Issue Highlight Vol 40 Issue 1: Hope, Despair, and Chronic Pain

Posted by jknopes

The first 2016 issue of Culture, Medicine & Psychiatry has arrived! Over the coming weeks, we will feature article highlights from a selection of the newest research published at our journal. To access the full issue, click here.

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In this week’s blog, we visit Eaves, Nichter, and Ritenbaugh’s article “Ways of Hoping: Navigating the Paradox of Hope and Despair in Chronic Pain” (accessible here.) The authors carried out a series of qualitative interviews with patients experiencing temporomandibular disorders (TMDs) throughout a clinical trial where these patients received traditional Chinese medical treatments (TCM.) The authors’ research with 44 patients in the clinical trial highlight the paradoxical nature of hope: that is, a tendency to both place faith in the possible efficacy of a treatment, while cautiously gauging these expectations to avoid feelings of despair should treatment fail to produce a positive result. The authors argue that hope serves as a complex placebo, in that while not itself being an active pharmaceutical or other intervention, it can have significant implications for a patients’ course of care.

Following a review of methodology and the theoretical basis of medical “hope,” the authors present a diverse array of examples from their interviews that illustrate the range of expectations, beliefs, and experiences of the chronic pain patients. For some patients, hope is secular: related to realistic treatment goals (such as a small reduction in overall pain), or to utopian ideas about the treatment’s future potential for other patients. For others, hope is an expression of spiritual faith, or a form of almost religious belief in the effectiveness of bioscientific breakthroughs, or even a belief that biomedicine has failed the patient and a remedy for their pain can only be found in other medical systems (like TCM.) Other patients described an embodied response to the treatment that, the authors comment, underscores the relationship between placebo and (psycho)somatic healing.

In all these examples, however, what is perennially apparent is the patients’ tenuous balancing of hope with tempered expectations for a cure. However it comes to be framed, hope both enhances and complicates the treatment of chronic pain. In some cases, hope acts as a “positive” placebo in that it bolsters the patients’ faith or trust in the potential (or even observable) efficacy of the treatment. In other instances, hope can prove to be a harmful placebo in that it may promise beneficial change and render any failing of an experimental treatment more troubling for the patient. Because hope offers such conflicting possibilities for patients’ satisfaction and trust in a treatment modality, it is essential for both anthropologists and clinicians to consider the cultural, cognitive, embodied, and religious frameworks in which a patient conceptualizes and subsequently approaches treatment.

Book Releases: New Texts on Sex Tourism, Biotechnology

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This week, we are featuring two book releases from the University of Chicago Press. The first book is Gregory Mitchell’s Tourist Attractions: Performing Race and Masculinity in Brazil’s Sexual Economy. This new book, published in December 2015, presents an ethnographic perspective on gay sex tourism in Rio de Janeiro, Salvador de Bahia, and the Amazon. Mitchell examines issues of race, masculinity, and sexual identity amongst both sex workers and sex tourists. In particular, he asks how men of various racial, cultural, and national backgrounds come to understand their own identities and one another’s within this complex series of commercial, sexual, and cultural exchanges. Details about the book can be found here.

About the author: Gregory Mitchell is assistant professor at Williams College, where he teaches in the Women’s, Gender and Sexuality Studies program and in the Department of Anthropology and Sociology.

Image via UC Press website

The second book, debuting in September 2016, is Hallam Stevens’ Biotechnology and Society: An Introduction (cover image not yet available.) Each chapter of the text will address a different topic in the cultural and historical study of biotechnology, from gene patents, to genetically-modified foods, to genetic testing and disability, assisted reproductive technologies (ARTs), and the intersections of race, diversity, and biotechnologies. The text will be of equal interest to scholars of science and technology studies (STS), posthuman theory, and the history and culture of medical technology. Details about the book can be found here.

About the author: Hallam Stevens is assistant professor at Nanyang Technological University in Singapore. He teaches courses in the history of the life sciences and information technologies. He is the author of Life Out of Sequence: A Data-Driven History of Bioinformatics, also available here via the University of Chicago Press.

Spring 2016 Blog Hiatus & Update

Posted by jknopes

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This week, we are taking a one-week Spring hiatus on the blog. In our coming installments, we will return to highlight articles published in the first issue of Culture, Medicine & Psychiatry for 2016. You can access the full March 2016 issue here from our publisher’s website.

