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

 

Issue Highlight: Vol 39 Issue 4, Posthumous Reproduction

Our final issue of the year– Volume 39 Issue 4 December 2015– has just arrived. In our last blog post series for 2015, we begin with a three-part feature of the latest publications at the journal in this new issue. In addition to the article previews in this series, our readers can access the full issue here. In this post, we explore Yael Hashiloni-Dolev’s preliminary research on posthumous reproduction in Israel (full article accessible here.)


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Biomedicine, through its innovative application of technology, can reconfigure biological experiences in ways that alter or reinforce cultural beliefs surrounding life, death, reproduction, kinship, parenthood, and social roles. Most recently, this has become a central issue in the field of assisted reproductive technologies: where biomedical interventions potentiate new relationships between parents, families, and children. But while assisted reproductive medicine is often discussed in terms of generating life, these new generative technologies may also intersect with death in novel ways that challenge existing understandings of kinship and familial relationships.

Hashiloni-Dolev article studies Israeli lay perceptions of a new concept in assisted reproductive medicine called posthumous reproduction (PHR.) In sum, PHR entails the use of genetic material from deceased parents to conceive children after their deaths. This usually means a woman will opt to become artificially inseminated with a husband or partner’s sperm retrieved while the man was in a coma or vegetative state: however, it may also include the fertilization of a woman’s eggs, frozen while she was alive, and gestated in a surrogate mother. Even frozen embryos of two deceased parents (a mother and father) might be “adopted” and implanted into a female relative or another recipient, who subsequently gives birth to a child whose biological parents are no longer alive. This process also facilitates the possibility of posthumous grandparenthood, and indeed, some parents whose adult children have died may seek out PHR technologies (include allied technologies such as surrogacy) to produce grandchildren.

Israel is one of the few countries that permits some forms of PHR, and it is a progressive nation in terms of reproductive technologies: its state health system covers the costs of ARTs (assisted reproductive technologies) for couples who have difficulty conceiving. Although Israel does not permit all forms of PHR, it does allow for the collection of a man’s sperm upon a wife’s request to carry his child upon his death (what the author calls the “prototype scenario.”) In this regard, Israel served as a prime location for surveying participants and testing initial ideas about the public perception of PHR: a new frontier of ARTs yet to be studied in the anthropological literature.

Through 26 semi-structured interviews with newlywed or childless couples, Hashiloni-Dolev discovered that there were some inconsistencies between the Israeli PHR policies and the participants’ understanding of PHR technologies. For instance, the government stipulated that PHR could occur via the retrieval of sperm from a dying or recently deceased father upon the wife or female partner’s instruction. The policy states that the retrieval could occur given evidence of a man’s “presumed wish” that he would want his spouse or partner to carry his child after death. However, “wish” and “consent” were interpreted differently by men interviewed for the study. The men typically stated that while they would defer to their partner’s wishes to have a child after their death, they themselves were uncomfortable with the possibility of their partners having the child and being unable to “move on” should they pass away. In this instance, while the man’s presumed “wish” might not change a woman’s decision to retrieve his sperm posthumously, it does not mean the man would “consent” to the process if he were not already dead.

Conversely, consent becomes more complicated given the circumstances that typically surround the use of PHR. The man is presumably young, such that his female partner would be able to carry his child, and would have died suddenly: thus making it nearly impossible to obtain his consent unless he had already affirmatively offered it while still alive and healthy.

There were also issues related to the family life of a child born through PHR techniques. Both male and female participants worried about the emotional stability and security of children born out of such conditions, and expressed their concern with new policies being proposed that would allow for expanded posthumous grandparenthood rights. The participants believed that the decision to have children following the death of a spouse was between the couple, and was not between other family members. Likewise, many participants worried about the birth of a child as a living shrine to the deceased, rather than as a new and autonomous member of the family.

In these responses, it is clear that while both biomedical technologies and governmental policies may enable PHR to occur, the process is not always viewed in such liberal terms by individuals who could be most likely to use it. Posthumous reproduction thus supplies medical anthropologists and scholars of social medicine with a nuanced case of the cultural position of new technologies, and the concerns that individuals across cultures have with these new reproductive tools: particularly as they relate to consent, kinship, and the roles of parents.

