The clinician as ethnographer: A psychoanalytic perspective on the epistemology of fieldwork

Ethnography is a process yielding a particular kind of knowledge. From the psychoanalytic perspective this bears on the question: how may individual lives which report their own experience, but cannot directly apprehend the unconscious factors behind that experience, be related to social life which does not report itself but is observed and interpreted by others? The person of the ethnographer and ethnographer-informant relationships are considered in this respect. Clinicians' informants include people to whom they relate in the course of adaptation to the new community; those who are help-seeking (patients) with whom their relationship is both therapeutic and investigative; and clients in health-service (e.g., family planning) contexts who may be studied with tests and structured interviews. The clinician's status, role, helping and scientific values are examined as factors determining the nature of knowledge gained under these various circumstances. To the degree that the clinician is an intentional transformer, data emerge as the informant's consciousness changes in the therapeutic or research process. Research or therapy-aimed interventions based on psychoanalytic theory add their own epistemological problems to the process.     

Big Science vs. Little Science: How Scientific Impact Scales with Funding

Agencies that fund scientific research must choose: is it more effective to give large grants to a few elite researchers, or small grants to many researchers? Large grants would be more effective only if scientific impact increases as an accelerating function of grant size. Here, we examine the scientific impact of individual university-based researchers in three disciplines funded by the Natural Sciences and Engineering Research Council of Canada (NSERC). We considered four indices of scientific impact: numbers of articles published, numbers of citations to those articles, the most cited article, and the number of highly cited articles, each measured over a four-year period. We related these to the amount of NSERC funding received. Impact is positively, but only weakly, related to funding. Researchers who received additional funds from a second federal granting council, the Canadian Institutes for Health Research, were not more productive than those who received only NSERC funding. Impact was generally a decelerating function of funding. Impact per dollar was therefore lower for large grant-holders. This is inconsistent with the hypothesis that larger grants lead to larger discoveries. Further, the impact of researchers who received increases in funding did not predictably increase. We conclude that scientific impact (as reflected by publications) is only weakly limited by funding. We suggest that funding strategies that target diversity, rather than “excellence”, are likely to prove to be more productive.     

Exciting chaos with noise: unexpected dynamics in epidemic outbreaks

 In this paper, we identify a mechanism for chaos in the presence of noise. In a study of the SEIR model, which predicts epidemic outbreaks in childhood diseases, we show how chaotic dynamics can be attained by adding stochastic perturbations at parameters where chaos does not exist apriori. Data recordings of epidemics in childhood diseases are still argued as deterministic chaos. There also exists noise due to uncertainties in the contact parameters between those who are susceptible and those who are infected, as well as random fluctuations in the population. Although chaos has been found in deterministic models, it only occurs in parameter regions that require a very large population base or other large seasonal forcing. Our work identifies the mechanism whereby chaos can be induced by noise for realistic parameter regions of the deterministic model where it does not naturally occur. Received: 13 October 2000 / Revised version: 15 May 2001 / Published online: 7 December 2001     

The Asian Taenia and the possibility of cysticercosis

In certain Asian countries, a third form of human Taenia, also known as the Asian Taenia, has been discovered. This Asian Taenia seems to be an intermediate between Taenia solium and T. saginata since in morphological terms it is similar to T. saginata, yet biologically, as it uses the same intermediate host (pigs), it is more akin to T. solium. Taenia solium causes human cysticercosis, while T. saginata does not. It is not known whether the Asian taeniid is able to develop to the larval stage in humans or not. The arguments proposed by those authors who consider it unlikely that the Asian Taenia causes human cysticercosis are: (a) its molecular similarities with T. saginata; (b) the absence of cases of human cysticercosis in populations where the Asian adult is highly prevalent; and (c) the unsupporting results derived from an experimental infestation study. These three arguments are debated, although bearing in mind that at present there is still no clear scientific data to support that human cysticercosis can be caused by the Asian Taenia.     

Chance and serendipity in science: two examples from my own career

The usual scientific paper follows a rather narrowly (but not ever rigidly) defined pattern. Both the author and the journal like to see a linear logical presentation of a "story." Seldom does the paper give the reader the "backstory." Where did the idea come from in the first place? How many false leads led down blind alleys? What happened by chance and what by logical planning? Was there an element of serendipity involved? Perhaps as we enter the paperless era and do not have to count words quite so religiously, it may be possible to encourage a more freewheeling scientific paper, but for now, we have to rely on the historians of science and/or those who "tell all" about their own research. "Reflections" seems an appropriate space for the latter. I have chosen two scenarios from my own career in which happy accidents played important roles but, unhappily, received little recognition in my published papers.     