As always, we continue to accept guest submissions to our blog showcasing research and recent projects by our readers. We are also pleased to invite authors of newly-published books in medical anthropology, sociology, history of medicine, and medical humanities to contact us with publication information so that these new works can be featured here on the blog. For details on guest submissions and book features, please contact our social media editor Julia Knopes at jcb193@case.edu.

In the meantime, we look forward to sharing previews of the latest research in our journal in the coming weeks.

Best wishes from the Editorial Staff at Culture, Medicine & Psychiatry

Blog Archive: Latour’s AAA 2014 Address

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In this installment of the blog, we revisit one of our first conference features. This commentary piece examined Bruno Latour’s Distinguished Lecture address at the 2014 Annual Meeting of the American Anthropological Association in Washington, DC. You can access the original post here.

This year at the American Anthropological Association 2014 Meeting, Bruno Latour was invited to deliver the distinguished lecture. Entitled “Anthropology at the Time of the Anthropocene,” Latour discusses the rise in the term anthropocene to describe our current stage of natural history. Although the term makes reference to how “human” (anthro) our current age may be, Latour jests that this term was introduced by geologists, not social scientists. In the anthropocene, it is humans that play the defining role in our geological historical moment.

via Wikimedia Commons

The assumption, Latour notes, is that human agency is the prime source of action that shapes the physical world. Humans are responsible for climate change, for pollution, for altering the literal, natural fabric of our world. Yet we know that not all humans have the same impact on our environment. As Latour quips, there is not “One Human” who is responsible for the changes we see in our climate or environment. We are simultaneously assessing human power as a plural, collective entity, as well as using this concept to suggest that the blame for global change does not fall evenly across all humans. As anthropologists and cultural theorists, we know how fragile human agency can be when we divide it amongst many contending social and cultural groups.

Is there another way to think about human action that does not problematically configure humans as both collective and individual, acting but not universally accountable for all human actions? Latour posits that rather than focusing solely on agency, with a strong emphasis on human intention and purpose when committing action, we could think instead about animation, or what forces–human and non-human– are in motion in a given social space. To do so, we can no longer assume that the human agent is a colloquial be-all-end-all.

How does this assertion speak to medical anthropology, social medicine, and medical humanities? At first, we might raise our brows at the discussions of geography, environment, and most of all the suspicion surrounding the primacy of human agency. Decentralizing the human agent, we might say, is perhaps the least humanistic approach to the study of human experience. Indeed, medicine is the care of humans by humans!

However, our human ability to question our own power and position in the universe, amidst other natural and non-human forces, is a mark of our species. Whether through philosophy, religion, or social science, humans have a proclivity for ruminating about our place in the material, corporal world. We crave knowledge about what sets us apart from non-human things, and how we are sometimes reliant on them. For scholars of medicine, such inquiries about our relationships with the physical universe is key. We consider the place of non-human agents in disease and care. We ask: why do physicians rely on certain tools? Why do patients see stethoscopes, thermometers, and scalpels as making a clinician legitimate in his or her practice? How are medical traditions made unique by their tools and pharmaceutical formulas? Could the layout of a hospital or clinic itself alter the way care is given?

In an age where technology permeates developed and developing societies, Latour’s suggestion to destabilize human agency is productive when considering medicine as a cultural object. We must think not only of ourselves, but the physical environments we live in and the material objects and devices we cannot seem to live without.

Many scholars understandably resist Latour’s idea that non-humans could have some primitive agency. Yet even if we do not assign agency to non-human tools, things, and environments, thinking seriously about their role in sociocultural systems is informative. Medicine is a lively site of exchange between patients and physicians, as well as practitioners and devices, patients and new medical innovations, and the built environments which house them. As Latour invites us to do, we should pause to consider humans within the midst of a rich material world around us that– like humanity itself– is constantly in motion.

From the Archive: Revisiting Neurasthenia in Japan

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In 1989, our June special issue centered on the theme of neurasthenia: an illness category made most recognizable in current medical anthropology by Arthur Kleinman in his book Social Origins of Stress and Disease: Depression, Neurasthenia, and Pain in Modern China (1988.) Neurasthenia is a flexible diagnosis that encompasses a set of broad psychosomatic symptoms: fatigue, emotional unease, irritability, and bodily pains. It has fallen in and out of favor throughout history, yet in China and other Asian countries, it continues to be used to describe psychiatric distress. The special issue was published during the final year of Kleinman’s tenure as the editor-in-chief of Culture, Medicine & Psychiatry, and represents the culmination of research carried out throughout Asia on the diagnosis and treatment of the illness. You can access the full issue here.

