Race, Place, and Medicine examines the impact of a group of nineteenth-century Brazilian physicians who became known posthumously as the Bahian Tropicalista School of Medicine. Julyan G. Peard explores how this group of obscure clinicians became participants in an international debate as they helped change the scientific framework and practices of doctors in Brazil. Peard shows how the Tropicalistas adapted Western medicine and challenged the Brazilian medical status quo in order to find new answers to the old question of whether the diseases of warm climates were distinct from those of temperate Europe. They carried out innovative research on parasitology, herpetology, and tropical disorders, providing evidence that countered European assumptions about Brazilian racial and cultural inferiority. In the face of European fatalism about health care in the tropics, the Tropicalistas forged a distinctive medicine based on their beliefs that public health would improve only if large social issues—such as slavery and abolition—were addressed and that the delivery of health care should encompass groups hitherto outside the doctors’ sphere, especially women. But the Tropicalistas’ agenda, which included biting social critiques and broad demands for the extension of health measures to all of Brazil’s people, was not sustained. Race, Place, and Medicine shows how imported models of tropical medicine—constructed by colonial nations for their own needs—downplayed the connection between socioeconomic factors and tropical disorders. This study of a neglected episode in Latin American history will interest Brazilianists, as well as scholars of Latin American, medical, and scientific history.
Radiation Evangelists explores X-ray and radium therapy in the United States and Great Britain during a crucial period of its development, from 1896 to 1925. It focuses on the pioneering work of early advocates in the field, the “radiation evangelists” who, motivated by their faith in a new technology, trust in new energy sources, and hope for future breakthroughs, turned a blind eye to the dangers of radiation exposure. Although ionizing radiation effectively treated diseases like skin infections and cancers, radiation therapists—who did not need a medical education to develop or administer procedures or sell tonics containing radium—operated in a space of uncertainty about exactly how radiation worked or would affect human bodies. And yet radium, once a specialized medical treatment, would eventually become a consumer health product associated with the antibacterial properties of sunlight.
This book raises important questions about medical experimentation and the so-called Golden Rule of medical ethics, issues of safety and professional identity, and the temptation of a powerful therapeutic tool that also posed significant risks in its formative years. In this cautionary tale of technological medical progress, Jeffrey Womack reveals how practitioners and their patients accepted uncertainty as a condition of their therapy in an attempt to alleviate human suffering.
Designed for busy medical students, The Radiology Handbook is a quick and easy reference for any practitioner who needs information on ordering or interpreting images.
The book is divided into three parts:
- Part I presents a table, organized from head to toe, with recommended imaging tests for common clinical conditions.
- Part II is organized in a question and answer format that covers the following topics: how each major imaging modality works to create an image; what the basic precepts of image interpretation in each body system are; and where to find information and resources for continued learning.
- Part III is an imaging quiz beginning at the head and ending at the foot. Sixty images are provided to self-test knowledge about normal imaging anatomy and common imaging pathology.
Published in collaboration with the Ohio University College of Osteopathic Medicine, The Radiology Handbook is a convenient pocket-sized resource designed for medical students and non radiologists.
David S. JONES Harvard University Press, 2004 Library of Congress RA408.I49J66 2004 | Dewey Decimal 614.4208997
Ever since their arrival in North America, European colonists and their descendants have struggled to explain the epidemics that decimated native populations. Century after century, they tried to understand the causes of epidemics, the vulnerability of American Indians, and the persistence of health disparities. They confronted their own responsibility for the epidemics, accepted the obligation to intervene, and imposed social and medical reforms to improve conditions. In Rationalizing Epidemics, David Jones examines crucial episodes in this history: Puritan responses to Indian depopulation in the seventeenth century; attempts to spread or prevent smallpox on the Western frontier in the eighteenth and nineteenth centuries; tuberculosis campaigns on the Sioux reservations from 1870 until 1910; and programs to test new antibiotics and implement modern medicine on the Navajo reservation in the 1950s. These encounters were always complex. Colonists, traders, physicians, and bureaucrats often saw epidemics as markers of social injustice and worked to improve Indians' health. At the same time, they exploited epidemics to obtain land, fur, and research subjects, and used health disparities as grounds for "civilizing" American Indians. Revealing the economic and political patterns that link these cases, Jones provides insight into the dilemmas of modern health policy in which desire and action stand alongside indifference and inaction.
Table of Contents:
List of Figures Acknowledgments
Introduction 1. Expecting Providence 2. Meanings of Depopulation 3. Frontiers of Smallpox 4. Using Smallpox 5. Race to Extinction 6. Impossible Responsibilities 7. Pursuit of Efficacy 8. Experiments at Many Farms Epilogue and Conclusions
Rationalizing Epidemics is a superb work of scholarship. By contextualizing his deep and thorough research in original documents within the larger literature on the history and nature of epidemics, Jones has produced a profound account of how epidemics are social and cultural phenomena, not just biological. This book will be of great interest to scholars of American Indian history and the history of medicine, and with its engaging and accessible writing style, it promises to be a book that students and the general public will appreciate as well. --Nancy Shoemaker, University of Connecticut
An imaginative and insightful approach to health and disease among American Indians, Rationalizing Epidemics represents a remarkable accomplishment. The breadth of reading and depth of research, the subtlety used in explaining each case, and the original approach to the material are altogether impressive. Jones's book undoubtedly will be a major contribution to American history. --Daniel H. Usner, Jr., Vanderbilt University
Mental illness is the poor, and somehow "damaged," cousin to physical ailments in the eyes of too many in our society. Compare the difference in how people would respond to someone who had fallen and broken their leg on the street, to how most react to those mentally ill among us, on those same streets, who spend their winters on steam grates and forage for food in dumpsters. Rationing Sanity is a provocative analysis of the mental health care system in the United States, dealing with issues of justice and access to mental health care.
