Clinical Medical Anthropology

I chose this intersection because it relates most closely to my future career of choice. If I end up going to medical school instead of graduate school, it would be with the intent that I would pursue becoming a Radiologist. Clinical Medical Anthropology is the most relevant to this choice, as there are only a few rare cases in which radiology in not performed in a clinical setting.

If I was working for a provider who was not an anthropologist, I believe that an anthropologist’s perspective would be useful in terms of cultural competency. Assuming that I would be in the U.S. (as I don’t have any particular plans to leave the country after finishing school), I would say that an understanding of anthropology would be most important for improving cultural sensitivity in the clinician’s setting, and not for improving the patient’s understanding of their illness and the need to follow through with the clinician’s advice. This is not to say that an understanding of anthropology would not help the clinician and patient better understand each other, just that cultural sensitivity would be more relevant in the U.S. (in my opinion) However there are some cases where an anthropological view is not always helpful in a clinical setting, especially when the one attempts to simplify the anthropological view to make basic assumption.  An example of this is present in the Kleinman-Benson article (The scenario is fictional but supposedly based on actual clinical encounters). In it, a Mexican man has not been bringing his child in for treatment as regularly as the doctors would like. The clinicians assume that it is due to some problem understanding the severity of the illness and the urgency of the treatment related to his cultural understanding of illness. In actuality however, the man has not been bringing his child in because his job prevents him from doing so regularly. In this example, an anthropological is incorrectly used and an assumption is made that later turns out to be false. This highlights the need for a proper understanding of anthropology, and the problems anthropology can cause if utilized poorly.

http://anthropology.msu.edu/anp204-us12/files/2012/06/6.-Kleinman-and-Benson-Anthropology-in-the-clinic.pdf

http://www.cabdirect.org/abstracts/19802902517.html;jsessionid=15C048C05EAF9977E2C78156B7ECACD3?freeview=true

http://www.sciencedirect.com/science/article/pii/0277953690900798

Infant Mortality in China

According to the CIA fact book, China is ranked 111th in the world for infant mortality rate, with an infant mortality rate of 1.562 percent (all of the rates cited in this article refer to the 2012 predicted mortality rate). The U.S. is ranked 174th in the world, with an infant mortality rate of 0.598 percent. This means that the infant mortality rate between the U.S. and China differs by about 9 in 1000 births. For additional comparison, Afghanistan has the worst infant mortality rate in the world at 12.163%, while Monaco has the lowest at 0.18 percent. Given the range of 0.18-12.163, the infant mortality rate in China is not a whole lot different from that of the U.S. Government efforts in China to reduce infant mortality have made fairly substantial progress. The primary way in which their government is tackling infant mortality is by encouraging rural women to give birth at hospitals, and providing subsidies to provide for the journey to them. Plans are also underway to provide basic medical insurance coverage for 90 percent of the population. As a result of China’s efforts, their infant mortality rate has dropped 62 percent between 1996 and 2008. The largest hurdle China faces is in bringing more advanced facilities to urban residents, who receive subpar treatment when compared to their urban counterparts. Interestingly, the decrease in infant mortality has been more pronounced for males than for females, however the article which concludes this is from 1994 and I have only been able to locate the abstract to the article online. Overall it appears that China is having a fair amount of success in improving their infant mortality rate.

I had a hard time finding an anthropologist working in this specific field currently, but there are several Chinese anthropologists who were the front-runners for Anthropology in China during the early 20th Century, including Yang Zhicheng and Lin Huixiang. They focused on social surveys of the various ethnic groups in China.

http://blogs.wsj.com/chinarealtime/2011/09/19/report-china-sees-dramatic-drop-in-infant-deaths/

http://www.ncbi.nlm.nih.gov/pubmed/7716434

http://www.ncbi.nlm.nih.gov/pubmed/12319406

https://www.cia.gov/library/publications/the-world-factbook/rankorder/2091rank.html

http://www.china.org.cn/english/2002/May/32689.htm

 

 

Obesity

I believe that obesity has been medicalized in U.S. culture as a result of profit-centered weight loss related items. The weight loss industry is worth $60.9 Billion in the U.S alone. (http://www.prweb.com/releases/2011/5/prweb8393658.htm) I believe that obesity has been medicalized largely due to the economic influence of the weight loss industry that has cropped up since the rise of obesity. However, this industry would not be possible without the ‘quick-fix’ culture of the U.S., where we expect to receive results that are disproportionate to the effort that we put towards those results. While there are always exceptions, I believe that the vast majority of individuals with obesity have it because they lead sedentary lives and eat unhealthy food.

