Traumatic Amputation: A Case of Laotian Indignation and Injustice

Culture is an essential variable of diagnosis and treatment. A cultural perspective draws attention to the social context within which symptoms arise, are given meaning, and are managed. Ethno-cultural work on illness narratives suggests that most people can provide culturally-based explanations for their symptoms. While these explanations are inconsistent with biomedical theory, they relieve patient distress by allowing the patient to create meaning for symptoms. Exploring the characteristics, context, and antecedents of the symptoms enables the patient to convey them to the clinician who may have a divergent explanation of sickness. This case study uses the Outline for Cultural Formulation of the DSM-IV created for clinicians to elicit a narrative account of the illness experience from the patient. Our study examines how the patient, a Laotian used social indignation (“Kwam khem keuang”) as an explanatory model for his ailment. He was diagnosed with post-traumatic stress disorder after having undergone a traumatic amputation. In the process of explaining his illness through a cultural idiom, the patient was able to reveal both personal and collective meaning of repressed anger and frustration, expressing them in a context that was acceptable to him. This cultural idiom allowed the patient to reflect upon the structure of the health care system and the specific context in which symptoms and their possible origins are recounted and explored. It also clarified to the treating clinicians some categories of experience and causal explanations that did not fit easily with western biomedical and psychiatric understanding. The case study illustrates how a cultural approach to illness from the patient’s perspective offers a reflexive stance on the clinician–patient interaction that allows for better patient care.     

“WE CAME TO TALK WITH THE PEOPLE BEHIND THE DISEASE:” COMMUNICATION AND CONTROL IN MEDICAL EDUCATION

To explore the ways in which biomedical culture responds to the new curricular addition of communication skills training, we observed activities related to the communication skills training of a class of 70 first-year medical students in an Israeli medical school during 2002–3. In addition, focus groups were conducted with medical students (n = 210) during 1998–2001. A gap was found between the rhetoric of “patient-centered communication” and “empathy” and the traditional concerns of medical authority, efficiency, and scientism. Communication skills and empathy training were appropriated into medical socialization by being reconstructed as clinical competence. Findings are further discussed in the context of medical professionalism, Israeli culture, service acting and service roles, and organizational learning.     

En-case-ing the Patient: Disciplining Uncertainty in Medical Student Patient Presentations

The problem-oriented medical record is the widespread, standardized format for presenting and recording information about patients, which is taught to future physicians early in their medical training. Based on our participant observation of medical training, we analyze the ways in which the patient presentation operates in medical training as a disciplinary technology that manages uncertainty in the clinical decision-making process. We uncover various mechanisms at work including the construction of a coherent narrative structure in which chaotic experiences are re-organized and re-interpreted to fit neatly in a linear plot with a predictable ending, the atomization of the patient as a whole into separable “problems,” the attempt to solve these “problems” as though they are independent of one another, and the mystification of translations in scale, which give rise to much of the uncertainty in medicine. Operating at the boundary of the chaotic and often ungraspable world of the suffering experience of the patient and the highly structured realm of the medical record, a patient presentation is one medium through which both a disciplined record of experience and disciplined medical practitioners are produced. This process functions to transform the human subject patient into a recognizable, generic clinical case, and the medical student into an identifiable, professional future physician.     

Problems with the current deinococcal hypothesis: an alternative theory

All theories related to the evolution of Deinococcus radiodurans have a common denominator: the strong positive correlation between ionizing-radiation resistance and desiccation tolerance. Currently, the widespread hypothesis is that D. radiodurans’ ionizing-radiation resistance is a consequence of this organism’s adaptation to desiccation (desiccation adaptation hypothesis). Here, we draw attention to major discrepancy that has emerged between the “desiccation adaptation hypothesis” and recent findings in computational biology, experimental research, and terrestrial subsurface surveys. We explain why the alternative hypothesis, suggesting that D. radiodurans’ desiccation tolerance could be a consequence of this organism’s adaptation to ionizing radiation (radiation adaptation hypothesis), should be considered on equal basis with the “desiccation adaptation hypothesis”.     