How should a decent society, affluent but facing many serious calls on its resources, best care for citizens afflicted with severe and persistent mental illnesses? James Lindemann Nelson brings together, for the first time, scholars of the ethics of mental health care and top managed care policy analysts to address this crucial problem. Rationing Sanity integrates those perspectives with the thoughtful practice-based experience of physicians well versed in the actual care of people with emotional and behavioral problems. Over a period of years, the contributors met face-to-face to engage each other on the ethics of managed mental health care—the result is a unique, collaborative effort that provides a wealth of important new insights on not only how Americans can readjust their attitudes toward the mentally ill—but also how we may find more just and humane treatment for those afflicted.
Raw Material analyzes how Victorians used the pathology of disease to express deep-seated anxieties about a rapidly industrializing England’s relationship to the material world. Drawing on medicine, literature, political economy, sociology, anthropology, and popular advertising, Erin O’Connor explores “the industrial logic of disease,” the dynamic that coupled pathology and production in Victorian thinking about cultural processes in general, and about disease in particular. O’Connor focuses on how four particularly troubling physical conditions were represented in a variety of literature. She begins by exploring how Asiatic cholera, which reached epidemic proportions on four separate occasions between 1832 and 1865, was thought to represent the dangers of cultural contamination and dissolution. The next two chapters concentrate on the problems breast cancer and amputation posed for understanding gender. After discussing how breast cancer was believed to be caused by the female body’s intolerance to urban life, O'Connor turns to men’s bodies, examining how new prosthetic technology allowed dismembered soldiers and industrial workers to reconstruct themselves as productive members of society. The final chapter explores how freak shows displayed gross deformity as the stuff of a new and improved individuality. Complicating an understanding of the Victorian body as both a stable and stabilizing structure, she elaborates how Victorians used disease as a messy, often strategically unintelligible way of articulating the uncertainties of chaotic change. Over the course of the century, O’Connor shows, the disfiguring process of disease became a way of symbolically transfiguring the self. While cholera, cancer, limb loss, and deformity incapacitated and even killed people, their dramatic symptoms provided opportunities for imaginatively adapting to a world where it was increasingly difficult to determine not only what it meant to be human but also what it meant to be alive. Raw Material will interest an audience of students and scholars of Victorian literature, cultural history, and the history of medicine.
In Reading for Health: Medical Narratives and the Nineteenth-Century Novel, Erika Wright argues that the emphasis in Victorian Studies on disease as the primary source of narrative conflict that must be resolved has obscured the complex reading practices that emerge around the concept of health. By shifting attention to the ways that prevention of illness and the preservation of well-being operate in fiction, both thematically and structurally, Wright offers a new approach to reading character and voice, order and temporality, setting and metaphor. As Wright reveals, while canonical works by Austen, Brontë, Dickens, Martineau, and Gaskell register the pervasiveness of a conventional “therapeutic” form of action and mode of reading, they demonstrate as well an equally powerful investment in the achievement and maintenance of “health”—what Wright refers to as a “hygienic” narrative—both in personal and domestic conduct and in social interaction of the individual within the community.
Readings in American Health Care is an introduction to the historical development and current status of a wide variety of health care topics. The readings, written by historians, sociologists, economists, physicians, nurses, and public health researchers, are organized in sections:
• Basic Concepts: mortality trends, concepts of disease, changes in medical therapy
• Public Health: AIDS, cigarette smoking, preventive medicine, fluoridation
• Health Care Professions: cardiology, pathology, women in medicine, nursing, podiatry, midwives
• Health Care Organizations: hospitals, HMOs
• Mental Illness
• Financing Health Care
• Medical Education
• Issues: abortion, ethical issues, cancer control, prenatal care, home care, the pharmaceutical industry
• Background Readings: American medicine from 1920 to midcentury.
The readings were chosen especially for course use in history, sociology, public health, and related fields, but can also provide useful background reading for anyone interested or involved in American health care. Each selection includes an introduction, questions for the reader, and a bibliography. Scholars and students alike will find the book an invaluable resource.
The Rebirth of the Clinic begins with a bold assertion: the doctor-patient relationship is sick. Fortunately, as this engrossing book demonstrates, the damage is not irreparable. Today, patients voice their desires to be seen not just as bodies, but as whole people. Though not willing to give up scientific progress and all it has to offer, they sense the need for more. Patients want a form of medicine that can heal them in body and soul. This movement is reflected in medical school curricula, in which courses in spirituality and health care are taught alongside anatomy and physiology. But how can health care workers translate these concepts into practice? How can they strike an appropriate balance, integrating and affirming spirituality without abandoning centuries of science or unwittingly adopting pseudoscience?
Physician and philosopher Daniel Sulmasy is uniquely qualified to guide readers through this terrain. At the outset of this accessible, engaging volume, he explores the nature of illness and healing, focusing on health care's rich history as a spiritual practice and on the human dignity of the patient. Combining sound theological reflection with doses of healthy skepticism, he goes on to describe empirical research on the effects of spirituality on health, including scientific studies of the healing power of prayer, emphasizing that there are reasons beyond even promising research data to attend to the souls of patients. Finally, Sulmasy devotes special attention and compassion to the care of people at the end of life, incorporating the stories of several of his patients.
Throughout, the author never strays from the theme that, for physicians, attending to the spiritual needs of patients should not be a moral option, but a moral obligation. This book is an essential resource for scholars and students of medicine and medical ethics and especially medical students and health care professionals.
From physical location to payment processes to expectations of both patients and caregivers, nearly everything surrounding the contemporary medical clinic's central activity has changed since Michel Foucualt's Birth of the Clinic. Indebted to that work, but recognizing the gap between what the modern clinic hoped to be and what it has become, Rebirth of the Clinic explores medical practices that shed light on the fraught relationship between medical systems, practitioners, and patients.
Combining theory, history, and ethnography, the contributors to this volume ground today's clinic in a larger scheme of power relations, identifying the cultural, political, and economic pressures that frame clinical relationships, including the instrumentalist definition of health, actuarial-based medical practices, and patient self-help movements, which simultaneously hem in and create the conditions under which agents creatively change ideas of illness and treatment.
From threatened community health centers in poor African American locales to innovative nursing practices among the marginally housed citizens of Canada's poorest urban neighborhood, this volume addresses not just the who, what, where, and how of place-specific clinical practices, but also sets these local experiences against a theoretical backdrop that links them to the power of modern medicine in shaping fundamental life experiences.