 

4S 2015: Sessions on Biomedicine, the Body, and Knowledge

Last year, we featured blog posts that highlighted paper sessions on various topics in medical anthropology and social medicine presented at the annual AAA (American Anthropological Association) meeting in Washington, DC. This year, we are heralding in conference season by featuring details on two upcoming events: the AAA meeting and the annual meeting of the Society for Social Studies of Science (4S). Both conferences will be held in November 2015 in Denver, CO. You can find out more about the AAA Meeting here (http://www.aaanet.org/meetings/) and the 4S Meeting here (http://www.4sonline.org/meeting.)

Logo of 4S via the organization's website

Logo of 4S via the organization’s website

The 4S organization brings together researchers whose works span all aspects of scientific research, production, and the impact of science on society. Despite the organization’s breadth of represented interests, many scholars of social medicine take a science and technology studies (STS) approach and are active in 4S. This week, we highlight sessions at the 4S Meeting that emphasize their research and paper sessions on biomedicine. Sessions are organized chronologically by date and time.


Sex and Gender in Biomedicine

Thursday, November 12th 8:30-10:00am

Click here for details on this session.

This session will feature three presentations on sex and gender in biomedicine focused on the following topics: cosmetic surgery in South Korea and the United States, the history of biological sex as defined by the sciences, and the role of a parasite transmitted through sex on the reproductive lives of humans. The papers propose new understandings of sex and gender as constructed through scientific knowledge and practice.

Examining the Exceptional: Case Studies of Knowledge Production in Biomedicine and Science

Thursday, November 12th 10:30am-12:00pm

Click here for details on this session.

Topics in this session will address: microevolution and genetic science on indigenous men in Brazil; the definition of crisis in emergency medicine in the United States; sickle cell patient advocacy in Brazil; a comparative case of pregnancy monitoring in the USA and the United Kingdom; and immigrant physicians and medical professionals arriving in the United States as an “exceptional” population. These papers will offer various examples of the way that science constructs meaning for patients and practitioners of biomedicine alike.

Biomedicine and Difference

Thursday, November 12th 2:00-3:30pm

Click here for details on this session.

In this session, presenters will explore: human microbiome research; astronauts, race, and physical preparation for conditions in outer space; representations of race in a stroke awareness campaign; past technologies for measuring skin color; and the breakdown of ethnic origin by genetic percentages. These papers will scrutinize the complex and often problematic relationships between race, science, medicine, and the body.

The Body in Biomedical Knowledge

Friday, November 13th 4:00-5:30pm

Click here for details on this session.

This session will address the following topics: food insecurity, the use of inmates as test subjects, obesity, and anatomical and physiological representations in 20th century Chinese medicine. The session will also feature the work of our blog editor, Julia Knopes, on the ontological status of cadavers as objects in Western medical traditions.

Replaceable Parts: Prosthetic Technologies in Biomedicine 

Saturday, November 14th 10:30am-12:00pm

Click here for details on this session.

Presenters in this session will speak about new surgical robots, the role of prosthetic limbs amongst wounded military veterans, cross-cultural readings of prosthetic making in Canada and Uganda, 3D organ printing and facial transplants, and the experiences of amputees in an ever-changing landscape of prosthetic and bionic technologies. The sessions in this paper panel will offer fresh perspectives on the meaning of the cyborg, a continued area of interest for many medical anthropologists and researchers in social medicine.

News: WHO Release on Worldwide Hearing Loss

When medical anthropologists consider the impacts of technology on human health, we envision life-saving drugs, surgeries, or diagnostic tools to detect disease. Technology in these ways can prove instrumental– quite literally — in improving patients’ health outcomes. However, it is equally important to think about the ways in which technology can diminish health, particularly in an age where the global spread of technology deserves the attention of clinicians and anthropologists alike.