“Not <Emphasis Type="Italic">Here</Emphasis>”: Making the Spaces and Subjects of “Global Health” in Botswana

This essay argues that what makes “global health” “global” has more to do with configurations of space and time, and the claims to expertise and moral stances these configurations make possible, than with the geographical distribution of medical experts or the universal, if also uneven, distribution of threats to health. Drawing on a study of public–private partnerships supporting Botswana’s HIV/AIDS treatment program, this essay demonstrates ethnographically the processes by which “global health” and its quintessential spaces, namely “resource-limited” or “resource-poor settings,” are constituted, reinforced, and contested in the context of medical education and medical practice in Botswana’s largest hospital. Using Silverstein’s work on orders of indexicality, I argue that the terms of “global health” are best understood as chronotopic, and demonstrate how actors orient themselves and others spatio-temporally, morally, and professionally by using or refuting those terms. I conclude by arguing that taking “global health” on its own terms obscures the powerful forces by which it becomes intelligible. At stake are the frames within which medical anthropologists understand their objects of study, as well as the potential for the spaces of “global health” intervention to expand ever outward as American medical personnel attempt to calibrate their experiences to their expectations.     

THE NEW PARADIGM OF RECOVERY FROM SCHIZOPHRENIA: CULTURAL CONUNDRUMS OF IMPROVEMENT WITHOUT CURE

This article is a qualitative investigation of the subjective experience of recovery from the perspective of persons living with schizophrenia-related disorders. An NIMH-sponsored ethnographic study of community outpatient clinics was completed for 90 persons taking second-generation antipsychotic medications. Research diagnostic criteria and clinical ratings were obtained in tandem with an anthropologically developed Subjective Experience of Medication Interview (SEMI) that elicits narrative data on everyday life and activities, medication and treatment, management of symptoms, expectations concerning recovery, and stigma. Ethnographic observations from diverse settings (clinics, public transportation, restaurants, homes) were also obtained. The primary findings are that recovery was experienced in relation to low levels of symptoms, the need to take medications to avoid hospitalization or psychotic episodes, and personal agency to struggle against the effects of illness. The majority of participants articulated their sense of illness recovery and expectation that their lives would improve. Improvement and recovery is an incremental, yet definitively discernable subjective process. Several problems were identified as part of this process surrounding cultural conflicts that generate the experience of ambivalence analyzed here as the “paradox of recovery without cure,” irreconcilable “catch-22” dilemmas involving sacrifice (e.g., one must be “fat” or be “crazy”), and substantial stigma despite improvement in illness and everyday life experience.     

“Camel nanoantibody” is an efficient tool for research,diagnostics and therapy

This short review provides an introduction to the rapidly developing field of generation and utilization of “camel nanoantibodies” (or “nanobodies”). The term “nanoantibody” or “nanobody” was given to single-domain variable fragments of special type of antibodies that naturally exist (in addition to classical types of antibodies) in blood of Camelidae family animals and in some chondrichthyan fishes. The existence of very efficient technology of nanobody generation and some very useful characteristic features promise a big potential for their use in immunobiotechnology and medicine.     

I/We Narratives Among African American Families Raising Children with Special Needs

This paper examines a statistics debate among African American caregivers raising children with disabilities for insights into the work of “African American mothering.” Using ethnographic, narrative and discourse analyses, we delineate the work that African American mothers do—in and beyond this conversation—to cross ideological and epistemological boundaries around race and disability. Their work entails choosing to be an “I” and, in some cases, actively resisting being seen as a “they” and/or part of a collective “we” in order to chart alternative futures for themselves and their children.     

“Good Mothering” or “Good Citizenship”? Conflicting Values in Choosing Whether to Donate or Store Umbilical Cord Blood

Umbilical cord blood banking is one of many biomedical innovations that confront pregnant women with new choices about what they should do to secure their own and their child’s best interests. Many mothers can now choose to donate their baby’s umbilical cord blood (UCB) to a public cord blood bank or pay to store it in a private cord blood bank. Donation to a public bank is widely regarded as an altruistic act of civic responsibility. Paying to store UCB may be regarded as a “unique opportunity” to provide “insurance” for the child’s future. This paper reports findings from a survey of Australian women that investigated the decision to either donate or store UCB. We conclude that mothers are faced with competing discourses that force them to choose between being a “good mother” and fulfilling their role as a “good citizen.” We discuss this finding with reference to the concept of value pluralism.     

Anorexia: A “losing” strategy?