The focus of this From the Archive feature is Tomonori Suzuki’s article on the diagnosis and treatment of neurasthenia in Japan. Unlike China, where neurasthenia continued to be clinically relevant through Kleinman’s research in the 1980s-1990s, the disease category fell out of its original use in Japan following World War II. Suzuki writes that this shift was not directly due to changes in Western psychiatry, in which European and American physicians replaced ‘neurasthenia’ with new categories under the umbrellas of neuroses, depression, or anxiety. These shifts may have influenced psychiatric disease models elsewhere, but in Japan, neurasthenia was instead rebranded and treated via a different historical pathway.

Morita, a renowned Japanese psychiatrist who lived in the late nineteenth and early twentieth centuries, was the first to suggest that neurasthenia was not exogenous: in other words, it did not stem from social disorder on the outside, but from psychological unrest within the mind. His therapeutic regimen for this newly-conceived “neurasthenia” became widely adopted, even into the contemporary age. Thus neurasthenia– while formally removed from the diagnostic lexicon– took a new form with an accompanying treatment as proposed by Morita.

Following WWII, when Japanese medical practitioners did begin to employ American principles of psychiatry, clinicians began to replace “neurasthenia” with the new category “neurosis.” Although this aligned with shifts in the nature of treatment that occurred in other places where biomedicine was practiced, Japan was unique in that many patients labeled as neurotic nevertheless sought out Morita therapy: a treatment initially designed to ameliorate an illness closer to the original form of neurasthenia. Some patients also opted for Naikan therapy, another indigenous psychotherapy based on Buddhist principles similar to those woven into the practice of Morita therapies. While the importation of “Western” diagnoses of neurosis brought with it accompanying forms of therapy native to Europe and North American, Morita and Naikan proved to be durable therapies equipped to treat Japanese patients with illnesses somewhere within the neuroses-neurasthenia spectrum.

Although the author notes that the use of these therapies (in the 1980s) could decline as Western models of psychotherapy continue to spread, Suzuki’s research into Japanese psychiatry practice revealed that many patients continued to seek out indigenous Morita and Naikan therapies. The two treatments’ focus on inner self-mastery, connectedness to the social and physical worlds, and the minimization rather than elimination of symptoms echo native Japanese spiritual beliefs, making these therapies legitimate alternatives to imported models of treatment. In sum, though the category for neurasthenia changed across time, foreign models for the conceptualization of mental illness did not always neatly correspond to foreign models for treatment. For the Japanese, local therapies such as Morita and Naikan proved to be quite resilient, as the therapies adapted to address psychiatric disorders despite the repackaging of mental illness into new forms.

2016 Preview: Books Received at the Journal

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First made available online last month, Culture, Medicine & Psychiatry has released its most recent lists of books received for review at the journal (which you can access on our publisher’s website at this link.) These books include Carlo Caduff’s The Pandemic Perhaps: Dramatic Events in a Public Culture of Danger and Janis Jenkins’ Extraordinary Conditions: Culture and Experience in Mental Illness. Last year, we featured Caduff’s text (here) and Jenkin’s text (here) in book release features here on the blog.

The journal has also received the following two books for review. Here are the two releases:

Image via UPenn Press website

New from the University of Pennsylvania Press is a collection of essays entitled Medical Humanitarianism: Ethnographies of Practice (available here.) Edited by Sharon Abramowitz and Catherine Panter-Brick, with a foreword by Peter Piot, the book explores the experiences of health workers and other practitioners who deliver humanitarian medical aid throughout the world. The book promises a “critical” yet “compassionate” account of humanitarian projects spanning Indonesia, Ethiopia, Haiti, Liberia, and other nations.

Image via Cornell UP website.

From Cornell University Press comes Gabriel Mendes’ Under the Strain of Color:
Harlem’s Lafargue Clinic and the Promise of an Antiracist Psychiatry (available here.) This historical text examines a mental health clinic in the 1940s established to treat psychiatric complaints amongst a primarily black, urban, underserved population. Unlike other treatment centers for mental illness at the time, the Lafargue Clinic was unique in its emphasis on the medical as well as the social contexts in which its patients experienced distress. The clinic challenged existing notions of “color-blind” psychiatry and became both a scientific and equally political institution, highlighting the “interlocking relationships” between biomedicine, the state, racial inequity, and community-based health care.