 

http://www.youtube.com/user/RocaLabs?v=c_g3MUgzTFk&feature=pyv&ad=7578636244&kw=losing%20weight

The ad I found is for a diet supplement which is eligible for a health insurance discount. Essentially the product is made up of excess dietary fiber, with the intent that the sheer volume of it once expanded(Wikipedia has a decent article on the actions of dietary fiber in the intestinal tract) will physically prevent you from excess eating while also making you feel like you’re full.

Advertising Strategy: It is primarily marketed as an alternative to gastric bypass surgery. It is also marketed as requiring little effort from the patient; they claim that when taking this supplement you will feel full after eating only half of what you would normally eat, allowing you to maintain a calorie-deficient diet without having to feel hungry. At the end of the advertisement they also mention that it contains beta-glucan and that you wouldn’t have that advantage if you had surgery.

Cultural Values and Ideologies: This ad exemplifies the quick-fix mentality we too often hold in the U.S. They essentially market the supplement as controlling your cravings so you don’t have to. Emphasis is placed on the fact that you will eat less without having to feel hungry, and that it lowers your cravings for food. Instead of altering their calorie rich, nutrient poor diet, this supplement claims that individuals will lose weight without having to make any changes to their lifestyle.

Social Roles: The ad is pitched by a physically attractive woman, who speaks in an enthusiastic and friendly tone. The company wants to be viewed as a friend providing you with an awesome method for safely losing weight. The cost of the supplement is downplayed throughout the ad, they mention that it is $480 and compare that price to an $8,000 surgery, but fail to mention how long $480 worth will last. (Looking through their website (https://www.rocalabs.com/en/), it appears that $480 is for a four-month supply.)

Presentation of Medical Information: I did not see any information presented in the ad which I would consider to be medically validated, as they did not provide any tangible data with which to support their claims.

Doctor-patient interactions: None are presented, as this is a diet supplement marketed directly to the consumer by the company which manufactures it.

Healthy/Sick Dichotomy

What we mean by the culture of bio-medicine is that bio-medicine, while claiming to be free of cultural bias is actually a culturally influenced institution. In most cases, bio-medicine is associated with western culture, and is sometimes referred to as western medicine. It is important to realize that bio-medicine is culturally influenced because there have been many cases where bio-medicine is used as ‘proof’ to rationalize or justify one group or another’s action. The most prominent example of this is eugenics, which essentially legitimized racist beliefs by providing scientific ‘proof’ of inferiority.

I think that the difference between being healthy versus being sick from a biomedical standpoint is not always clear. Specifically, I believe that the pharmaceutical industry has pushed our medical system to prescribe more medication, whether or not medication is the best answer. The first example that pops into my mind is ADHD. I believe that ADHD and its corresponding medication to be over diagnosed and over-prescribed, respectively. I also do not agree with the way that children are targeted for ADHD medication, or with the way that parents can be led to believe that it will solve all their child’s school performance problems. While I’m sure some people actually need the medication and benefit from it, I think that ADHD for the most part is culture-bound.

I am not entirely sure where my beliefs on the dichotomy on being healthy versus being sick originated. While I believe that pharmaceuticals can be extremely useful, I dislike the way in which we jump to straight to prescriptions to solve all our problems. I believe that prescriptions should be used as a last resort, and that lifestyle changes should be the first attempt at improving health. In line with that train of thought, I believe that many of the variations in an individual’s health we consider to be a disease are caused by that individual’s lifestyle, and can be corrected with changes to their lifestyle. If a condition is caused by a person’s lifestyle and can be easily corrected by changes to their lifestyle, I do not see why that condition should be considered an illness or warrant a prescription medication. The problem with this ideal is that individuals are not always in control of their lifestyle or fully understand the cause-effect relationship between their lifestyle and their illness. Once again, I am not entirely sure where my personal views on this dichotomy originated.