Anthropology and politics: The logic of their interrelationship

Conclusion The thesis of value neutrality is logically untenable and anthropologically naive. It is logically untenable because it does not attend to contextual (i.e. historical, sociological and political) meaning. It is anthropologically naive because it does not take into account that values are culturally mediated and historically situated, i.e. it assumes that values are the result of arbitrary choices. And, one must add, it is morally objectionable because it eliminates the notion of responsibility, though it pretends to defend it.Rather than attacking the thesis of value neutrality by following the more usual procedure of unmasking specific substantive theories, I have dismantled the logic of value neutrality itself by concentrating on the insurmountable formal contradictions of the fact-value dichotomy. In neglecting social, economic and cultural constraints, while stressing the freedom of the individual, the thesis of value neutrality emerges as liberal ideology. Whatever the liberating effect of decisionism may have been, it has de facto become the ideology of a scientific establishment which was conditioned to sell its services to the highest bidder. Decisionism has promoted a division of labor between those who determine the ends and those who supply the technical means without being concerned about their application . Thus it supports the status quo, and becomes a means of repression and exploitation .Decisionism is an inherent aspect of positivism . The subjectivity of ethics is the counterpart of the objectivity of science. Both are the result of a subjective idealism which takes the individual subject as point of departure. It is the individual subject who constructs his world on the basis of sensory impressions and his reason and who chooses his values. This implies not only the autonomy of ethics vis-à-vis science, but also an autonomy of facts vis-à-vis theory, and an autonomy of both science and ethics vis-à-vis history. This epistemological position is, therefore, elementaristic, individualistic and ahistorical.A radical alternative has to take as point of departure that cognition in its diverse manifestations (scientific and epistemological paradigms, logic, etc.) and value systems are interrelated historical products. It has to reject the compartmentalization of fact and value, fact and theory , subject and object, and it must place these relations in a truly dialectical perspective. Such a perspective does not provide us with unshakable moral and political precepts, but — since it does not take what is historically given for the eternally valid nor confound history with mere arbitrariness — it does point to the possibility and necessity of transformation and emancipation, i.e., the historically ly possible.Cornelis J.J. Vermeulen is Professor of Anthropology at the University of Amsterdam.

---

     

Evaluation and recommendations for greater accessibility of colour figures in ornithology

People who are colour‐blind or have some form of colour vision deficiency form an invisible minority and scientists should strive to be as inclusive as possible. We reviewed 2873 figures published in 2019 from 1031 scientific papers in 27 ornithological journals to determine those that were colour‐blind compatible, and those that were black‐and‐white printer friendly. About 26% of the published figures were in colour, and while most were colour‐blind compatible, only ~ 60% of them were black‐and‐white printer friendly. Ensuring figures in all forms of scientific communication can be interpreted by readers who are colour‐blind, and can be printed in black‐and‐white will improve the accessibility of ornithological research.     

On the scientific,medical, dental and educational value of collections of human skeletons

Having been approached from time to time by various museum, university and governmental authorities in Australia, California and Scotland, I have set down some brief notes on the scientific, medical, dental and educational importance and value of collections of recent human skeletons drawn from populations in all parts of the world. This article does not pretend to completeness. It has been set down in the hope that it may be of assistance to those officiers in charge of such collections and who may be pondering upon the worthwhileness of such collections being retained and maintained.     

Incommensurable Worldviews? Is Public Use of Complementary and Alternative Medicines Incompatible with Support for Science and Conventional Medicine?

Proponents of controversial Complementary and Alternative Medicines, such as homeopathy, argue that these treatments can be used with great effect in addition to, and sometimes instead of, ‘conventional’ medicine. In doing so, they accept the idea that the scientific approach to the evaluation of treatment does not undermine use of and support for some of the more controversial CAM treatments. For those adhering to the scientific canon, however, such efficacy claims lack the requisite evidential basis from randomised controlled trials. It is not clear, however, whether such opposition characterises the views of the general public. In this paper we use data from the 2009 Wellcome Monitor survey to investigate public use of and beliefs about the efficacy of a prominent and controversial CAM within the United Kingdom, homeopathy. We proceed by using Latent Class Analysis to assess whether it is possible to identify a sub-group of the population who are at ease in combining support for science and conventional medicine with use of CAM treatments, and belief in the efficacy of homeopathy. Our results suggest that over 40% of the British public maintain positive evaluations of both homeopathy and conventional medicine simultaneously. Explanatory analyses reveal that simultaneous support for a controversial CAM treatment and conventional medicine is, in part, explained by a lack of scientific knowledge as well as concerns about the regulation of medical research.     

