AAA 2016 Session Highlights: Part 2, Discoveries

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Image via AAA Website

This is the second in a two-part series spotlighting sessions in medical anthropology at the upcoming 2016 Annual Meeting of the American Anthropological Association (AAA) in Minneapolis, Minnesota. In this second installment, we present a selection of sessions on the theme of “discoveries.” For more information about this year’s meeting, click this link.


Sessions on “Discoveries”: New approaches to the anthropological study of medicine and medical systems, and studies of new and contemporary medical technologies/therapies

RETHINKING GENDER NORMATIVITY, SEXUALITY, AND MORALITY THROUGH NON-BIOMEDICAL EPISTEMOLOGIES

Thursday, November 17th 8:00 AM – 9:45 AM

Organizer(s): Venera Khalikova (University of Pittsburgh) and Kristin Bright (Carleton University, Canada)

Chair: Venera Khalikova (University of Pittsburgh)

Discussant(s): Lucinda Ramberg (Cornell University) and Kristin Bright (Carleton University, Canada)

This session will propose new ways of thinking about gender and sexuality as heterogeneous subjects. The papers will examine how gender and sex are configured and reconfigured in biomedicine and complementary or alternative medical and health systems.

DISCOVERING WAYS IN WHICH DEATH OCCURS IN A CULTURAL CONTEXT

Friday, November 18th 8:00 AM – 9:45 AM

Organizer: Erica Borgstrom (Open University, United Kingdom)

Chair: Erica Borgstrom (Open University, United Kingdom)

Discussant: James Green (University of Washington)

In this session, presenters will reveal how death occurs and is interpreted in both biomedical and local cultural contexts. Papers address death, dying, and aging in India, China, the United States, and in migrant communities in Australia.

(RE)DISCOVERING PSYCHEDELICS IN THE 21ST CENTURY

Friday, November 18th 10:15 AM – 12:00 PM

Organizer(s): Shana Harris (University of Central Florida) and Hilary Agro (University of British Columbia, Canada)

Chair(s): Shana Harris (University of Central Florida) and Hilary Agro (University of British Columbia, Canada)

Discussant: Michael Oldani (Concordia University Wisconsin)

Papers in this session will explore the (re)emergences of psychedelic drugs, particularly in the contexts of treatment and medical research, but also beyond the boundaries of biomedicine: including traditional use of ayahuasca, and the use of drugs in rave culture.
NEW DIRECTIONS IN THE INTERSECTION OF MEDICAL ANTHROPOLOGY AND BIOETHICS 

Friday, November 18th 4:00 PM – 5:45 PM

Organizer(s): Eileen Anderson-Fye (Case Western Reserve University) and Jonathan Sadowsky (Case Western Reserve University)

Chair: Paul Brodwin (University of Wisconsin, Milwaukee)

Discussant(s): Rebecca Lester (Washington University, St Louis) and Jonathan Sadowsky
(Case Western Reserve University)

In this session, presenters will offer four different anthropological cases that highlight the intersections of anthropology and bioethics: genomic research in Africa, physician-aided dying, body image and obesity, and transnational healthcare in Brazil.
“BODY-WORK”: SCIENCE AND TECHNOLOGY STUDIES IN MEDICAL ANTHROPOLOGY

Saturday, November 19th 2:30 PM – 2:45 PM

Papers in this session will explore the intersections of medical anthropology and contemporary studies in science and technology. Paper topics include the use of human tissue in continuing medical education, ‘smart machines’ and disability, new genetics sequences technologies in a cancer clinic, neuropsychiatry and resistance, and relationships between nurses and patients in HIV clinical settings.

 

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From the Archive: Patients-as-Syndromes in Internal Medicine

In our “From the Archive” series, we highlight an article from a past issue of the journal. In this installment, we explore Robert A. Hahn’s piece “‘Treat the patient, not the lab’: Internal medicine and the concept of ‘Person,'” available in full here. This article was featured in Volume 6, Issue 3 (September 1982.)


