good on a bagel. But that is not the only way of thinking about salmon. For example, the Coastal Salish Indigenous communities here on Turtle Island that have treaties with the salmon nations and have different ways of thinking about how salmon flow through rivers and bring nutrients from, you know, way out into the Pacific Ocean, all the way into an ecosystem very, very deep inland where you can trace the arrival of certain kinds of nutrients in you know, Pacific forest in the northwest way, way, way upstream from the Pacific Ocean through the vector of the salmon that then end up in our bodies in different ways.

So, when we think about our approach to thinking of systems – the capitalist way of thinking about salmon is, oh, well, you know, one salmon’s very much like another, and if we farm them it’ll be just as good as if we get, you know, if we harvest them from the sea. But one of the things that we observe in the book is that actually farmed salmon lack the anti-inflammatory benefits and lack precisely the sort of nutritious and healing oils that are found in wild salmon and capitalism doesn’t care about that.

But if your relationship to salmon was not as a commodity, but as a member of a nation with, with which, with whom you had a treaty, then your approach to that being would be really rather radically different. And that’s what it is that we’re showing, not just in the dysfunction that causes inflammation from eating farmed salmon, as opposed to wild salmon. But in the, the web of relations that extend and recognize the relationship of this body and this thing of our personhood to the personhood of other beings in the web of life.

Salima Hamirani: That web of relations has been broken by our modern capitalist world. And that’s not just a mystical idea. This part of the book is really striking because it compares the waterways of the earth with our own blood vessels and shows exactly how damaged waterways and the farmed seafood we’ve created to replace the natural spawning we’ve destroyed also affects our arteries. And that’s because the salmon in these environments are themselves stressed out and displaced and unhealthy.

Rupa Marya: By keeping salmon penned, by feeding them corn, by feeding them substances that are not part of their diet, the ways in which we drive their stress response ends up impacting inflammation in the fish itself. In fact, there were interesting studies we read on the presence of viruses that have proliferated with farmed fish, farmed salmon in particular that cause heart and muscle and eye inflammation of those animals so that when you know, animals experience damage to their life ways they become inflamed. It’s just so interesting when we were we’re researching this book, how much inflammation was a sign of damage. And the lack of inflammation was a sign of something being in harmony with its surroundings and its place in the web of life. And that was, looking at soil throughout looking at you know, the way that water moves, how water behaves in damned rivers versus wild rivers. All of these things were very interesting to me to see and observe the body of the earth, like the body of a patient. the body of other beings in the web of life being consonant with our bodies, what, what I’m seeing and what we’re seeing in the medical literature, and starting to understand how, what is being said through the language of our bodies through the language of biology is it’s, it’s saying this very similar thing.

Salima Hamirani: And I think many of us hearing this would think, okay, so farm salmon is dangerous. So I just have to go out and make sure to buy wild salmon. But the answer’s not that easy because if we want to talk about health in any meaningful way, we need to address the social conditions instead of the individual.

Raj Patel: So medicine has been very successful in following the contours of power around society in general. And capitalist society operates on the basis of hiding the social causes of things and pathologizing individuals. So for example if you develop type two diabetes, it’s your fault.

It’s nothing to do with the fact that you may live in an environment where it’s hard for you to find the kinds of diet that would you know, tamp down the, the flames of diabetes or that you don’t earn enough money to be able to afford a decent diet, which many Americans don’t. So instead the way that medicine approaches any given disease is to view it within the constraints of the body.

And one, one of the things we do in the book is tease apart this idea of diagnosis, cause diagnosis is really always about storytelling. And the stories that capitalist medicine tells are always capitalist stories about individual failings and a brave doctor coming in to bring the, joys of the pharmaceutical industry to, to treat any particular deficit in a particular body without understanding that that body very little choice in, you know, what is it’s exposed to. And one of the ideas we use in the book is this idea of the exposome, the, the sum total of exposures in your life that leads to either healthy or unhealthy outcomes. So the reason that we don’t think it’s helpful to say, well, you know, what you need is to have the right kind of diabetes medicine or the right kind of diet and just sort of pathologize the individual is because that’s a misdiagnosis of how it is that most disease is happening. If the story is the, the story of the propagation of inflammation, you know, that folk have very little control over like, you know, if you are in debt, then you are more likely to be subject to inflammation. If you are worried about being pulled over by the police, you are more likely to be subject to the stresses that cause inflammation. If you’re a minority, particularly if you are Black in America, then you are subject to those kinds of stresses to the nth degree. And that’s not something that you can treat with a pill, nor should it be.

You know, this idea of understanding that the, the drivers of inflammation are social and therefore the treatment needs to be social and revolutionary. That only follows logically from a, a very reasonable science based description of the problem in the first place. So all we are doing by turning away from individual solutions is to observe that pathologizing the individual is part of the problem.