Contributors: Christine Ceci, U of Alberta; Lisa Diedrich, Stony Brook U; Suzanne Fraser, Monash U; John Liesch, Simon Fraser U; Jenna Loyd, CUNY; Annemarie Mol, U of Amsterdam; Mary Ellen Purkis, U of Victoria.
Across early modern Europe, men and women from all ranks gathered medical, culinary, and food preservation recipes from family and friends, experts and practitioners, and a wide array of printed materials. Recipes were tested, assessed, and modified by teams of householders, including masters and servants, husbands and wives, mothers and daughters, and fathers and sons. This much-sought know-how was written into notebooks of various shapes and sizes forming “treasuries for health,” each personalized to suit the whims and needs of individual communities.
In Recipes and Everyday Knowledge, Elaine Leong situates recipe knowledge and practices among larger questions of gender and cultural history, the history of the printed word, and the history of science, medicine, and technology. The production of recipes and recipe books, she argues, were at the heart of quotidian investigations of the natural world or “household science”. She shows how English homes acted as vibrant spaces for knowledge making and transmission, and explores how recipe trials allowed householders to gain deeper understandings of sickness and health, of the human body, and of natural and human-built processes. By recovering this story, Leong extends the parameters of natural inquiry and productively widens the cast of historical characters participating in and contributing to early modern science.
Isidor Sadger; Edited and introduced by Alan Dundes; Translated by Johanna Micaela Jacobsen and Alan Dundes University of Wisconsin Press, 2005 Library of Congress BF109.F74S2413 2005 | Dewey Decimal 150.1952092
This eyewitness account by one of Sigmund Freud's earliest students has been rediscovered for twenty-first-century readers. Isidor Sadger's recollections provide a unique window into the early days of the psychoanalytic movement and also illuminate Freud's own struggles: his delight in wit, his attitudes toward Judaism, and his strong opinions concerning lay, nonmedical psychoanalysts.
As a student, Sadger attended Freud's lectures from 1895 through 1904. Although Sadger was not part of Freud's inner circle, he was a participant observer of Freud's early years as teacher, therapist, and clinician. In 1930, Sadger published the biography Sigmund Freud: Persönliche Erinnerungen, but with the rise of Nazism and World War II, the book was almost lost to the world of psychoanalytic history. Recollecting Freud is a long-lost personal account that provides invaluable insights into Freud and his social, cultural, and intellectual context.
Drawing on the controversial case of “Ashley X,” a girl with severe developmental disabilities who received interventionist medical treatment to limit her growth and keep her body forever small—a procedure now known as the “Ashley Treatment”—Reconsidering Intellectual Disability explores important questions at the intersection of disability theory, Christian moral theology, and bioethics.
What are the biomedical boundaries of acceptable treatment for those not able to give informed consent? Who gets to decide when a patient cannot communicate their desires and needs? Should we accept the dominance of a form of medicine that identifies those with intellectual impairments as pathological objects in need of the normalizing bodily manipulations of technological medicine?
In a critical exploration of contemporary disability theory, Jason Reimer Greig contends that L'Arche, a federation of faith communities made up of people with and without intellectual disabilities, provides an alternative response to the predominant bioethical worldview that sees disability as a problem to be solved. Reconsidering Intellectual Disability shows how a focus on Christian theological tradition’s moral thinking and practice of friendship with God offers a way to free not only people with intellectual disabilities but all people from the objectifying gaze of modern medicine. L'Arche draws inspiration from Jesus's solidarity with the "least of these" and a commitment to Christian friendship that sees people with profound cognitive disabilities not as anomalous objects of pity but as fellow friends of God. This vital act of social recognition opens the way to understanding the disabled not as objects to be fixed but as teachers whose lives can transform others and open a new way of being human.
This is a provocative look at writing by and about people with illness or disability—in particular HIV/AIDS, breast cancer, deafness, and paralysis—who challenge the stigmas attached to their conditions by telling their lives in their own ways and on their own terms. Discussing memoirs, diaries, collaborative narratives, photo documentaries, essays, and other forms of life writing, G. Thomas Couser shows that these books are not primarily records of medical conditions; they are a means for individuals to recover their bodies (or those of loved ones) from marginalization and impersonal medical discourse.
Responding to the recent growth of illness and disability narratives in the United States—such works as Juliet Wittman’s Breast Cancer Journal, John Hockenberry’s Moving Violations, Paul Monette’s Borrowed Time: An AIDS Memoir, and Lou Ann Walker’s A Loss for Words: The Story of Deafness in a Family—Couser addresses questions of both poetics and politics. He examines why and under what circumstances individuals choose to write about illness or disability; what role plot plays in such narratives; how and whether closure is achieved; who assumes the prerogative of narration; which conditions are most often represented; and which literary conventions lend themselves to representing particular conditions. By tracing the development of new subgenres of personal narrative in our time, this book explores how explicit consideration of illness and disability has enriched the repertoire of life writing. In addition, Couser’s discussion of medical discourse joins the current debate about whether the biomedical model is entirely conducive to humane care for ill and disabled people.
With its sympathetic critique of the testimony of those most affected by these conditions, Recovering Bodies contributes to an understanding of the relations among bodily dysfunction, cultural conventions, and identity in contemporary America.
Faced with a world that is environmentally out of balance, that is unhealthy in many respects, and that reflects stark inequalities, anthropologists are challenging themselves and others to engage in recovery, renewal, and reclaiming. This volume of Southern Anthropological Society Proceedings seeks to grapple with these challenges head-on. The essays provide wide-ranging discussions of concrete problems, often with a focus on the Appalachian region. Among the important issues raised are the following: the effect of landscape on health in Huntington, West Virginia; food justice; drug use and its misrepresentation in Appalachia; the relationship between evangelical religion and depression; the changing definitions of mental illness over time and how those definitions are used as instruments of social control; how the spiritual practices of Eastern Band Cherokees are connected to medical care; and the challenges recent Haitian immigrants face in obtaining health care in a new culture.
