1) The “culture of biomedicine” alludes to Western medicine as a microcosm of Western culture, embodying and reinforcing the values, ideology, hierarchy, kinship structures, and power dynamics of Western culture. For example, the arrangement of allopathic medical personnel reflects the classism and gender stratification that typify Western society. As such, biomedicine replicates gender relations and represents a quasi-family in the sense that physicians have historically been a male ‘father’ character while nurses were predominately a female ‘mother’ character’, with the former endowed with more prestige and entitlements. This concept is important since, despite operating on premises of objectivity, empiricism, and universal truth, theory and organizational structure in biomedicine reflects cultural attitudes.
For example, as cited in lecture, anthropologists adopt the view of a hospital as a “miniature city, where each ward is a different suburb with its own administration, bureaucracy, workers, security, and a fluid stream of patient citizens,” demonstrating how biomedicine is a subculture embedded within a larger cultural context (Karim, 2012). Thus, it also epitomizes socioeconomic aspects of Western culture such as a capitalist, competitive spirit between practitioners and a market-driven fee-for-service paradigm, where a hospital is a for-profit enterprise. Furthermore, the “culture of biomedicine” is aptly named because it exemplifies culture-specific rites of passage. For example, a rite of transition is illustrated by the sequestration of the sick in a hospital, which could be interpreted as a trial of ordeal in the liminal period between illness and health. Furthermore, recitation of the Hippocratic Oath is a component of the rite of incorporation whereby medical students become endowed with the esteem and privilege of a doctor. Moreover, biomedicine is cultural in that health care delivery observes taboos and rituals, including pre-operative hand washing, instrument sterilization, and use of caps, masks, and ‘booties’ in the surgical theater, despite a deficiency in literature supporting that these last practices reduce risk of infection. As Quebbeman notes, these customs “function to define ‘us’ and differentiate and distance ‘us’ from ‘them’”.
2) In my opinion, the medication-enhancement dichotomy separates drugs that can fix, as in eradicating acute illness and reversing chronic, degenerative illness, from drugs that can improve quality of life, such as preemptive treatments that forestall disease development. I think my personal view comes from labels used in the cultural of biomedicine that divide treatments of emergency or ‘medical necessity’ from those that are ‘elective’ or ‘cosmetic’. Originally, this language was likely employed by insurance companies in defining therapies for which reimbursement is possible.
3) I think that the dichotomy of medication-enhancement has emerged due to the pharmaceutical innovations that have essentially enabled the institution of medicine not only to relieve suffering, but to extend life expectancy and healthy years. On the one hand, the germ theory gave rise to vaccinations against biological threats such as polio and smallpox, showcasing the near-miraculous potential of medicine to eliminate infectious disease. Because acute, epidemic disease declined, the medical community shifted efforts to treat non life-threatening conditions and to magnify health and human potential. For example, the inception of Viagra medicalized less-than-perfect sexual performance and represented a life enhancement for those with only occasional erectile dysfunction (Cohen, 2009). Similarly, Ritalin can be a “cognitive enhancer,” augmenting working memory capacity and productivity in healthy subjects (Cohen, 2009). Furthermore, statins are now prescribed to preempt heart attacks, representing a widening of the net where medicines are now designed to treat risk factors (Cohen, 2009). Such developments have set the stage for the impression that medicine could not only produce ‘quick fix’, magic bullet cures, but also enhance health and longevity, generating a seemingly natural medication-enhancement dichotomy.
Cohen, A. (Editor). (2009). Pill Poppers[Documentary]. United Kingdom: BBC Horizon.
Karim, Taz. Medical Anthropology. Michigan State University. 3 August 2012.
Quebbeman, E.J. (1996). Rituals in the Operating Room: Are They Necessary? Infectious Diseases in Clinical Practice, 5(2): S68-S70.