This is the nature of the concern posed by the latest World Health Organization (WHO) report, released on February 27th 2015. After studying noise exposure in middle and high income countries and among participants ages 14-35, WHO officials stated that an estimated 1.1 billion people are at risk for hearing loss due to “recreational noise.” This includes music piped through headphones and noise experienced at entertainment venues. Exposure to high decibels of sound is not itself harmful: for instance, hearing a heavy pot fall from the counter and crash onto the floor would not cause hearing damager. Rather, the extended length of exposure to such loud noises is what proves detrimental. The WHO defines dangerous levels of noise exposure as 85 decibels for eight hours or 100 decibels for 15 minutes. The report notes that a rock concert that lasts for two hours may cause temporary hearing loss or lead to other symptoms such as a ringing sensation in the ears, and regular extended exposure may lead to more permanent damage.

The WHO flag, via Wikimedia Commons

The WHO flag, via Wikimedia Commons

What does the WHO recommend to address this global health concern? The report singles out teenagers and implores them to take noise management into their own hands: purchasing noise-canceling headphones, taking “sound breaks” if extended exposure to loud sounds is unavoidable, or wearing ear plugs to loud music venues. This places the responsibility to manage noise exposure on young people rather than on their families and caregivers. Likewise, the report suggests that patrons of entertainment venues like clubs and bars that feature loud music and sounds should limit their time spent in such environments. There are no extensive recommendations listed in the report for those who work in loud venues, other than limiting shifts to eight hours to shorten exposure.

From a medical anthropological standpoint, many of the factors in sound environments are tangled with social life. For instance, in many developed countries, concerts are an important social gathering place for young people. Teens may not avoid these events, but if they follow the WHO recommendations and wear earplugs to the venue, they may be ostracized by their peers for looking out of place. Likewise, neighborhood bars and clubs are important hubs of activity for locals, and avoiding them may come at the cost of social isolation. As technologies spread both to developing and developed countries, the ways that people integrate audio technologies, new entertainment venues, and popular music into their lives is worth considering given the impacts of these tools, sounds, and social spaces on hearing health.


To read the WHO’s news release, click here: http://www.who.int/mediacentre/news/releases/2015/ear-care/en/

From the Archive: Biotechnology and the Culture of Medicine

In the “From the Archive” series, we highlight articles published throughout the journal’s history. We look forward to sharing with our readers these samples of the innovative research that CMP has published on the cultural life of medicine across the globe.

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In this installment of From the Archive, we turn to Mary-Jo Delvecchio Good’s article The Biotechnical Embrace (Vol 25 Issue 4, December 2001.) In this piece, Delvecchio Good frames three concepts in the cultural study of biomedicine: medical imaginaries, biotechnical embraces, and clinical narratives. Here, we will briefly outline these notions.

The medical imaginary, we learn, is the envisioned potential of the new technologies and treatments that medicine could produce in the future. The power of possibility in this sense impacts both clinicians, who are always working to stay ahead of new scientific knowledge, and patients: often those afflicted with diseases for which no current remedy exists. The medical imaginary situates medical progress in a position of hope and opportunity. Stories of medical failure, malpractice, or dearths of medical knowledge, although evidence contrary to establishing an “optimistic” view of the field, are framed in an overarching positive narrative of scientific progress.

Delvecchio Good next describes the biotechnical embrace: the embracing of, and the “being embraced” by technical innovations. This refers to the public “enthusiasm” for biotechnical therapies, as well as the engagement of biotechnologies with the patient’s body. Like the medical imaginary, the biotechnical embrace concept recalls a biomedical commitment to scientific progress and possibility. Even whenever a treatment is highly experimental, not yet approved as effective, or so new that its pitfalls are not fully known, patients will ’embrace’ and request it– and the public will hastily invest in it.

Lastly, we parse the concept of the clinical narrative, or ethnographic frame. This qualitative data is what evidences popular and clinical enthusiasm for bioscientific innovation and the use of the latest technological treatments.

Put simply, narratives can demonstrate that patients and clinicians alike are able to frame care in terms of the gap between what is presently the case, and what might be. For instance, a cancer patient might note the gaps between their condition, current treatments they have used, future therapeutic options, and subsequent clinical outcomes for his or her illness. Clinical narratives remind us that patients (and caregivers) do not view medicine as a static database of information, but instead a dynamic and progressive body of knowledge that exists in relation to illness experiences.


Click here for a link to the abstract and further details about the paper: http://link.springer.com/article/10.1023/A%3A1013097002487