In the News: Telemedicine in the United States

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The intersections between technology, medicine, and health are a frequent site of discussion at Culture, Medicine & Psychiatry. In our last issue of 2015, for instance, Yael Hashiloni-Dolev[1] examined the role of new medical technologies that enable posthumous reproduction, while Petersen and Traulsen[2] shed light on the nuanced social uses of psychoactive medications amongst university students. These articles underscore the centrality of technology in everyday human health behaviors, and on the cultural meaning of these new tools in local medical landscapes.

Another technological innovation altering the social world of medicine—one making headlines in recent months—is telemedicine. In the Journal of the American Medical Association[3] (JAMA), telemedicine has been described as “the use of telecommunications technologies to provide medical information and services,” often a shorthand “for remote electronic clinical consultation” via phones and internet applications.

In the December 2015 AARP Bulletin, author Charlotte Huff[4] remarked that over 1 million patients will use telemedicine services this year, and remote access to physicians by phone, video chat, and email is more and more commonly covered by American employers’ health insurance packages. A Reuters article[5] adds that in Texas, a telemedicine company is working to block a state law that would require physicians to see a patient in-person before consulting with them via phone, email, or other means. And in the New York Times[6], a physician observed that telemedicine may prove a useful tool for children and adolescents: many of whom have grown up in a digital culture of “oversharing” and would not balk at texting their physicians images of strange rashes or lesions on their bodies. As this new tool of health care delivery is negotiated in different societal arenas, so too are its implications increasingly worthy of anthropological attention.

Telemedicine is altering the social fabric of medicine in a number of significant ways. Here, we will outline two potential outcomes of telemedicine on medical exchanges facilitated by technology. First, telemedicine extends the professional reach of biomedical clinicians. Areas where biomedical care is inaccessible, or where only indigenous medical systems exist, may now fall under the electronic eye of a faraway practitioner. This has extraordinary consequences for the ubiquity of biomedicine and the consolidation of biomedical power. Second, and rather conversely, telemedicine empowers the patient in the clinical encounter. Because the physician or clinician is not physically present to examine the patient’s body, the patient themself is the one who touches a swollen throat, or flexes a stiff joint, and relays their response through phone or web camera. In sum, the patient gains greater control over bodily (and verbal) narratives that, unlike an in-person exam, the clinician does not have total access to.

The rise of telemedicine speaks to medical anthropologists, certainly, but it also presents a fascinating case more broadly for science and technology theorists and scholars in health communication. As the topic of telemedicine continues to capture the interest of medicine and the media, so too will it fall under the consideration of researchers piecing together the networks that bring patients and their caregivers together in novel ways.

[1] http://link.springer.com/article/10.1007/s11013-015-9447-6

[2] http://link.springer.com/article/10.1007/s11013-015-9457-4

[3] http://jama.jamanetwork.com/article.aspx?articleid=386892

[4] http://www.aarp.org/health/conditions-treatments/info-2015/telemedicine-health-symptoms-diagnosis.html#slide1

[5] http://www.reuters.com/article/health-case-to-watch-teladoc-idUSL1N14H0CT20151228

[6] http://well.blogs.nytimes.com/2016/01/18/using-phones-to-connect-children-to-health-care/?ref=health

Book Release: Tomes’ “Remaking the American Patient”

Posted by jknopes

Images via UNC Press website

Released in January 2016 from the University of North Carolina Press is Nancy Tomes’ Remaking the American Patient: How Madison Avenue and Modern Medicine Turned Patients into Consumers. Through historical and cultural analysis, Tomes illuminates the threads between public relations and marketing in medicine, asking throughout: how have patients in the United States come to view health care as a commodity to be “shopped” for? What connections are shared between the history of medicine and the growth of consumer culture? Likewise, Tomes investigates what it means to be a “good patient” in this system of marketed care, and how “shopping” for care can both empower and disorient patients in the contemporary age. She also reviews the resistance, and ultimate yielding, of the medical profession to this model of care seeking. The book was recently reviewed in the New York Times (read the article here.)

The book will prove insightful for both historians of medicine and medical anthropologists who study the political-economic landscape of biomedicine and patienthood in the United States. It will also speak to conversations in bioethics about patient autonomy, choice, and medical decision-making.

About the Author

Nancy Tomes serves as professor of history at Stony Brook University. She is also the author of The Gospel of Germs: Men, Women, and the Microbe in American Life, published by Harvard University Press (details here.)

Have you published a recent book in medical anthropology, history of medicine, social medicine, or medical humanities? Email our blog editor (Julia Knopes) at jcb193@case.edu with a link to the book’s page at the academic publisher’s website, and we will feature it here.

