Meaning, Medicine, and the "Placebo Effect"

Meaning, Medicine, and the "Placebo Effect" Daniel Moerman Cambridge: Cambridge University Press, 2002. xiii. 172 pp.     

Hopi Indians, "cultural" selection,and albinism

The incidence of albinism in Hopi Indians has been estimated as approximately 1 in 200 individuals. It has been suggested that "cultural" selection as the result of a mating advantage of males with albinism has been important in the maintenance of this high incidence. To examine this hypothesis quantitatively, a model that includes male-mating advantage, mutation, and viability selection is analyzed. In order to play an important role in the maintenance of the high incidence of albinism, the necessary mating advantage of males with albinism appears unrealistically high. However, if the extent of viability selection against individuals with albinism is not as large as previously assumed, the necessary amount of mating advantage is not as high. Other related aspects are also discussed here, such as the type of albinism in Hopi Indians and its impact, the conditions for a polymorphism with male-mating advantage and viability selection, and the time necessary to change the incidence of albinism either by the relaxation or institution of male-mating advantage.     

蕲州地区的蕲艾、青蒿、黄花蒿与茵陈的考订

<正> 蕲州是我国中药材主要产地之一,是湖北省蕲春县的一个集镇,,是我国中医药大师李时珍的家乡。该地区生长的菊科蒿属植物Artemisia Linn。颇多,其中入药的有十余种,并在李时珍《本草纲目》中曾有记载。这里仅对该地区常见入药的蕲艾、青蒿、黄花蒿与茵陈结合《本草纲目》记载的材料作初步的考订。     

"Brother" and "Uncle": An Analysis of Rules, Structural Contradictions, and Meaning in Vietnamese Kinship

This paper analyzes the meanings of Vietnamese kinship terms on the basis of the rules that regulate their referential and nonreferential uses. These rules are not completely consistent with one another. They constitute contradictory models of and for sociocultural reality at a certain level. The structural contradictions among these models render "fuzzy" even the definitions of the prototypical uses of Vietnamese kin terms. The coexistence of alternative models makes the use of a linguistic form both a goal-directed action and the representation of an order.     

Decision making in the NICU--strategies,statistics, and "satisficing"

As science progresses, new issues in bioethics grab the headlines, but in neonatal medicine communication and decision making for sick and premature infants is as important today as it was thirty years ago. Decisions have to be made and made well, despite suboptimal time, data, or knowledge. To this end, the authors propose good communication and a cooperative model as key to interpreting the best interest standard in a way that respects parental rights and responsibility and allows best interest to be decided from an amalgam of medical facts and human values.     

The Neanderthal "chignon": variation, integration, and homology

The occipital bun ("chignon") is cited widely as a Neanderthal derived trait. It encompasses the posterior projection/convexity of the occipital squama and is associated with lambdoid flattening on the parietal. A 'hemibun' in some Upper Paleolithic Europeans is thought by some authors to indicate interbreeding between Neanderthals and early modern Europeans. However, 'bunning' is difficult to measure, and the term has been applied to a range of morphological patterns. Furthermore, its usefulness in phylogenetic reconstruction and its homologous status across modern and fossil humans have been disputed. We present a geometric morphometric study that quantitatively evaluates the chignon, assesses its usefulness in separating Neanderthals from modern humans, and its degree of similarity to Upper Paleolithic 'hemibuns.' We measured the three-dimensional coordinates of closely spaced points along the midsagittal plane from bregma to inion and of anatomical landmarks in a large series of recent human crania and several Middle and Late Pleistocene European and African fossils. These coordinate data were processed using the techniques of geometric morphometrics and analyzed with relative warps, canonical variates, and singular warps. Our results show no separation between Neanderthals and modern humans, including early modern Europeans, when the shape of the occipital plane midsagittal-profile is considered alone. On the other hand, Neanderthals are well separated from both recent and fossil modern humans when information about the occipital's relative position and relative size are also included. Furthermore, the occurrence of a highly convex and posteriorly projecting midline occipital profile (interpreted as the occipital bun) is highly correlated (>0.8) with a flat parietal midsagittal profile and with antero-superiorly positioned temporal bones across both our recent and our fossil human samples. We conclude that the shape of the occipital profile alone should not be considered an independent trait, as it is very tightly integrated with braincase shape. Our analysis does not support differences in integration of the posterior midsagittal profile and the cranial base in Pleistocene and recent humans.     