Prognosis for infants with idiopathic respiratory distress syndrome.

Infants with the idiopathic respiratory distress syndrome admitted to the intensive care unit during January 1972 to September 1974 were reviewed. The overall mortality rate for infants whose birth weight was 1000 g or more was under 10%, and for those who established spontaneous respiration after birth it was less than 5%. The hyperoxia test was not a useful guide to prognosis. It was possible on the basis of the infants'' ability to establish spontaneous ventilation after birth to divide them into two groups. In those who established adequate ventilation the mortality rate was 4-5%; in those who did not it was 57%. This test should be generally applied, since not only does it give an immediate guide to the severity of the disease, which is better than that provided by birth weight, gestational age, or the hyperoxia test, but it may be applied to infants born in and outside a hospital providing neonatal intensive care. Improvement in the outlook for infants with a bad prognosis will be achieved only by improvements in perinatal care designed to minimize severe intrapartum asphyxia in infants of low birth weight.     

Relationships of desire for no more children and socioeconomic and demographic factors in Sri Lankan women.

Data from the 1982 Sri Lanka Contraceptive Prevalence Survey are used to identify women who wish to stop childbearing; they differ in socioeconomic status from their counterparts who want more children. Educated women are more likely to be motivated to cease childbearing than non-educated women; Christian or Sinhalese/Buddhist women are more willing to stop childbearing than Moor/Muslim or Tamil/Hindu women. The relationships between sex composition of existing children and women's fertility desires indicate that although moderate son preference exists it does not affect their contraceptive behaviour. Among those who want no more children, 15% are at risk of unwanted pregnancy because they do not practise contraception. Again better education and being Christian or Sinhalese/Buddhist reduced the risk of unwanted pregnancy. Women whose husbands disapproved of contraception had over four times higher risk of unwanted pregnancy than women whose husbands approved.     

Legalization of consensual unions in Mexico

Abstract

There is ample evidence that there are important behavioral differences in Latin America between couples living in consensual unions and those who are legally married. In this paper, we examine the frequency of and variations in legalization of consensual unions in Mexico, using data from the 1976–77 Encuesta Mexicana de Fecundidad. Our results indicate that the frequency of legalization of consensual unions appears to have risen among recent cohorts. Women in first unions, those who start a union at older ages, and those who are more highly educated are also more likely to marry their partners. Our results also indicate that pregnancy does not appear to be a major factor precipitating legalization, and that whether a couple lived together before marriage has no effect on the stability of the marriage.     

Editorial

Dear reader, dear colleagues all around the world,this is a personal declaration and a policy statement.Volume 52 of this journal appears in a different form. One of the elements which are most noticeable externally is the reduction of the non-English parts in the original article section, particularly the omission of the Zusammenfassungen and the Résumés. This change recognises the obvious fact that English has become the lingua franca of science today.This, however, does not justify to any extent ignoring papers in other languages. Since, for instance, the foundation of epigenetics has been first summarised by Le Double who wrote in French or since the first and most comprehensive papers on enamel hypoplasia were published by Berten in German, the author of a respective paper today must read French or German or obtain relevant translations. If he/she does not, then this work becomes seriously flawed in terms of one of the most important quality criteria for scientific work, the due acknowledgement of important existing contributions to the field. This criterion has been stressed by many compendia, laws and bylaws on ethical behaviour in science and is e.g. included in the Helsinki Declaration. If the author of a paper submitted to HOMO does not comply with the requirement of due acknowledgement of all contributions to the relevant field of work, irrespective of the language in which they were published, that paper will not pass the editorial review process in HOMO.A living language as the lingua franca poses, in contrast to the use of Latin in Mediaeval and Renaissance times, consequential problems: scientists from English speaking countries tend to disregard work produced in other cultures, the others, the vast majority of the world who do not speak English at home, tend to focus on the work of mother-tongue English writers. Both effects lead to a serious loss of ideas and a disregard of a substantial body of facts and data, and both are a violation of the internationality and openness of science.We recommend to every consumer of written science to check the percentage of non-English entries in the bibliography of a paper or a book. If there is not one: please ignore it, it is seriously biased.Naturally there are exceptions to this rule, e.g. simple basic lab reports and very young subfields like DNA method development. For the remainder, the bulk of serious scientific publication, this holds true. In comparative human biology at present about one-third of works quoted should be in languages other than English.This will obviously vary between subfields and character of contribution, and this percentage will reduce as the time goes on and most new works are published in English, but, as a rule, nil is bias.As always, the quality of papers submitted to HOMO will be judged on all sound scientific criteria. The fact that the editors and most of the board members of our journal are able to read papers in several languages other than English will help to maintain breadth and quality of our journal's content.Summer 2001Fw Rösing, Editor     