Several theorists have tried to model anorexia on Wasser and Barash’s (1983) “reproductive suppression model” (RSM). According to the RSM, individual females adaptively suppress their reproductive functioning under conditions of social or physiological stress. From this perspective, mild anorexia is viewed as an adaptive response to modern conditions; more severe anorexia is viewed as an adaptation gone awry. Previous models have not, however, examined the full richness of the RSM. Specifically, Wasser and Barash documented not only self-imposed reproductive suppression, but also manipulative reproductive suppression of subordinate females by dominants. I propose that the modern “epidemic” of anorexia is explained neither by adaptive self-suppression nor by environmental mismatch (an adaptation gone awry); I propose that the “epidemic” levels of anorexia seen in modern western society are a direct consequence of intrasexual competition, the scope of which has been enhanced by the power and reach of modern communications media. According to this perspective, anorexia, even in its mild forms, is a manipulative strategy imposed on subordinates by dominants. Anorexia is, in both senses, a “losing” strategy. Linda Mealey developed the intrasexual manipulation model of anorexia while on a three-year stint in the psychology department of the University of Queensland; she is currently at the College of St. Benedict in central Minnesota, where she is associate professor of psychology. She is President of the International Society for Human Ethology, a councilor of the Human Behavior and Evolution Society, on the editorial board of Politics and the Life Sciences, and chair of the 1999 and 2000 Aaron Beck New Investigator Award Committee (sponsored by ASCAP: Across Species Comparisons and Psychiatry).     

Sacred Conceptions: Clinical Theodicies, Uncertain Science, And Technologies Of Procreation In India

This article argues that the rapid transfer of assisted conception technologies, such as in vitro fertilization, to India is not restricted merely to the modalities of offering potential biomedical resolution of infertility but includes, more crucially, how clinicians and infertile consumers assimilate the “Western technoscience” of conception. The article draws on a larger multisite ethnographic study of infertility and assisted conception in India’s five major cities and is principally based on narratives of clinicians and infertile couples and on clinic-based ethnographic observations. In this article I contend that the success or failure of assisted conception, when situated in the universe of Hindu faith, becomes a powerful critique of the “incompleteness” of the “Western” science of conception. Situating this contention in the broader context of a clinician’s faith, I assert that assisted conception—by conjoining seemingly disparate domains of the traditional and the modern, the sacred and the profane, the human and the superhuman, science and religion—produces clinical theodicies that help explain and contain the tentativeness permeating the conception technologies. The article concludes by arguing that this enchanted version of a thoroughly disenchanted worldview of biomedicine is part of a larger cultural process of indigenization of biomedicine in India.     

Negotiating A Path To Efficacy At A Clinic Of Traditional Chinese Medicine

Chinese medicine emphasizes the underlying connection of the bodily, emotional, social, and environmental dimensions in illness experience and healing. The therapeutic process, characterized as tiao (attuning, balancing), targets the patient’s overall illness condition and experience including both physical and nonphysical aspects of suffering. This study, incorporating techniques of microanalysis as an ethnographic tool and using an actual recorded clinical interaction as data, analyzes how the path to effective healing is negotiated among multiple clinical realities at a clinic of Chinese medicine in Beijing. A close examination of interactive features of actual face-to-face communication between a doctor and a patient in a specific case of “stagnation of emotions” reveals that, for an illness recognized in Chinese medicine as originating from disordered emotions, adjustment of the patient’s perceptions of reality and social relations is particularly salient in the “attuning” process. Efficacy then should be understood as more than physiological changes produced by herbs, but also as emergent through an interactive event of clinical encounters. This study demonstrates empirically how the clinical process of Chinese medicine works to define and transform the patient’s emotions and experience.     

The Futility of Futility: Death Causation is the ��Elephant in the Room�� in Discussions about Limitation of Medical Treatment

The term “futility” has been widely used in medical ethics and clinical medicine for more than twenty years now. At first glance it appears to offer a clear-cut categorical characterisation of medical treatments at the end of life, and an apparently objective way of making decisions that are seen to be emotionally painful for those close to the patient, and ethically, and also potentially legally hazardous for clinicians. It also appears to deal with causation, because omission of a futile treatment cannot surely be a cause of death. The problem is that futility can be argued to be a “false friend”, in that it gives an appearance of representing a reliable conceptual basis, in ethics, for limitation of medical treatment—usually in the context of dying—without actually doing so. In fact, the concept of futility is a conflation of clinical judgement about outcomes of treatment and the quality or even value of life, and has really failed to contribute much to the advancement of decision-making and hence care at the end-of-life. It also has the capacity to medicalise the personal space. Deliberations about the likely outcomes of medical treatment are necessary, and medical expertise is pivotal. However, futility is argued to have a better future in partnership with a broad social action agenda about the process of dying, such as that articulated in health promoting palliative care, as a basis for better “death-ways” in the 21st century (Kellehear 2005). Medicine needs to more honest and upfront about its limits, as death is, after all, the elephant in everybody's room.     