Blog Archive: Medical Museums in the USA

Posted by jknopes

After almost 2 years online, the Culture, Medicine & Psychiatry blog has established a growing collection of guest posts, commentaries, and special features. In a new intermittent series on the blog, we will be reposting some of our most popular past blogs, with added updates, new information, or prefaces related to current events.

This week, we revisit one of our most-viewed posts from the early months of the blog: an extensive list of medical museums across the United States. In the updated list, we’ve added links to all of the institutions for easy access to museum hours, location, and related resources. Access the original post here.

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Boston, MA

The Warren Anatomical Museum in partnership with Harvard University contains the skeletal remains and the infamous tamping iron of Phineas Gage, as well as phrenological casts and other objects in the history of the study of the human body. Details here.

The Public Health Museum is located on the grounds of the former Tewksbury Hospital, and features exhibits on the development of public health in history. Details here.

Chicago, IL

The International Museum of Surgical Science, located on the shores of Lake Michigan just north of “The Magnificent Mile,” is a collection of surgical instruments, medical artifacts, and displays on the history of anatomical and surgical learning housed in a beautifully restored former mansion. Details here.

The Museum of Science and Industry in the Hyde Park neighborhood is an enormous building which houses not only a permanent collection of plastinated and preserved cadaveric specimens, but features many exhibits on human health, the body, and other areas of scientific and industrial development. Details here.

Cleveland, OH

The Dittrick Museum of Medical History houses a newly-renovated exhibit on medical instruments and devices, as well as the Percy Skuy Collection of artifacts in the history of contraception and abortion. It also features exhibitions on the history of birth and on medical practice in the Cleveland area. Details here.

Danville, KY

The McDowell House Museum is the restored home and office of Dr. Ephraim McDowell, who for the first time in history in 1809 successfully removed an ovarian tumor. The museum features a collection of early medical equipment in the USA, gardens, and a recreated 19th century apothecary. Details here.

Houston, TX

The Health Museum features a series of interactive exhibits about the human body and disease, with rotating exhibitions on various aspects of biomedical technology and science. It is a family-friendly destination if you happen to be in town with little ones. Details here.

Indianapolis, IN

The Indiana Medical Museum can be found on the grounds of the former Central State Hospital, inside the old pathology building. The museum highlights the early history of biomedical psychiatry, and in its own words: “maintains a collection of scientific artifacts from the nineteenth and twentieth centuries in a completely authentic setting. Constructed in 1895 and inaugurated in 1896, the nineteen-room Pathological Department Building, as it was then called, is equipped with three clinical laboratories, a photography lab, teaching amphitheater, autopsy room, and library.” Details here.

Kirksville, MO

The Museum of Osteopathic Medicine at A.T. Still University is the first museum dedicated to osteopathic care. It is home to an impressive collection of over 50,000 artifacts in the history of osteopathy, many from the founder of the field: Dr. Andrew T. Still, whose cabin is on the museum grounds. Details here.

New York, NY

The Morbid Anatomy Museum, newly opened by independent scholar Joanna Ebenstein, is located in Brooklyn. It features an array of exhibits on the intersections of death, art, and medicine, as well as a coffee café on the bottom level. Details here.

Philadelphia, PA

The Mütter Museum is a world-renowned collection of medical oddities and human pathological specimens, including (not for the faint of heart) the mummified body of a woman whose fat chemically decomposed into a soap-like material. The Mütter Museum has partnered with the Penn Museum of Archaeology and Anthropology to offer a one-price two-museum admission ticket, if you wish to visit both institutions. Details here.

Rangley, ME

The Wilhelm Reich Museum, situated inside the former home and estate of psychiatrist and psychoanalyst Dr. Wilhelm Reich, displays Dr. Reich’s collection of scientific devices and artwork. It also features a bookstore with the widest selection of his publications, as well as a conference center on the estate grounds. Details here.

Rochester, NY

The Rochester Medical Museum and Archive is located in the Rochester Academy of Medicine, and houses a collection of photos, articles, and vignettes on display that document the history of medicine in the Rochester area. The museum also features a climate-controlled storage area for clinical costumes and other artifacts in the history of medicine. Details here.

Washington, DC / Metro Area

The National Museum of Health and Medicine highlights not only the historical development of medicine in America, but the impact of medicine during important moments in American history, such as the Civil War and the assassination of President Abraham Lincoln. Details here.