While solutions to these problems are complex and always have their roots in local circumstance, the essays in Recovery, Renewal, Reclaiming will inspire strategies that will clear blighted environments, deliver nourishing food, ease the lives of marginalized people, and lead to respect for all beliefs as we work together to bring balance to our environmental, physical, and spiritual health.
This book provides a scientific and personal perspective on health services research over the last half-century. Its essays and commentaries suggest how that science base, constructed over decades of sustained effort, can stimulate innovative thinking about ways to make health care systems safer, more efficient, more cost-effective, and more patient-centered.
Recent debates on Medicare reform focus on prescription drug coverage, expanding managed-care choices, or technical issues of payment policy. Despite all the heat generated by these issues, Edward F. Lawlor's new book, Redesigning the Medicare Contract, demonstrates that fundamental questions of purpose and policy design for Medicare have been largely ignored.
Challenging conventional ideas, Lawlor suggests that we look at Medicare as a contract between the federal government, the program's beneficiaries, and health care providers. Medicare reform, then, would involve rewriting this contract so that it more successfully serves the interests of both beneficiaries and taxpayers. To do this, Lawlor argues that we must improve the agency of the program—the informational, organizational, and incentive elements that assure Medicare program carries out beneficiary and taxpayer interests in providing the most appropriate, high-quality care possible. The book includes a chapter devoted solely to concepts and applications that give definition to this brand of agency theory. Lawlor's innovative agency approach is matched with lucid explanation of the more comprehensive groundwork in the history and politics of the Medicare program.
Lawlor's important and timely book reframes the Medicare debate in a productive manner and effectively analyzes alternatives for reform. Lawlor argues that effective policy design for Medicare requires greater appreciation of the vulnerability of beneficiaries, the complexity of the program itself, its wide geographical variations in services and financing, and the realistic possibilities for government and private sector roles. Tackling difficult problems like end-of-life and high-tech care—and offering sensible solutions—Redesigning the Medicare Contract will interest political scientists, economists, policy analysts, and health care professionals alike.
New medical technologies are a leading driver of U.S. health care spending. This report identifies promising policy options to change which medical technologies are created, with two related policy goals: (1) Reduce total health care spending with the smallest possible loss of health benefits, and (2) ensure that new medical products that increase spending are accompanied by health benefits that are worth the spending increases.
Examining the health care market in a historical framework, Drake analyzes the forces and events that have shaped American health care in the twentieth century and sheds new light on why and how our health care system has dampened competitive market forces and failed to provide sound value for much of our health care expenditures. He examines the roles that physicians, hospitals, insurance companies, businesses, individual consumers, and government legislation have played in creating a provider-dominated market in which the cost of care has been concealed from consumers. Comparing U.S. health care expenditures with those of other developed countries, he concludes that a significant part of our health care problem is the style of medicine practiced in the United States, which is much more specialized and high tech than in other developed nations.
Drake develops proposals for health care financing reform that consider the political and economic difficulties involved. He first examines the Clinton health care reform plan and makes specific recommendations for revisions that would improve its likelihood of controlling costs. He then offers an alternative proposal that would both maintain the principle of universal, noncancelable coverage and eliminate the flaws in the market for health care services by giving consumers a financial stake in cost containment.
This timely argument, combining economic and historical analysis with thoughtful consideration of the motivating humanitarian and political concerns, will be of interest to everyone seeking to understand and to reform our ailing health care system.
America's current system of health insurance, which relies almost exclusively on employer-sponsored coverage, is in danger of collapse, and this problem is not limited to the poor and working class. An increasing number of middle class Americans do not have employer-provided insurance and—due to skyrocketing premiums—cannot afford to purchase coverage for themselves. Reinsuring Health, by economist Katherine Swartz, examines this growing national crisis and outlines a concrete plan to make health insurance accessible and affordable for all Americans. Reinsuring Health documents why the number of uninsured Americans—now 45.5 million people—has grown in the last twenty-five years. Swartz focuses on how labor market changes—such as the decline of domestic manufacturing, decreased unionization, and the growth of non-standard work arrangements—have led U.S. employers to retreat from providing health insurance for their workers. These trends, combined with the increasing costs of medical care, have led to an explosion in health insurance premiums and a decline in coverage, particularly among the middle-class. Since those who seek insurance as individuals are generally most likely to need health care, private insurers charge higher premiums in the individual (non-group) markets than to people who obtain group insurance. This makes individual health insurance less attractive to the young and increasingly unaffordable for middle-class Americans. Similarly, insurers charge higher per person (or per family) premiums to small firms than to large companies, so many small firms do not sponsor coverage for their employees. Reinsuring Health shows how these problems can be overcome if the federal government provides a new reinsurance program which would protect insurance companies that provide small group and individual health insurance against the possibility that their policy-holders will incur very high medical expenses. By assuming some of the risk that people will face extremely costly medical bills, the government will make insurers less hesitant to offer coverage to high-risk individuals, and will help drive down premiums for others. Reinsuring Health demonstrates that this form of government reinsurance has worked in the past, helping to establish smooth running private markets for catastrophe insurance and secondary mortgages. Today, growing numbers of middle class Americans lack health insurance. Protection against the possibility of falling ill or getting hurt and having to pay extraordinary health care bills should not be a luxury available only to the very rich and the very poor. Reinsuring Health proposes a straightforward solution that would bring health insurance back within the reach of the increasing ranks of the uninsured, particularly those who are in the middle class.
There are more psychoanalytic theories today than anyone knows what to do with, and the heterogeneity and complexity of the entire body of psychoanalytic though have become staggering. In Relational Concepts in Psychoanalysis, Stephen A. Mitchell weaves strands from the principal relational-model traditions (interpersonal psychoanalysis, British school object-relations theories, self psychology, and existential psychoanalysis) into a comprehensive approach to many of the knottiest problems and controversies in theoretical and clinical psychoanalysis.