Counting Highly Cited Papers for University Research Assessment: Conceptual and Technical Issues

A Kuhnian approach to research assessment requires us to consider that the important scientific breakthroughs that drive scientific progress are infrequent and that the progress of science does not depend on normal research. Consequently, indicators of research performance based on the total number of papers do not accurately measure scientific progress. Similarly, those universities with the best reputations in terms of scientific progress differ widely from other universities in terms of the scale of investments made in research and in the higher concentrations of outstanding scientists present, but less so in terms of the total number of papers or citations. This study argues that indicators for the 1% high-citation tail of the citation distribution reveal the contribution of universities to the progress of science and provide quantifiable justification for the large investments in research made by elite research universities. In this tail, which follows a power low, the number of the less frequent and highly cited important breakthroughs can be predicted from the frequencies of papers in the upper part of the tail. This study quantifies the false impression of excellence produced by multinational papers, and by other types of papers that do not contribute to the progress of science. Many of these papers are concentrated in and dominate lists of highly cited papers, especially in lower-ranked universities. The h-index obscures the differences between higher- and lower-ranked universities because the proportion of h-core papers in the 1% high-citation tail is not proportional to the value of the h-index.     

NON-DIRECTIVE PSYCHOTHERAPY

Psychotherapy is a word to describe an age-old process. It would be better not to speak of psychotherapy, but of psychotherapies. Specialists are not the only ones who act as psychotherapists, since every human being fills this role at one time or another. Besides this, no two persons follow an identical approach. Finally, all therapists change technique constantly. The kinds of psychotherapy must therefore approach infinity.Some physicians appear to assume that only one type of psychotherapy may claim a scientific basis. Although Freud first put psychotherapy on a scientific path, there is no reason to say that Freud must be the last in this field.Over the past few years a new trend has started in psychotherapy which deserves close study. This new trend challenges some old beliefs and gives a new tool to help patients of some types. It is called non-directive or client-centered psychotherapy. This therapy does not try to solve the patient''s problems for him, but rather establishes the conditions under which a patient can work out his own salvation.Each year non-directive psychotherapy grows in importance. Much can be learned from the method.     

L’art Paléolithique est-il un « art » ?: Réflexions autour d’une question d’actualité

During the last years, an international debate about the concept of “Palaeolithic art” has taken place. On one hand, several specialists have critiqued the use of the concept of “art” in naming the images created by Homo sapiens during the Palaeolithic era. They claim that the use of this term implies the projection of a modern category to a world - that of prehistoric humans - which is completely different from our own. On the other hand, some archaeologists consider that the term “Palaeolithic art” does not imply an anachronistic interpretation of prehistoric representations. In presenting the historical context, which has made such a discussion possible, we consider the causes and effects of this controversy. Firstly, we analyze the traditional interpretation, which considered Palaeolithic images as “works of art”. Secondly, we examine the connections, which can be found between the debate about “Palaeolithic art” and certain polemics, which have arisen from the history of art and anthropological frameworks. Thirdly, we consider the arguments utilized by those who are for and those who are against the term “Palaeolithic art”. Finally, we emphasize the importance of this debate to better understand the categories and the concepts, which determine the scientific practice.     

Associations between the masticatory system and muscle activity of other body districts. A meta-analysis of surface electromyography studies

The aim of this meta-analysis regarding the use of surface electromyography (sEMG) is to assess the scientific evidence for detectable correlations between the masticatory system and muscle activity of the other body districts, particularly those mainly responsible for body posture. A literature survey was performed using the PubMed database, covering the period from January 1966 to April 2011, and choosing medical subject headings. After selection, five articles qualified for the final analysis. One study article was judged to be of medium quality, the remaining four of low quality. No study included a control group or follow-up; in only one study, subjects with impairment of the masticatory system were enrolled. In all studies, detectable correlations between the masticatory systems and muscle activity of the other body districts, or vice versa, were found; however, after a reappraisal of the data provided in these studies, only weak correlations were found, which reached biological, but not clinical relevance. With the limitations that arise from the poor methodological quality of the published study reports discussed here, the conclusion is that a correlation between the masticatory system and muscle activity of the other body districts might be detected through sEMG under experimental conditions; however, this correlation has little clinical relevance. While more investigations with improved levels of scientific evidence are needed, the current evidence does not support clinically relevant correlations between the masticatory system and the muscle activity of other body districts, including those responsible for body posture.     