The NIH US National Library of Medicine, an impressive collection of medical books and artifacts, is open to the public. Details here.

The National Museum of Civil War Medicine features exhibits on medicine and care in the Civil War era, as well as highlighting the changing roles of women and medical professionals in the delivery of treatment at that time. Details here.

From the Archive: Informed Consent and Medical Research

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In our “From the Archive” series, we revisit articles from past issues of the journal. This installment of the series will focus on the nature of informed consent in medical research: here through a case of using radioactive plutonium on living hospital patients. In response to our readership poll, this article was chosen for its discussion of themes valuable to both medical anthropology and to science and technology studies. The article touches on issues pertinent to social studies of health, human subjects research, and the relationships between government, science, and public knowledge.

Today in From the Archive, we will explore Sharon R. Kaufman’s article “The World War II Plutonium Experiments: Contested Stories and their Lessons for Medical Research and Informed Consent” (Culture, Medicine & Psychiatry June 1997. Volume 21 Issue 2, pages 161-197.) Kaufman opens her argument by asserting that “informed consent is shown to be an evolving process and discursive practice that cannot be understood apart from its historical and cultural embeddedness.” To address this point, she draws on the public response to medical research carried out on 18 patients across the United States who were injected with plutonium: a WWII-era experiment that illustrates the evolving nature of consent between the past and the present. Kaufman suggests that, rather than simply maligning this past research as unethical, we must consider how consent itself is not a static concept.

The author begins by explaining that this experiment, which operated between 1945-1947, only entered common public knowledge in 1993, when once-classified documents about the research were released. The release led to widespread outrage, as media outlets decried the federal government for sponsoring the secret project and endangering the lives of patients. Two central narratives emerged from the information release: a report penned by a journalist, and a report developed between 1994-1995 by a faculty committee at the University of California San Francisco (UCSF) where three of the patient experiments had formerly occurred. The faculty committee’s report aimed to develop a scientific and ethical account of the experiment to be made available to the public and the “university community.”

Though both reports drew information from numerous primary historical documents that described the case, Kaufman cautions us that both accounts are anachronistic, and each crafts a contemporary story consistent with the audience and the authorship of each piece. The journalist’s scathing report emphasized the vulnerability of individual citizens and the hazards of a government able to “harm and deceive,” whereas the committee report instead highlighted the ethics of scientific research and the methodology of the experiment, while paying less heed to the matter of government secrecy. The latter report concluded that the research did not meet either modern measures of informed consent or consent practices of the era in which the experiment was performed; the journalist’s report did not draw this distinction, instead suggesting that the experiment was unethical in both past and present because of the long-term effects of the research on participants or their families.

Kaufman writes that while both reports rightfully agreed that the experiment was “troubling” and that it had undeniable effects on research participants, they simultaneously direct us to a larger issue. Consent, she posits, is scarcely stable: it is situated within too many contexts to be defined in any single fashion. For instance, she notes that patients cannot always distinguish between “therapy” and “experiment” in medical research: thus meaning that the trust participants have in their clinicians’ recommendations for care, and informed consent for research on their illness, cannot always be separated. Likewise, high-risk experiments are not inherently unethical despite being potentially ‘unsuccessful,’ in whatever manner this is defined by researchers and participants. Thus there is no stable measure for informed consent which can be applied to all experiments, in all historical periods.

Kaufman also remarks that such discussions about the “elusive” nature of consent did not formally begin until 1966, the year that Henry Beecher published a landmark article on ethics in clinical research. This was historically much later than the era of the plutonium experiments in the 1940s, when “consent, however informal in character before the war, frequently took a back seat to the sense of urgency and necessity for human experimentation brought on by the war.” Today’s conversations about the autonomy of the patient, transparency surrounding the risks and aims of medical research, and the strengthening of informed consent arrive out of a “different” historical moment, the author states.

This leads Kaufman back to the two plutonium narratives published in the 1990s. She concludes that “as evocations of a moral stance, the narratives
challenge us to compare the past with the present and to reconsider the
idea of moral progress in human experimentation. They promote scrutiny
of contemporary ethical discourses about trust, risk, and the nature of the
physician/investigator-patient/subject relationship.” Kaufman’s article, in sum, invites us to consider the social and historical situatedness of consent in medical research. Rather than characterizing consent as stable across time, she presents a case that underscores how past experiments, contemporary perspectives, and current ethical standards intersect to create new narratives about the complexities of medical research.

To access the full article, click here: http://link.springer.com/article/10.1023/A%3A1005360928209