Mitchell’s earlier book, Object Relations in Psychoanalytic Theory, co-authored with Jay Greenberg, set the stage for this current integration by providing a broad comparative analysis of important thinking on the nature of human relationships. In that classic study Greenberg and Mitchell distinguished between two basic paradigms: the drive model, in which relations with others are generated and shaped by the need for drive gratifications, and various relational models, in which relations themselves are taken as primary and irreducible. In Relational Concepts in Psychoanalysis, Mitchell argues that the drive model has since outlived its usefulness. The relational model, on the other hand, has been developed piecemeal by different authors who rarely acknowledge and explore the commonality of their assumptions or the rich complementarity of their perspectives.
In this bold effort at integrative theorizing, Mitchell draws together major lines of relational-model traditions into a unified framework for psychoanalytic thought, more economical than the anachronistic drive model and more inclusive than any of the singular relational approaches to the core significance of sexuality, the impact of early experience, the relation of the past to the present, the interpenetration of illusion and actuality, the centrality of the will, the repetition of painful experience, the nature of analytic situation, and the process of analytic change. As such, his book will be required reading for psychoanalytic scholars, practitioners, candidates in psychoanalysis, and students in the field.
Sasaks, a people of the Indonesian archipelago, cope with one of the country's worst health records by employing various medical traditions, including their own secret ethnomedical knowledge. But anxiety, in the presence and absence of illness, profoundly shapes the ways Sasaks use healing and knowledge. Hay addresses complex questions regarding cultural models, agency, and other relationships to conclude that the ethnomedical knowledge they use to cope with their illnesses ironically inhibits improvements in their health care.
M. Cameron Hay is a NSF Advance Fellow and an Assistant Adjunct Professor at the UCLA Center for Culture and Health.
Contemporary health care often lacks generosity of spirit, even when treatment is most efficient. Too many patients are left unhappy with how they are treated, and too many medical professionals feel estranged from the calling that drew them to medicine. Arthur W. Frank tells the stories of ill people, doctors, and nurses who are restoring generosity to medicine—generosity toward others and to themselves.
The Renewal of Generosity evokes medicine as the face-to-face encounter that comes before and after diagnostics, pharmaceuticals, and surgeries. Frank calls upon the Roman emperor Marcus Aurelius, philosopher Emmanuel Levinas, and literary critic Mikhail Bakhtin to reflect on stories of ill people, doctors, and nurses who transform demoralized medicine into caring relationships. He presents their stories as a source of consolation for both ill and professional alike and as an impetus to changing medical systems. Frank shows how generosity is being renewed through dialogue that is more than the exchange of information. Dialogue is an ethic and an ideal for people on both sides of the medical encounter who want to offer more to those they meet and who want their own lives enriched in the process.
The Renewal of Generosity views illness and medical work with grace and compassion, making an invaluable contribution to expanding our vision of suffering and healing.
In Replacement Parts, internationally recognized bioethicist Arthur L. Caplan and coeditors James J. McCartney and Daniel P. Reid assemble seminal writings from medicine, philosophy, economics, and religion that address the ethical challenges raised by organ transplantation. Caplan's new lead essay explains the shortfalls of present policies. From there, book sections take an interdisciplinary approach to fundamental issues like the determination of death and the dead donor rule; the divisive case of using anencephalic infants as organ donors; the sale of cadaveric or live organs; possible strategies for increasing the number of available organs, including market solutions and the idea of presumed consent; and questions surrounding transplant tourism and "gaming the system" by using the media to gain access to organs.
Timely and balanced, Replacement Parts is a first-of-its-kind collection aimed at surgeons, physicians, nurses, and other professionals involved in this essential lifesaving activity that is often fraught with ethical controversy.
The Republic of Therapy tells the story of the global response to the HIV epidemic from the perspective of community organizers, activists, and people living with HIV in West Africa. Drawing on his experiences as a physician and anthropologist in Burkina Faso and Côte d’Ivoire, Vinh-Kim Nguyen focuses on the period between 1994, when effective antiretroviral treatments for HIV were discovered, and 2000, when the global health community acknowledged a right to treatment, making the drugs more available. During the intervening years, when antiretrovirals were scarce in Africa, triage decisions were made determining who would receive lifesaving treatment. Nguyen explains how those decisions altered social relations in West Africa. In 1994, anxious to “break the silence” and “put a face to the epidemic,” international agencies unwittingly created a market in which stories about being HIV positive could be bartered for access to limited medical resources. Being able to talk about oneself became a matter of life or death. Tracing the cultural and political logic of triage back to colonial classification systems, Nguyen shows how it persists in contemporary attempts to design, fund, and implement mass treatment programs in the developing world. He argues that as an enactment of decisions about who may live, triage constitutes a partial, mobile form of sovereignty: what might be called therapeutic sovereignty.
How are human subjects treated in biomedical research? What are the expressed standards and self-reported behavior of biomedical researchers in regard to what has sometimes been called their "animal of necessity"? What are some of the determinants of the "strict" and "permissive" patterns which describe the standards and behavior of biomedical researchers? These are the important questions asked and answered in Research on Human Subjects. It is a book based on four years of intensive research. Two studies were completed, one on a nationally representative sample of biomedical research institutions, a second on a sample of 350 researchers who actually use human subjects. In their chapters on "the dilemma of science and therapy," the authors look at the tension between the values of humane therapy and discovery in science. They show that the significant minority of researchers who are "permissive" on the issues of informed consent and a favorable risk-benefit ratio are more likely to be those who are "relative failures" in pursuing the science value. Research on Human Subjects also documents the inadequate training that biomedical researchers get in the ethics of research on human subjects not only in medical schools but in their postgraduate training as well. The medical schools pay relatively more attention to the scientific training of their students than they do to the ethical training that should be its essential complement. The local peer review groups that screen research on human subjects in the institutions where it is carried on are another central focus of attention of the research and analysis reported in this book. The peer review groups do a fairly good job but, the authors show, there are various conditions of their relative efficacy which are not met by review groups in many important research institutions. The medical school review groups, for example, have not been outstanding performers with respect to the several conditions of relative efficacy. In the concluding chapter, the authors discuss the general problem of the social responsibilities of powerful professions and make very specific suggestions for policy change and reform for the biomedical research profession and its use of human subjects.