Source-sink landscape theory and its ecological significance

Exploring the relationships between landscape pattern and ecological processes is the key topic of landscape ecology, for which, a large number of indices as well as landscape pattern analysis model were developed. However, one problem faced by landscape ecologists is that it is hard to link the landscape indices with a specific ecological process. Linking landscape pattern and ecological processes has become a challenge for landscape ecologists. “Source” and “sink” are common concepts used in air pollution research, by which the movement direction and pattern of different pollutants in air can be clearly identified. In fact, for any ecological process, the research can be considered as a balance between the source and the sink in space. Thus, the concepts of “source” and “sink” could be implemented to the research of landscape pattern and ecological processes. In this paper, a theory of sourcesink landscape was proposed, which include: (1) In the research of landscape pattern and ecological process, all landscape types can be divided into two groups, “source” landscape and “sink” landscape. “Source” landscape contributes positively to the ecological process, while “sink” landscape is unhelpful to the ecological process. (2) Both landscapes are recognized with regard to the specific ecological process. “Source” landscape in a target ecological process may change into a “sink” landscape as in another ecological process. Therefore, the ecological process should be determined before “source” or “sink” landscape were defined. (3) The key point to distinguish “source” landscape from “sink” landscape is to quantify the effect of landscape on ecological process. The positive effect is made by “source” landscape, and the negative effect by “sink” landscape. (4) For the same ecological process, the contribution of “source” landscapes may vary, and it is the same to the “sink” landscapes. It is required to determine the weight of each landscape type on ecological processes. (5) The sourcesink principle can be applied to non-point source pollution control, biologic diversity protection, urban heat island effect mitigation, etc. However, the landscape evaluation models need to be calibrated respectively, because different ecological processes correspond with different source-sink landscapes and evaluation models for the different study areas. This theory is helpful to further study landscape pattern and ecological process, and offers a basis for new landscape index design. __________ Translated from Acta Ecologica Sinica, 2006, 26(5): 1444–1449 [译自: 生态学报]     

Contribution to the theory of random and biased nets

The probabilistic theory of random and biased nets is further developed by the “tracing” method treated previously. A number of biases expected to be operating in nets, particularly in sociograms, is described. Distribution of closed chain lengths is derived for random nets and for nets with a simple “reflexive” bias. The “island model” bias is treated for the case of two islands and a single axon tracing, resulting in a pair of linear difference equations with two indices. The reflexive bias is extended to multiple-axon tracing by an approximate method resulting in a modification of the random net recursion formula. Results previously obtained are compared with empirical findings and attempts are made to account for observed discrepancies.     

Defining Medical Futility and Improving Medical Care

It probably should not be surprising, in this time of soaring medical costs and proliferating technology, that an intense debate has arisen over the concept of medical futility. Should doctors be doing all the things they are doing? In particular, should they be attempting treatments that have little likelihood of achieving the goals of medicine? What are the goals of medicine? Can we agree when medical treatment fails to achieve such goals? What should the physician do and not do under such circumstances? Exploring these issues has forced us to revisit the doctor-patient relationship and the relationship of the medical profession to society in a most fundamental way. Medical futility has both a quantitative and qualitative component. I maintain that medical futility is the unacceptable likelihood of achieving an effect that the patient has the capacity to appreciate as a benefit. Both emphasized terms are important. A patient is neither a collection of organs nor merely an individual with desires. Rather, a patient (from the word “to suffer”) is a person who seeks the healing (meaning “to make whole”) powers of the physician. The relationship between the two is central to the healing process and the goals of medicine. Medicine today has the capacity to achieve a multitude of effects, raising and lowering blood pressure, speeding, slowing, and even removing and replacing the heart, to name but a minuscule few. But none of these effects is a benefit unless the patient has at the very least the capacity to appreciate it. Sadly, in the futility debate wherein some critics have failed or refused to define medical futility an important area of medicine has in large part been neglected, not only in treatment decisions at the bedside, but in public discussions—comfort care—the physician’s obligation to alleviate suffering, enhance well being and support the dignity of the patient in the last few days of life.     

On the Semio-Mathematical Nature of Codes

The relational structure of RNA, DNA, and protein bears an interesting similarity to the determination problem in category theory. In this paper, we present this deep-structure similarity and use it as a springboard for discussing some abstract properties of coding in various systems. These abstract properties, in turn, may shed light on the evolution of the DNA world from a semiotic perspective. According to the perspective adopted in this paper, living systems are not information processing systems but “meaning-making” systems. Therefore, what flows in the genetic system is not “information” but “value.” We define meaning, meaning-making, and value and then use these terms to explain the abstract dynamics of coding, which can illuminate many forms of sign-mediated activities in biosystems.