Salima: So Raj, can you talk to me about what it means to fight for health collectively then, and not individually? Because I have to admit that I was a little worried about my own body and future thinking about all of the trauma and the exposures that I’ve had in my lifetime, you know, I was just like, oh my God, I’m gonna die.

So what, what is your message to people who read this like me and become overwhelmed?

Raj Patel: Well, I mean a couple of things first.  I mean, it’s true that there is trauma, some of it transmitted intergenerationally. That is the burden in particular of people of color and of the working class and of women and you know, in the United States and around the world, oppressed communities bear this burden as, as precisely that as, as a huge disadvantage in their life, chances that begins, you know, at the moment of conception, but it’s not destiny.

And that’s the other part of the story of inflammation is that everywhere that we looked and, you know, the ways that we researched, we found Indigenous communities for instance, that because they were able to hold onto their languages and were able to understand and interpret and tell different stories and diagnose differently what was happening and maintain a certain kind of collective line beyond which capitalism couldn’t go. Those communities were better able to resist, for example, type two diabetes than communities that had been forced to lose their language. And so what, what this suggests is that it is possible to develop and nurture within us, no matter how damaged we are a capacity to be able to fight back. And that I think is the, I mean, I, I think, you know, we would be doing everyone a disservice if we didn’t address with open eyes, quite how bad things are at the moment. We’re not in the business of saying, oh no, everything’s gonna be fine, you know, just drive a Prius and drink through a metal straw and buy kale and put it in a tote bag. And everything’s going to be fine. But on the other hand what we’re trying to do is open our collective eyes to the resistance that is happening around the world.

Salima Hamirani: We can find examples of collective action benefiting our health in places we really wouldn’t expect. Take payday loans. For example, payday loans are a quick turnaround type of loan. Often used by poor people and people of color. They’re extremely exploitative. If you take out say $300 to pay rent, eventually you end up paying back $800.

Raj Patel: So an APR of 400%. And what we found was that in places that had banned payday loans, then the, the, the consequences of certain kinds of inflammatory disease like suicide and drug overdose rates dropped precipitously. And so this is a way of saying, hey, you know what? Yes, we are burdened by stress, but we can collectively undertake certain kinds of policies together that will end that inflammation. And so the, the treatment is not, you know, just take your probiotics. It’s rise up and reclaim the state and fight back against capitalism. And we can do that together cause there’s data that shows that we can.

Salima Hamirani: Fixing the social conditions that lead to disease through collective revolutionary action is what Raj and Rupa called Deep Medicine.

Rupa Marya: We can achieve health when the whole system is healthy. Which means that people aren’t being cast out and stepped over on a sidewalk. Which means people aren’t being swept up like trash because they happen to be poor. Which means that we are obligated to duties of care, not just to one another but to the entire web of life.  And that is the mentality that is required. That’s the deep medicine that is required is to reawaken our responsibilities to one another and to the life around us. And that doesn’t just include humans. It includes the non-human the more than human world around us.

Salima Hamirani: Tré Vasquez is one of the many organizers on the forefront of restoring that balance and creating the deep medicine that Raj and Rupa argue for in their book. But he says, he’s also learned something else very important about what deep medicine might look like for all of us. As we begin to feel the effects of a struggling planet and social systems.

Tré Vasquez: I mean, I think for me, like a huge part of this process for me has unearthed so much of how violently ableist, this culture that we live in is in all levels, right?. You know, I had to really face some deep shadows inside of myself, like how ableism had been deeply conditioned in me. I remember at some of the peaks of my flareups, I was just like, what is my worth? Like, I can’t do anything right now. And I had a really good friend of mine and mentor type person, comrade, um, Patty Berne, who works with Sins Invalid, who asked me some deep questions.

And she was like, if you were completely immobilized, You know, would you believe that you were worth living? And she was like, if you were like, in a coma, would you believe that, that you were worth living still? And I had to really sit with that question and realize that I had been in taught to believe that if I was then I wasn’t worth living. And I’ve heard so many other folks talk about that when dealing with disabilities and particularly as we’re linking it to environmental conditions and all the inextricable links to capitalism and, and all that, I feel like we have to deal with ableism as a huge, part of this climate crisis that we’re in of this, the, the collapse that we’re experiencing right now. Like we have to, just the same as white supremacy, just the same as all of the other forms of oppression that we are trying to break down in our movement. So I’m always like, I gotta bring that to the forefront.

Salima Hamirani: And that does it for today’s show. Also thank you to Raj Patel and Rupa Marya. You can find out more information about the book, “Inflamed: Deep Medicine and the Anatomy of Injustice” on our website. Please visit us at and leave us a comment.

I’m Salima Hamirani. Thank you for listening to Making Contact.

Author: Radio Project

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