Toxoplasma gondii, "new" genotypes and virulence

Toxoplasma gondii has been described as a parasite with a low genetic diversity and a clonal population structure. The three main clonal lineages designated as type I, II or III largely predominate in Europe and North America. But strains not related to these main lineages circulate, notably, in other continents. They possess a shuffled combination of alleles that typify the three clonal types and unique polymorphisms detected by multilocus analysis. The population structure of Toxoplasma in these continents is also characterized by a higher genetic diversity associated with a lower linkage desequilibrium suggesting a role for genetic exchange. Due to their genomic diversity, it is difficult to draw global conclusions about their virulence. However, most of them are virulent in mice at isolation. Several reports also suggest a higher pathogenicity in humans and an association with ocular toxoplasmosis or severe cases of acquired toxoplasmosis in immunocompetent patients.     

"Sweeping up after the parade": professional, ethical, and patient care implications of "turfing"

"Turfing" denotes a patient transfer or triage from one physician to another when the care of that patient feels more troublesome than it is worth. A widespread phenomenon in medical training programs, turfing appears to allocate patient care to meet physicians' rather than patients' needs. Although turfing reportedly causes inter-physician discord and inter-specialty stereotyping, its deeper consequences are poorly understood. Turfing is an interpersonal conflict masquerading as a medical issue. After examining turfing alongside other patient-related slang, I analyze the distinction between "the turf," a person, and "to turf," a practice. Several explanatory models from medical practice are explored in order to illuminate turfing's implications for medical professionalism, ethics, and patient care. I suggest that a physician's medical specialty or practice type--that is, professional culture--may link to that physician's degree of altruism. If so, then what it means fundamentally to be a physician might vary across medical specialties. Such a link calls for a new notion of cultural competence, one that physicians may apply not to patients but to each other.     

"Liking" and "wanting" of sweet and oily food stimuli as affected by high-fat diet-induced obesity, weight loss, leptin, and genetic predisposition

Cross-sectional studies in both humans and animals have demonstrated associations between obesity and altered reward functions at the behavioral and neural level, but it is unclear whether these alterations are cause or consequence of the obese state. Reward behaviors were quantified in male, outbred Sprague-Dawley (SD) and selected line obesity-prone (OP) and obesity-resistant (OR) rats after induction of obesity by high-fat diet feeding and after subsequent loss of excess body weight by chronic calorie restriction. As measured by the brief access lick and taste-reactivity paradigms, both obese SD and OP rats "liked" low concentrations of sucrose and corn oil less, but "liked" the highest concentrations more, compared with lean rats, and this effect was fully reversed by weight loss in SD rats. Acute food deprivation was unable to change decreased responsiveness to low concentrations but eliminated increased responsiveness to high concentrations in obese SD rats, and leptin administration in weight-reduced SD rats shifted concentration-response curves toward that seen in the obese state in the brief access lick test. "Wanting" and reinforcement learning as assessed in the incentive runway and progressive ratio lever-pressing paradigms was paradoxically decreased in both obese (compared with lean SD rats) and OP (compared with OR rats). Thus, reversible, obesity-associated, reduced "liking" and "wanting" of low-calorie foods in SD rats suggest a role for secondary effects of the obese state on reward functions, while similar differences between select lines of OP and OR rats before induction of obesity indicate a genetic component.     

"Land, Water, and Truth": San Identity and Global Indigenism

San peoples of southern Africa followed two very different trajectories through the 20th century. For some groups, colonial rule and apartheid meant segregation on geographically remote homelands (or in game parks); for the majority of San, however, they meant incorporation as a landless underclass of farm laborers, domestic servants, and squatters. This bifurcated history now presents obstacles to the recognition of a nascent pan–San identity as the contemporary San join other indigenous peoples in struggles over land rights, control over natural resources, and political voice in national and international arenas. This article discusses some of the ways in which international models of indigenism have colluded with essentialist conceptions of culture and ethnicity to (1) prevent the recognition of the San peoples' cultural identity, as it is shaped by their various historical experiences and socioeconomic conditions, and (2) distort the understanding of San claims for land and natural resources by transforming San struggles for social and economic justice into demands for "cultural preservation." [Keywords: indigenous peoples, San, southern Africa, social movements, cultural politics]     

"Strong Women" and "Pretty Girls": Self-Provisioning, Gender, and Class Identity in Rural Galicia (Spain)

In this article I examine expressions of class and gender identity in a worker-peasant community in rural Galicia (Spain). While men who have worked for decades in migrant destinations define their own class positionality partly through reference to the unpaid, subsistence work that is performed mainly by women who remain in the community, these same women adeptly "code switch" between "strong woman" and '"pretty girl" demeanors through their work activities, dress, and use of domestic spaces. Using the example of ethnographic data from this one part of rural Europe, 1 argue for the broader importance of anthropologists considering how laboring bodies become gendered; the intersections between gender and class identities; and connections among mixed livelihood strategies, the continuity of self-provisioning activities, and resistance to fully commoditized consumption. [Key words: class and gender identity, Galicia, Spain, unpaid provisioning work, consumption]