True Life: I have Diabetes

Type/Use of Narrative: I believe that this episode followed the chaos narrative, since the three individuals followed in the episode will have to deal with diabetes for the rest of their life. I feel that the part on Kristyn followed a quest narrative as well as a chaos narrative, as she is shown to be working quite hard in order to pay for an insulin pump which will improve her condition. For Matt and Jen, I believe that there is no quest narrative and it is entirely chaos, as both choose to ignore their condition and their health in favor of lifestyle choices (alcohol and unhealthy diet choices, respectively) I believe that this narrative is used to highlight the frustration all of them feel when dealing with diabetes, and the limits it places on their actions.

Culture and Stigma: I believe that cultural stigmas are most easily seen with Matt’s case. On the one hand, many people close to Matt are scared for him and his health, worried that his alcohol use will give him a strong enough blood-sugar rush to cause a coma or seizure. On the other hand, Matt is under constant pressure to go drinking, even though it is much more dangerous for him to do so than for the average college student. The culture of college drinking combined with Matt’s refusal to accept the limitations of his condition are strong enough for Matt to choose to endanger his life.

Experiences with Medical Professionals: Kristyn, Matt, and Jen have all had extensive experiences with medical professionals. Kristyn is in debt due to the cost of her treatments and medications from visiting professionals. Matt also has frequent visits with medical professionals as his drinking habit regularly induces diabetic seizures. He is constantly reprimanded for his drinking habits, especially because his A1C test (which measures his average blood sugar levels for the previous three months) is far higher than it should be. Jen is also constantly reprimanded, especially because her refusal to give up fast food has forced her to switch from oral medication to insulin injections, not to mention the fact that Jen is pregnant and her blood sugar levels can impact her unborn child.

The Sick Role: All three of the individuals in this True Life episode have a hard time accepting their role as an individual with a persistent, debilitating, chronic condition. Of the three, Kristyn is most accepting of her role as a sick individual, and is primarily struggling with the financial burden of diabetes. Matt and Jen have a much harder time accepting their illness. They refuse to recognize the fact that their illness places limitations on their lives; instead they continue on with their habitual lifestyle which is unfortunately detrimental for them as diabetics. Because they have a hard time accepting the reality of their situation, they have a much harder time dealing with their condition than does Kristyn.

I believe that illness narratives are useful for the patient because the full extent of their condition and the trials they face can often be hard to determine without the explanations of the patient. Additionally, talking about one’s illness is often an important step in the road to recovery, because it can help the patient to come to terms with their condition and find emotional/social comfort in dealing with their illness.

Chronic Pain

Chronic Pain is pain that has persisted for an extended period of time. The point at which acute pain becomes chronic pain is not well defined; 3-6 months is generally defined as the length of time the pain must persist before it is considered ‘chronic’, although this transition point is essentially arbitrary, meaning there is no specific reason why 3-6 months was chosen as the duration necessary to define chronic pain. Some also make the distinction between pain which is caused by the activation of nociceptors (the nerve receptors which signal the presence of ‘pain’), and pain which is caused by neurological damage or malfunction. Culture can play a huge role in the illness experience. Because it is often difficult to determine the cause of chronic pain, the presence of the illness rests entirely on the patient’s word. It is not uncommon for the patient to not be taken seriously when they complain of their pain, since some physicians believe that the individuals with chronic pain actually have a mental disorder and are just trying to gain attention for themselves, and are not actually in pain. (Werner – “Illness stories on self and shame in women with chronic pain”) This has a significant effect on the self-esteem and psychological health of the individual with chronic pain. Despite the fact that many believe that poor mental health can cause ‘chronic’ pain, it has been found that the opposite is actually true, and that chronic pain often leads to a degradation in mental health.( Fishbain, David A.; Cole, Brandly, Cutler, R. Brian, Lewis, J., Rosomoff, Hubert L., Rosomoff, R. Steele (1 November 2006). “Chronic Pain and the Measurement of Personality: Do States Influence Traits?” Pain Medicine 7 (6): 509–529.) It has also been found that once chronic pain is managed through therapy, mental health often makes an improvement. (JESS, P.; T. JESS, H. BECK, P. BECH (1 January 1998). “Neuroticism in Relation to Recovery and Persisting Pain after Laparoscopic Cholecystectomy” . Scandinavian Journal of Gastroenterology 33 (5): 550–553. )

I believe that this can make management and treatment of chronic pain very difficult, since it can be hard for the patient to convince anyone that they are actually in pain and not lying about it. This further complicates the patient’s health, as not being believed in this manner is often discouraging.