A North Carolina woman dies of a flesh-eating bacterial disease. Thousands of people in West Africa are suffering from cholera. And antibiotics are rapidly becoming less and less effective at fighting what were once mild infections. The biggest threat to the future of human society may not be terrorist attacks or nuclear war, but rather microscopic bacteria. Immunologist Norbert Gualde explains in Resistance the dangers we face from bacterial resistance, asserting that we must confront the reality awaiting us--the next fatal plague may occur sooner than we think.
Over the course of the twentieth century, incredible advances in medicine inspired a utopian belief among many that all common infectious diseases would eventually be eradicated. But Resistance shows that this dream is an impossible one. The book’s riveting narrative reveals how new infectious agents and diseases are being discovered every day and how bacteria previously thought to have been destroyed are returning with a vengeance. Drawing upon the history of past epidemics, Gualde explores how new outbreaks might be predicted and controlled. He also investigates the potentially devastating social and political impact of such public health disasters, particularly in underdeveloped countries in the southern hemisphere. He ultimately argues that the constant interaction between man and microorganisms will inevitably catalyze future epidemics similar to the horrific ones of centuries past.
Global outbreak monitoring and medical research on the human body’s immune system are beginning to produce effective strategies against bacterial resistance. But the most important weapon is awareness of the crisis, and this engrossing and brilliantly translated study will serve as a wake-up call for us all.
Respecting Patient Autonomy
Benjamin H. Levi University of Illinois Press, 1999 Library of Congress R727.42.L48 1999 | Dewey Decimal 610.696
Against a backdrop of real clinical situations, Benjamin H. Levi examines the dynamics that shape relations between patient and health care provider, addressing fundamental questions about how medical decisions should be reached and compelling the reader to think about health care issues and decisions in terms of the values and goals they promote.
Presenting bioethics as a practical, educational activity rather than an abstract intellectual exercise, this important volume shows how dialogue between patients and health care providers can clarify both medical and ethical issues, promoting patient autonomy and advancing health care.
Tracing the Sudden Infant Death Syndrome (SIDS) diagnosis from its mid-century origins through the late 1900s, Rest Uneasy investigates the processes by which SIDS became both a discrete medical enigma and a source of social anxiety construed differently over time and according to varying perspectives. American medicine reinterpreted and reconceived of the problem of sudden infant death multiple times over the course of the twentieth century. Its various approaches linked sudden infant deaths to all kinds of different causes—biological, anatomical, environmental, and social. In the context of a nation increasingly skeptical, yet increasingly expectant, of medicine, Americans struggled to cope with the paradoxes of sudden infant death; they worked to admit their powerlessness to prevent SIDS even while they tried to overcome it. Brittany Cowgill chronicles and assesses Americans’ fraught but consequential efforts to explain and conquer SIDS, illuminating how and why SIDS has continued to cast a shadow over doctors and parents.
Burn out. Two words that haunt those in high stress jobs, especially in the medical profession. Long hours and the literal life-and-death nature of the field creates expectations to not only be on call at all hours, but to be at one’s best, even at 3:00 AM after a twenty-hour shift. So much energy is devoted to the care of others that self-care is forgotten.
Yet, more are noticing and research confirms that self-care is needed, not only for personal sanity but also for quality of work. Unwell medical professionals are not the best at treating others. And this self-care includes not just rest, food, and water, but a deeper care, one that tends the spiritual side as well.
To both the spiritually active and the spiritually resistant, hospital chaplain William Dorman offers a guide to understand a more comprehensive, full-bodied self-care. Each chapter begins with case studies, concrete experiences that help unpack abstract concepts which bring much needed peace to stressed individuals. Dorman also structures each chapter to end with prayers and action steps, which offer more concrete ways to care for the self.
From working as a hospital chaplain for over 18 years, and serving as the director of chaplaincy services for the largest integrated health care system in New Mexico, Rev. Dorman recognizes the stresses that come to those who have made it their profession to heal others. Healers need healing too—and this guide is the first step.
States are increasingly important players in the current efforts to reform U.S. health care, as the federal government withdraws from this responsibility. Robert B. Hackey analyzes the varied routes states have taken in reformulating health care policy and provides a road map of what specific strategies work and why.
In this comparative case study, Hackey focuses on four states—Massachusetts, New Hampshire, New York and Rhode Island—that have had markedly different experiences with regulating health care over the past two decades. Hackey's detailed comparisons show how the states' policies changed over time, moving from regulatory to market-oriented solutions, and examines which policy programs appear best poised to meet the future.
Hackey uses regime theory to explain how the states' policy choices concerning cost control and entry regulation were shaped by the prevailing political culture and institution of each state. He concludes that the autonomy of state government form special interests is vital to the successful adoption, implementation and outcome of state initiatives.
Rethinking Health Care Policy offers policymakers, planners and specialists useful insights into the politics of state regulation and into future directions for health care reform.
One March morning, writer Floyd Skloot was inexplicably struck by an attack of unrelenting vertigo that ended 138 days later as suddenly as it had begun. With body and world askew, everything familiar had transformed. Nothing was ever still. Revertigo is Skloot’s account of that unceasingly vertiginous period, told in an inspired and appropriately off-kilter form.
This intimate memoir—tenuous, shifting, sometimes humorous—demonstrates Skloot’s considerable literary skill honed as an award-winning essayist, memoirist, novelist, and poet. His recollections of a strange, spinning world prompt further musings on the forces of uncertainty, change, and displacement that have shaped him from childhood to late middle age, repeatedly knocking him awry, realigning his hopes and plans, even his perceptions. From the volatile forces of his mercurial, shape-shifting early years to his obsession with reading, acting, and writing, from the attack of vertigo to a trio of postvertigo (but nevertheless dizzying) journeys to Spain and England, and even to a place known only in his mother’s unhinged fantasies, Skloot makes sense of a life’s phantasmagoric unpredictability.