Decision support systems for aquaculture licensing

Models used to assess the environmental impacts of aquaculture are becoming increasingly numerous and complicated. It is therefore becoming more and more difficult to present these moiels to non-scientists, even though the ultimate clients of research on aquaculture impacts are administrators and producers who have to deal with ractical considerations and have little time or inclination to deal with the complexities of scientific morfels. The Aquaculture Research Group within the Habitat Ecology Division has therefore been exploring the development of a decision support system (DSS) as a tool for communicating scientific advice to managers, specifically addressing the use of models to evaluate environmental impacts in order to assess whether the licensing of finfish aquaculture sites is likely to lead to degradation of natural marine habitat. The proposed DSS will incorporate simplified versions of several models along with a geographical data base of relevant hydrographic and other environmental information. The user will be able to enter various scenarios in a simple fashion (for example, a mouse can be used to specify site locations) and see an evaluation of the proposal based on several scientific models. Although a computer program cannot be expected to represent more than a fraction of the expertise of real scientists, the DSS approach appears to have several advantages; these include the ability to deliver a degree of expertise in remote and isolated regions, and, perhaps most important, a chance for managers to access scientific resources in a private environment which lets them explore various options without having to justify their eventual actions to scientists who may not fully appreciate all the pressures which bear on their decisions. The material developed so far includes a prototype of the proposed DSS in form of a computer program which demonstrates what the user interface for a working DSf would look like. The program has only a crude graphical user interface and does not actually interact with a real database, but the models are realistic and the output offers a simplified representation of what a real Decision Support System might provide.     

The Impact of Diabetes on the Labour Force Participation,Savings and Retirement Income of Workers Aged 45-64 Years in Australia

BackgroundDiabetes is a debilitating and costly condition. The costs of reduced labour force participation due to diabetes can have severe economic impacts on individuals by reducing their living standards during working and retirement years.MethodsA purpose-built microsimulation model of Australians aged 45-64 years in 2010, Health&WealthMOD2030, was used to estimate the lost savings at age 65 due to premature exit from the labour force because of diabetes. Regression models were used to examine the differences between the projected savings and retirement incomes of people at age 65 for those currently working full or part time with no chronic health condition, full or part time with diabetes, and people not in the labour force due to diabetes.ResultsAll Australians aged 45-65 years who are employed full time in 2010 will have accumulated some savings at age 65; whereas only 90.5% of those who are out of the labour force due to diabetes will have done so. By the time they reach age 65, those who retire from the labour force early due to diabetes have a median projected savings of less than $35,000. This is far lower than the median value of total savings for those who remained in the labour force full time with no chronic condition, projected to have $638,000 at age 65.ConclusionsNot only does premature retirement due to diabetes limit the immediate income available to individuals with this condition, but it also reduces their long-term financial capacity by reducing their accumulated savings and the income these savings could generate in retirement. Policies designed to support the labour force participation of those with diabetes, or interventions to prevent the onset of the disease itself, should be a priority to preserve living standards comparable with others who do not suffer from this condition.     

Physicians' participation in establishing criteria for hypertension management in the office: will patient outcomes be improved?

We designed this study to determine whether an intensive 1-day educational workshop involving family physicians in establishing essential criteria for hypertension management would significantly affect the short-term outcomes of hypertensive patients in their practices. Forty randomly selected physicians were separated into three groups: those who would be involved in establishing the criteria (15), those who would receive the criteria by mail (15) and those who would act as controls and not be aware of the criteria (10). We found no significant difference between the three groups in the number of hypertensive patients whose condition remained uncontrolled after the intervention. We conclude that physicians'' participation in the establishment of standards of care for conditions such as hypertension or their awareness of such standards does not independently result in significantly better patient outcomes. Consequently, we recommend that physicians and health care planners concerned with improving outcomes not rely on any single intervention strategy when planning change.