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Throughout the history of the journal, our authors have turned the same anthropological gaze equally onto both biomedicine and other medical systems. As Hahn introduces this article, he states that the healer in all cultural contexts fashions medical and social truths together, such that the patient and patient body are reinterpreted (and potentially reordered) through medical treatment by the healer. Biomedicine, he states, also recasts illness in ways that alter the medical position of the patient. To understand how physicians of biomedicine engage with patients conceptually in this way, Hahn conducted an ethnographic study of four internists. As internal medicine is often characterized as highly rationalistic and thus emblematic of biomedical practice, Hahn argues, he states that understanding the internists’ perspectives may shed light more broadly on biomedicine as a particular method of envisioning illness and its relationship to the patient.

Hahn begins by positing that the nature of internal medicine as a profession itself is a form of interpretation of what constitutes the patient and body over which it has medical purview. Internal medicine does not focus on mental health (psychiatry) or on the internal visceral body (surgery.) Thus, the “body” it treats exists in relative isolation from the mind, yet is not a physical or functional body such as the one manipulated directly through surgery. The conditions internists treat exist apart from the person and, to a degree, from the patient’s body: instead, the internist focuses on internal diseases and pathologies that become entities of treatment divorced from the individual receiving care. These illnesses– forged into concrete ontological “things”– are countered with similarly material antidotes. Hahn adds that the prestigious status of the internist in the culture of clinical practice, both currently and historically, lends this physiologically-based view of the body and its treatment significant legitimacy in the biomedical landscape.

To demonstrate these concepts, Hahn presents the case of internist Dr. Barry Siegler. “Barry,” as he comes to be called, repeatedly instructs his residents and other clinicians to be wary of individual metrics and lab results, as these single numbers and tests cannot be incrementally fixed: rather, he contends, they must be examined and addressed in concert such that the whole patient is successfully treated. Hahn describes this as relational knowledge of pathology, rather than “singly” reading and responding to individual metrics. However, Barry does not mean to champion holistic, person-centered care: instead, he posits that the entire patient should serve as the point of focus such that no aspect of the patient’s pathology is excluded from diagnosis and subsequent treatment. For example, Barry argues that the patient interview is a tool for the extraction of cues that would lead the clinician to better understand the etiology and symptomatology at hand.

Thus the patient’s “syndrome” comes to exist as a materially and ontologically “real” entity that is distinct from the social, personal, and existential contexts of the patient’s life. This perspective is crystallized in Barry’s tendency to refer to patients as their diseases, such as “a conversion reaction.” He also refers to patients he believes to have mental illness in the same manner, such as the “neurotic,” although he admits that psychiatric pathologies are a “Pandora’s box” beyond the limits of his professional power to address. Again, the patient as a person (and even as a subject or individual mind) fades as the disease pathologies that characterize their illness are reified and made the central objects of the internist’s medical gaze. Due to the close alignment between physiology and organic sciences (chemistry and biology), Hahn notes that the internist’s ontological transformation of the patient into their pathologies– and the pathologies into discrete objects of attention– are deemed especially real, true, and justifiable. Likewise, the body itself is interpreted as a closed, contained system that becomes the object of internal medicine: the ‘whole patient’ is instead the ‘whole pathophysiology.’

Hahn concludes that this vision of the body is decidedly Western: it individualizes the body, and makes a Cartesian division between the body (physical) and the mind (psychological, social) such that it is made treatable and conceptually readable by internists who isolate it from other contexts and who distinguish diseases as concrete, material things. The article ultimately suggests that certain biomedical visions of the body and appropriate patterns for treatment may not align with the perspectives of patients, who understand their illness within the social, spiritual, cultural, and other frameworks that structure their daily lives.

 

Fall 2016: Blog Update

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The Culture, Medicine & Psychiatry blog will return to regular, once-weekly updates next week on Wednesday, following our reduced summer upload schedule. In the meantime, our readers can access articles and illness narratives from our new September 2016 issue here.

In the coming weeks, check back on the blog for special article highlights from the new issue, as well as “From the Archive” features, news posts, book release updates, commentaries, and other entries at the blog. As always, we continue to welcome submissions of guest commentaries on the cultural, social, and humanistic study of health and medicine. Please contact our social media editor, Julia Knopes (jcb193@case.edu) for more information.

Best wishes from the CMP Editorial Team!