Finalist, Sarah Winnemucca Award for Creative Nonfiction, Oregon Book Awards
Revolutionizing Women’s Healthcare is the story of a feminist experiment: the self-help movement. This movement arose out of women’s frustration, anger, and fear for their health. Tired of visiting doctors who saw them as silly little girls, suffering shame when they asked for birth control, seeking abortions in back alleys, and holding little control over their own reproductive lives, women took action. Feminists created “self-help groups” where they examined each other’s bodies and read medical literature. They founded and ran clinics, wrote books, made movies, undertook nationwide tours, and raided and picketed offending medical institutions. Some performed their own abortions. Others swore off pharmaceuticals during menopause. Lesbian women found “at home” ways to get pregnant. Black women used self-help to talk about how systemic racism affected their health. Hannah Dudley-Shotwell engagingly chronicles these stories and more to showcase the creative ways women came together to do for themselves what the mainstream healthcare system refused to do.
2016 CCCC Best Book Award in Technical and Scientific Communication
In the past ten years, we have seen great changes in the ways government organizations and media respond to and report on emerging global epidemics. The first outbreak to garner such attention was SARS (severe acute respiratory syndrome). In Rhetoric of a Global Epidemic, Huiling Ding uses SARS to explore how various cultures and communities made sense of the epidemic and communicated about it. She also investigates the way knowledge production and legitimation operate in global epidemics, the roles that professionals and professional communicators, as well as individual citizens, play in the communication process, points of contention within these processes, and possible entry points for ethical and civic intervention.
Focusing on the rhetorical interactions among the World Health Organization, the United States, China, and Canada, Rhetoric of a Global Epidemic investigates official communication and community grassroots risk tactics employed during the SARS outbreak. It consists of four historical cases, which examine the transcultural risk communication about SARS in different geopolitical regions at different stages. The first two cases deal with risk communication practices at the early stage of the SARS epidemic when it originated in southern China. The last two cases move to transcultural rhetorical networks surrounding SARS.
With such threats as SARS, avian flu, and swine flu capturing the public imagination and prompting transnational public health preparedness efforts, the need for a rhetoric of global epidemics has never been greater. Government leaders, public health officials, health care professionals, journalists, and activists can learn how to more effectively craft and manage transcultural risk communication from Ding’s examination of the complex and varied modes of communication around SARS. In addition to offering a detailed case study, Rhetoric of a Global Epidemic provides a critical methodology that professional communicators can use in their investigations of epidemics and details approaches to facilitating more open, participatory risk communication at all levels.
Rheumatic Fever in America and Britain is the first book to examine comprehensively a disease that has been a moving target for physicians and health care workers. A disease of skin, brain, heart, connective tissue, blood, tonsils, and joints bound to a member of the streptococcus family of bacteria, this illness has practically disappeared from the present-day scene. Yet in 1940 more than one million Americans suffered from the heart disease that followed the ravages of rheumatic fever. It struck nearly 2 percent of all school-aged children, filling hospitals, convalescent homes, and special schools.
Rheumatic fever rose in prevalence throughout the nineteenth century, reaching its peak in that century's last decades, and then steadily declined-both in occurrence and severity-throughout the twentieth century. In the nineteenth century, acute rheumatic fever was largely a disease of children and young adults. Another remarkable epidemiological change occurred during the twentieth century; rheumatic fever shifted its character, became milder, and in doing so allowed its victims to live longer, if disabled lives. As this disease so altered, adults increasingly became its victims.
Dr. Peter C. English explores both the shifting biological nature of this disease and the experiences of physicians and patients who fought its ravages. Using insights from biology, epidemiology, and social history, Dr. English-both a physician and medical historian-is uniquely suited to unravel this disease's epidemiological and cultural complexities.
Anderson provides the context from which Selzer’s writing grows and a concept of language adequate to his purposes and accomplishments. He takes a careful look at Selzer’s writing to demonstrate that these abstract considerations do tell us why a surgeon would write. The works Anderson examines are "Jonah and the Whale" (an important early short story) and the first three essays in Mortal Lessons. These examples show the reader exactly how the symbols of literature interact directly with the world and the everyday communications of both writer and reader. According to Anderson, Mortal Lessons is also Selzer’s most artistic statement of his own sense of why and how he became a writer.
Selzer’s books include Rituals of Surgery, Mortal Lessons, Confessions of a Knife, Letters to a Young Doctor, and Taking the World in for Repairs.
More than ten million children suffer from severe acute malnutrition globally each year. In Uganda, longstanding efforts to understand, treat, and then prevent the condition initially served to medicalize it, in the eyes of both biomedical personnel and Ugandans who brought their children to the hospital for treatment and care. Medicalization meant malnutrition came to be seen as a disease—as a medical emergency—not a preventable condition, further compromising nutritional health in Uganda.
Rather than rely on a foreign-led model, physicians in Uganda responded to this failure by developing a novel public health program known as Mwanamugimu. The new approach prioritized local expertise and empowering Ugandan women, blending biomedical knowledge with African sensibilities and cultural competencies.
In The Riddle of Malnutrition, Jennifer Tappan examines how over the course of half a century Mwanamugimu tackled the most fatal form of childhood malnutrition—kwashiorkor—and promoted nutritional health in the midst of postcolonial violence, political upheaval, and neoliberal resource constraints. She draws on a diverse array of sources to illuminate the interplay between colonialism, the production of scientific knowledge, and the delivery of health services in contemporary Africa.
There are few issues more divisive than what has become known as “the right to die.” One camp upholds “death with dignity,” regarding the terminally ill as autonomous beings capable of forming their own judgment on the timing and process of dying. The other camp advocates “sanctity of life,” regarding life as intrinsically valuable, and that should be sustained as long as possible. Is there a right answer?
Raphael Cohen-Almagor takes a balanced approach in analyzing this emotionally charged debate, viewing the dispute from public policy and international perspectives. He offers an interdisciplinary, compelling study in medicine, law, religion, and ethics. It is a comprehensive look at the troubling question of whether physician-assisted suicide should be allowed. Cohen-Almagor delineates a distinction between active and passive euthanasia and discusses legal measures that have been invoked in the United States and abroad. He outlines reasons non-blood relatives should be given a role in deciding a patient’s last wishes. As he examines euthanasia policies in the Netherlands and the 1994 Oregon Death with Dignity Act, the author suggests amendments and finally makes a circumscribed plea for voluntary physician-assisted suicide.