In regards to the connection between belief and healing, I believe that individuals who maintain a positive attitude are often healthier. If they believe that they are being treated, then they will be more confident that they will recover and be healthy again. In the case of arthroscopic surgery for arthritis of the knee, it was found in clinical trials that essentially the entire benefit of the surgery was a placebo effect. (Placebo: Cracking the Code)

 

 

 

 

Obesity in the United States

Obesity is typically defined as the abnormal accumulation of body fat, which is in turn usually defined as 20% or more over an individual’s ideal body weight. 20-40% is considered mild obesity, 40-100% over is considered moderate obesity, and greater than a 100% more than ideal weight is considered to be morbid obesity. Ideal weight is defined as the weight corresponding to the lowest death rate for individuals of a specific height, gender, and age. The treatment and study of obesity is known as bariatric medicine.

The article I chose is “The Worldwide Obesity Epidemic”, an article published by Philip T. James, Rachel Leach, Eleni Kalamara, and Maraym Shayeghi.

http://www.nature.com/oby/journal/v9/n11s/full/oby2001123a.html

The major cause of obesity (at least in my opinion) is a hybrid of social and economic issues which have proven to be an effective combination for causing obesity. Specifically, I believe that the position processed foods have taken in our lives has profoundly affected obesity. Since the rise of processed food which is nearly always simultaneously packed with overly high levels of sodium and fats and an extreme lack of actual nutrition. There are many individuals in the United States who are malnourished not because they do not have enough to eat, but because the food that is widely available is not nutritious. This is made especially worse by the fact that these processed foods are incredibly cheap compared to food that is actually nutritious; because of this poverty is positively associated with higher obesity rates. Finally, this is also made worse by the extremely sedentary lifestyle that has emerged in the post-industrial United States.

In my opinion, not enough is being done towards the treatment and evaluation of obesity. Quick fix remedies are being extensively researched and marketed to individuals, but few work very well. Instead of convincing individuals that they need to change their lifestyle we try to provide them with drugs to solve their problems without having to change a thing(all the while making a tidy profit to boot) Unfortunately, I do not know what can be done to remedy this situation. The processed/fast food industry is too large and profitable for any action- such as the ban or taxing of processed fat, etc., etc. to ever occur. While we are still perfectly capable of simply changing our habits and eating healthier without government regulations ensuring it, this is not such an easy thing to do for those in poverty.

Clown Doctors in NYC

The article I am referring to is Clown Doctors: Shaman Healers of Western Medicine. This article focuses on a professional group of clowns who work in a pediatric unit. The main point of the article is to make a comparison between shaman healers and clown ‘doctor’s. I did not overly enjoy the article; I’m not entirely sure why. Essentially, the article posits that clowns and shamans are similar because both employ strange costumes, props, and behaviors, in addition to sleight of hand, ventriloquism, music, and feats of skill that break natural and cultural laws. The point about breaking social/cultural ‘laws’ is repeated quite frequently throughout the article. The article also talks about how children are a better focus point because they are less “vaccinated” against belief in magic. While that may be true, I do not agree that children would believe the clowns to be normal doctors with special powers. While convenient in enhancing the analogy between clowns and shamans, it is conjecture only in the article.

 

The healers are clown ‘doctors’. Specifically, they are a group of professional clowns who work in a hospital in NYC with the children admitted to the hospital. In this context, their social status is not as relevant as it would be for other ethno medical systems, but I would hazard the guess that professional clowns are probably somewhere in the middle of the social status spectrum. These healers use comedy to try to cheer up children and their families, helping to make their hospital visit a little less scary. They interact with their patients by telling jokes or performing rehearsed skits with them.