From the Archive: Martin’s “Pharmaceutical Virtue”

In our “From the Archive” series, we highlight articles from throughout the publication history of the journal. This week, we feature Emily Martin’s 2006 piece “Pharmaceutical Virtue” (accessible in full here.) Martin’s article was featured in a special issue from volume 30 exploring pharmaceutical cultures. Explore the full special issue here.

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Emily Martin’s “Pharmaceutical Virtue” tracks the changing ethic of the pharmaceutical industry and pharmacological research from the mid-20th century through today. To assess the shifting moral economy of this industry, Martin draws on interviews with retired, key figures in pharmaceutical sales and development active in the 1950s through 1970s. She then weighs their perspectives on the benefits and aims of the industry against those of contemporary pharmaceutical employees, including sales representatives and advertising workers. The latter group of individuals is increasingly faced with growing public “vilification” for aggressive marketing (and price-gauging.) Nevertheless, today’s sect of pharmaceutical workers strive to see the virtues in an industry which promises new treatments and potential cures.

Martin begins by analyzing interviews from the cohort of pharmaceutical industry workers from the 1950s-70s, here alongside the history of pharmaceutical research and its transformation into a powerful economic machine. Martin finds that the industry’s ability to provide a range of new tools to physicians, at a time when many health concerns had unsatisfactory or limited treatment options, allied the pharmaceutical industry with more “noble” biomedical or clinical research. Companies placed rigorous emphasis on training physicians to see the minute differences between medical conditions in order to best treat them. For instance, “Ativan’s marketing strategy was designed specifically to train doctors to prescribe it to reduce daytime anxiety,” Martin writes, “mixing that anti- anxiety benefit with the tranquilizing benefit of a sleep aid…would be confusing to doctors and make it harder to remember that they should prescribe the drug for daytime anxiety.”

Thus the pharmaceutical representatives and workers of the 1950s-1970s served as allies to the medical profession by helping them distinguish between medical conditions in ways productive for successful (and specific) treatment. There was no direct-to-consumer marketing: only direct, and informative, exchanges between physicians and pharmaceutical sales representatives. Educational materials distributed from the companies at this time had few references to the drugs being marketed and were free of advertisements. Instead they were aimed at better informing physicians and clinicians who would then provide improved overall care, drawn from a wider range of treatments made available by the companies.

The contemporary pharmaceutical industry suffers a less symbiotic relationship with the public and the medical profession, Martin observes. Clinical trials’ move overseas, often to developing countries, and the rigorous marketing and profiting off life-saving medications like anti-retrovirals, has generated significant ire against the industry. Even the industry’s funding for consumer advocacy outreach and educational programming is, while rosy on the surface, another means by which to court consumers. Educational materials are now penned largely for patients, not physicians, partially severing the physician from the care exchanges that occur between companies, clinicians, and patients.

In this climate, however, Martin finds that many pharmaceutical representatives and workers find dignity and virtue in their work by considering more minute interactions between individual patients or patient populations and the drugs themselves. One representative informant cites an elderly woman who, upon seeing the representative’s bag labeled with the name of the woman’s chronic pain medication, remarked in tears that the drug had changed her life. Another worker, who develops advertisement copy for a pharmaceutical company, notes that the stigma of mental illness is reduced because the available psychotropic drugs are so potent that they are able to restore even a very ill person to a functional life. An advertisement designer added that drugs reduce the blame on the patient, particularly for mental illness, and remove stigma by illustrating that illness is physiological rather than the result of a personal defect.

In sum, like the pharmaceutical workers of the 1950s-1970s, contemporary employees aspire to see the virtues in their industry. Changes in the fabric of pharmaceutical marketing, and other aspects which complicate the moral position of these companies, make this increasingly difficult. However, today’s representatives locate the social good in their work through examples that underscore the potential for improvement amongst patients. This shift in focus from physicians/pharmaceutical companies to patients/companies– while still indicative of the consumer relationship of buyers with companies–offers today’s pharmaceutical workers a positive vision of their work and the potential of new pharmaceuticals to improve human health and quality of life.

Blog Archive: Latour’s AAA 2014 Address

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.

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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.

 

Book Release: Tomes’ “Remaking the American Patient”

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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

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.