Nineteenth-century America saw numerous campaigns against masturbation, which was said to cause illness, insanity, and even death. Riotous Flesh explores women’s leadership of those movements, with a specific focus on their rhetorical, social, and political effects, showing how a desire to transform the politics of sex created unexpected alliances between groups that otherwise had very different goals.
As April R. Haynes shows, the crusade against female masturbation was rooted in a generally shared agreement on some major points: that girls and women were as susceptible to masturbation as boys and men; that “self-abuse” was rooted in a lack of sexual information; and that sex education could empower women and girls to master their own bodies. Yet the groups who made this education their goal ranged widely, from “ultra” utopians and nascent feminists to black abolitionists. Riotous Flesh explains how and why diverse women came together to popularize, then institutionalize, the condemnation of masturbation, well before the advent of sexology or the professionalization of medicine.
Geertje Boschma's complex study examines issues from the rise of scientific psychiatry and the emergence of mental health nursing to the social relationships of class, gender, and religion that structured asylum care in the Netherlands around 1900. Drawing on the archival collections of four Dutch asylums, Boschma highlights the gendered nature of mental health nursing politics, and captures the contradictory realities of hospital-oriented asylum care, both illustrating the social complexity of the care of the mentally ill and offering an important addition to the history of European psychiatry.
Will ever-more sensitive screening tests for cancer lead to longer, better lives? Will anticipating and trying to prevent the future complications of chronic disease lead to better health? Not always, says Robert Aronowitz in Risky Medicine. In fact, it often is hurting us.
Exploring the transformation of health care over the last several decades that has led doctors to become more attentive to treating risk than treating symptoms or curing disease, Aronowitz shows how many aspects of the health system and clinical practice are now aimed at risk reduction and risk control. He argues that this transformation has been driven in part by the pharmaceutical industry, which benefits by promoting its products to the larger percentage of the population at risk for a particular illness, rather than the smaller percentage who are actually affected by it. Meanwhile, for those suffering from chronic illness, the experience of risk and disease has been conflated by medical practitioners who focus on anticipatory treatment as much if not more than on relieving suffering caused by disease. Drawing on such controversial examples as HPV vaccines, cancer screening programs, and the cancer survivorship movement, Aronowitz argues that patients and their doctors have come to believe, perilously, that far too many medical interventions are worthwhile because they promise to control our fears and reduce uncertainty.
Risky Medicine is a timely call for a skeptical response to medicine’s obsession with risk, as well as for higher standards of evidence for risk-reducing interventions and a rebalancing of health care to restore an emphasis on the actual curing of and caring for people suffering from disease.
Risky Rhetoric: AIDS and the Cultural Practices of HIV Testing is the first book-length study of the rhetoric inherent in and surrounding HIV testing. In addition to providing a history of HIV testing in the United States from 1985 to the present, J. Blake Scott explains how faulty arguments about testing’s power and effects have promoted unresponsive and even dangerous testing practices for so-called healthy subjects as well as those deemed risky. A new afterword to the paperback edition discusses changes in testing technology, treatments, and public health responses in the last ten years. The ultimate goal of Risky Rhetoric is to offer strategies to policy makers, HIV educators and test counselors, and other rhetors for developing more responsive and egalitarian testing-related rhetorics and practices.
At the center of the debate over complementary and alternative medicine—from acupuncture and chiropractic treatments to homeopathy and nutritional supplements—is how to scientifically measure the effectiveness of a particular treatment. Fourteen scholars from the fields of medicine, philosophy, sociology, and cultural and folklore studies examine that debate, and the clash between growing public support and the often hostile stance of clinicians and medical researchers.
Proponents and critics have different methodologies and standards of evidence—raising the question of how much pluralism is acceptable in a medical context—particularly in light of differing worldviews and the struggle to define medicine in the modern world. The contributors address both the methodological problems of assessment and the conflicting cultural perspectives at work in a patient's choice of treatment. Sympathetic to CAM, the contributors nonetheless offer careful critiques of its claims, and suggest a variety of ways it can be taken seriously, yet subject to careful scrutiny.
The 1990s marked a new era in family formation. Increased access to donor sperm enabled single women and lesbian couples to create their families on their own terms, outside the bounds of heterosexual married relationships. However, emerging “alternative” families were not without social and political controversy. Women who chose to have children without male partners faced many challenges in their quest to have children. Despite current wider social acceptance of single people and same sex couples becoming parents, many of these challenges continue.
In Romancing the Sperm, Diane Tober explores the intersections between sperm donation and the broader social and political environment in which “modern families” are created and regulated. Through tangible and intimate stories, this book provides a captivating read for anyone interested in family and kinship, genetics and eugenics, and how ever-expanding assisted reproductive technologies continue to redefine what it means to be human.
Edgar Allan Poe vividly recalls standing in a prison cell, fearing for his life, as he watched men mutilate and dismember the body of his mother. That memory, however graphic and horrifying, was not real. It was a hallucination, one of many suffered by the writer, caused by his addiction to alcohol.
In Rum Maniacs, Matthew Warner Osborn reveals how and why pathological drinking became a subject of medical interest, social controversy, and lurid fascination in the early American republic. At the heart of that story is the disease that Poe suffered: delirium tremens. First described in 1813, delirium tremens and its characteristic hallucinations inspired sweeping changes in how the medical profession saw and treated the problems of alcohol abuse. Based on new theories of pathological anatomy, human physiology, and mental illness, the new diagnosis founded the medical conviction and popular belief that habitual drinking could become a psychological and physiological disease. By midcentury, delirium tremens had inspired a wide range of popular theater, poetry, fiction, and illustration. This romantic fascination endured into the twentieth century, most notably in the classic Disney cartoon Dumbo, in which a pink pachyderm marching band haunts a drunken young elephant. Rum Maniacs reveals just how delirium tremens shaped the modern experience of alcohol addiction as a psychic struggle with inner demons.