 

These clown doctors operate in regular a NYC hospital, rather than in their own separate institution. Healthcare is delivered through what I would imagine is standard biochemical medical practice in the U.S. This setup focuses only on treatment via medicine or procedures. IT is because of this that the clowns are able to serve a useful purpose. Because the hospital is rather intimidating and impersonal for a child, the clowns are able to ease the tension by cheering them up.

Caucasian – Skin Cancer

The health disparity I chose to talk about is Skin Cancer. There are many types of skin cancer, but the three most prevalent are basal cell cancer, squamous cell cancer, and melanoma. Skin cancer is also the most commonly diagnosed type of cancer. Basal and squamous cell cancer only has a .3% mortality rate, while melanoma has a 15-20% mortality rate. A much rarer form of melanoma known as malignant melanoma is responsible for 75% of all skin cancer deaths, despite being one of the least common. Skin cancer is much more prevalent among white individuals because their skin does not have as much melanin. There are actually three kinds of melanin, Eumelanin, Pheomelanin, and Neuromelanin, but Eumelanin is the one which differs most by race. (Pheomelanin is associated with red hair and the exact function of Neuromelanin is unknown) In general, individuals whose ancestors lived for long periods of time at the equator have higher levels of Melanin. It is interesting to note that while Melanin levels vary between different races, the number of melanocytes (the cells which produce melanin) hardly varies at all. Instead, the differences between races are due to the relative activity of the melanocytes. Melanin protects against the harmful effects of ionizing radiation, helping to protect against DNA mutations.

The relationship between race, genetics, and health is a complicated one. Oversimplification can often lead to grossly inaccurate conclusions; such oversimplifications have happened many times throughout recorded history. I would argue that while there are certain cases where race can have a direct effect on one’s health, the primary way in which race and health are related is actually a result of the varying social practices of the various races. This would mean that race and health share causation with social practices, but between themselves share only a correlation. (As the media is often prone to forgetting, correlation does not imply causation)

Melanoma of the Skin
Death Rates* by Race/Ethnicity and Sex, U.S., 1999–2008

Mortality source: U.S. Mortality Files, National Center for Health Statistics, CDC.
*Rates are per 100,000 persons and are age-adjusted to the 2000 U.S. standard population (19 age groups – Census P25-1130). Death rates cover 100% of the U.S. population.
Hispanic origin is not mutually exclusive from race categories (white, black, Asian/Pacific Islander, American Indian/Alaska Native).

http://www.cdc.gov/cancer/skin/statistics/race.htm

 

Bad Sugar

I got an 8/10 on the Health Equity Quiz. I took History of American and European Healthcare (HST 425) in the previous summer session, and that helped a lot with most of the questions. I was most surprised that recent Latino immigrants have the best overall health in the United States. I expected first generation immigrants to have lower overall health than U.S. citizens, or even second and third generation immigrants.

The case study that I am going to talk about is the Pima Indians and their water supply. Starting in the 1890s, irrigation projects on the Gila River upstream of the Pima Indians developed extensively. This brought a reliable water supply to the white farmers and ranchers upstream, and was quite beneficial for them. However, these projects caused the Gila River to drastically diminish downstream, severely crippling the Pima Indians who relied on the river to grow their own food. Winters v. United States did little to help the Pima Indians in 1908. With the Coolidge dam in 1930, the Pima Indian’s water supply increased somewhat, but not nearly as much as what was needed. It would not be until the Arizona Water Settlements Act of 2004 that the Pima Indians would gain water rights significant enough to bring a difference.

There are a lot of ways in which politics and economics can influence the development and spread of treatments and medical improvements. The most significant is the financial cost of expanding infrastructure to support new treatments or to supply medicine, in my opinion at least. For example, an area with a high rate of poverty is unlikely to have many hospitals or physicians. Caring for the poor does not generally pay well, and for many in the medical field money is the bottom line. The environment can also have a drastic effect on one’s health. In the case of the Pima Indians, the loss of their primary source of water dealt a huge blow to their health. Without water, the Pima were unable to sustain themselves with their own crops, and many had to subsist on government surplus, which was generally not very healthy.