Meaning, Medicine, and the "Placebo Effect"

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

Synthesis, topoisomerase I inhibition and antitumor cytotoxicity of 2,2':6',2"-, 2,2':6',3"- and 2,2':6',4"-terpyridine derivatives

For the development of new anticancer agents, 2,2':6',2"-, 2,2':6',3"- and 2,2':6',4"-terpyridine derivatives were designed and evaluated for their topoisomerase I inhibitory activity and antitumor cytotoxicity. Structure-activity relationship studies indicated that 2,2':6',2"-terpyridine derivatives were highly cytotoxic toward several human tumor cell lines, whereas 2,2':6',3"- and 2,2':6',4"-terpyridine derivatives were potent topoisomerase I inhibitors.     

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。     

"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]     

Colonial "Reformation" in the Highlands of Central Sulawesi, Indonesia, 1892-1995

Colonial "Reformation" in the Highlands of Central Sulawesi, Indonesia, 1892-1995. Albert Schrauwers. Toronto: University of Toronto Press, 2000. 279 pp.     

"Black Gal Swing": Color, Class, and Category in Globalized Culture

Scattered Belongings: Cultural Paradoxes of "Race," Nation and Gender. Jayne O. Ifekwunigwe. New York: Routledge, 1999. 221 pp.
Race and Ideology: Language, Symbolism, and Popular Culture. Arthur K. Spears. ed. Detroit, MI: Wayne State University Press, 1999. 242 pp.
Spurious Issues: Race and Multiracial Identity Politics in the United States. Rainier Spencer. Boulder, CO: Westview Press, 1999. 222 pp.     

The story catches you and you fall down: tragedy,ethnography, and "cultural competence"

Anne Fadiman's The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures (Noonday Press, 1997) is widely used in "cultural competence" efforts within U.S. medical school curricula. This article addresses the relationship between theory, narrative form, and teaching through a close critical reading of that book that is informed by theories of tragedy and ethnographies of medicine. I argue that The Spirit Catches You is so influential as ethnography because it is so moving as a story; it is so moving as a story because it works so well as tragedy; and it works so well as tragedy precisely because of the static, reified, essentialist understanding of "culture" from which it proceeds. If professional anthropologists wish our own best work to speak to "apparitions of culture" within medicine and other "cultures of no culture," I suggest that we must find compelling new narrative forms in which to convey more complex understandings of "culture."     

"Showing roughness in a beautiful way": talk about love, coercion, and rape in South African youth sexual culture

Sexual violence within as well as outside sexual relationships has far-reaching public health and human rights implications and is a continuing focus of popular debate, media coverage, and research in postapartheid South Africa. Partly because it has been shown to affect individual vulnerability to HIV/AIDS, sexual violence has in recent years become framed as a global public health issue. International research efforts to document the scale of this personally and politically sensitive problem can encounter conceptual, definitional, and methodological difficulties that anthropology is well placed to assist in alleviating. This article offers an ethnographic exploration of the spectrum of practices relating to sexual coercion and rape among young people in a township in the former Transkei region of South Africa. Contextualizing meanings of sexual coercion within local youth sexual culture, the article considers two emic categories associated with sex that is "forced": ukulala ngekani: "to sleep with by force" or ukunyanzela: "to force," both usually used to describe episodes occurring within sexual partnerships; and ukudlwengula, used to describe rape by a nonpartner or stranger. The article discusses the semantic content of and differences between these two key categories, demonstrating that encounters described as "forced sex" encompass not only various forms of sexual coercion but also, particularly in the narratives of young men, instances of more consensual sex. Of importance, in turn, in defining an act as "rape" rather than as "forced sex" are the character of the relationship between the two parties and interlinked ideas relating to exchange and sexual entitlement, love, and the importance of "intention," violation, and "deserving" victimhood.     

"The Vulgar Spirit of Blogging": On Language, Culture, and Power in Persian Weblogestan

This article is an ethnographic study of Persian-language weblogs (blogs), focusing on a divisive argument among Iranian bloggers that came to be known as the "vulgarity debate." Sparked by a controversial blogger who ridiculed assertions that Islam was compatible with human rights, the debate revolved around the claim that blogging had a "vulgar spirit" that made it easy for everything from standards of writing to principles of logical reasoning to be undermined. My study focuses primarily on the linguistic side of the controversy: I analyze blogging as an emergent speech genre and identify the structural features and social interactions that make this genre seem "vulgar." I also examine the controversy as a confrontation between bloggers with unequal access to cultural capital and a struggle over "intellectualist" hegemony. In the conclusion, I use the construct of "deep play" to weave together multiple layers of structure, explanation, and meaning in the debate.     

Fertility Politics as "Social Viagra": Reproducing Boundaries, Social Cohesion, and Modernity in Italy

In this article, we investigate the delicacy of adopting pronatalism as a public position in Italy. Mounting scientific and political knowledge about the demographic "problem" exposes a new hegemonic formation that low fertility is dangerous. Drawing on ethnographic contexts, political debates, media publications, and policy documents, we trace the "demographic emergency" and compare two policies: a monetary baby bonus and a law restricting assisted reproduction. The coexistence of incentives to counter superlow fertility with prohibitions on high-tech baby making reflect the contested governance of "social cohesion." We conclude that scholarly and popular discourses serve as a sort of "social Viagra." Ultimately, both policies sought to rejuvenate family norms. Both aimed to fortify the political terrain of a nation-state struggling to achieve and maintain modernity against a backdrop of immigration and aging. Modernity became a weapon of the state to exert control over Italian fertility practices and of its critics to deploy orientalizing representations of backwardness.     

Consciousness enigma: the "hard problem"--binding problem entanglement, "extra ingredient" and field principle

The "Hard problem" of consciousness relates to the perplexing emergence of consciousness as a result of the brain activity. The binding problem concerns separate processing of perceived data in functionally and topographically segregated cortical areas and functional integration of such locally disjoined operations into coherently perceived images and events. The existing field-grounded theories of consciousness fall into two groups: (i) those based on the physical (electromagnetic) field, and (ii) those grounded on autonomous fields irreducible to the established physical fundamentals. The critical analysis of the existing theories results in formulation of the extra ingredient and a novel irreducible field-based theory of consciousness.     

Introduction to "Moral Economies, State Spaces, and Categorical Violence"

By studying and writing about social revolutions and popular protest, James Scott has provided anthropologists and social theorists with a wide-ranging analytical vocabulary for speaking about peace and its inseparable twin—violence. His particular area of expertise has been the arts of repressive peace, and the artfulness of those who elude or defy such silencing technologies. The publication of The Moral Economy of the Peasant in 1976 initiated the first interactions between Scott's unique brand of political theory and anthropology in the shared topical space of peasant studies and the shared geographic space of Asian studies. The authors of this "In Focus" have assembled this special collection to celebrate and evaluate those and subsequent interactions covering a quarter of a century and spanning the publication of at least three other books: Weapons of the Weak (1985), Domination and the Arts of Resistance (1990), and Seeing Like a State (1998).     

"Extracts from "Clinical evidence": Menopausal symptoms

DefinitionMenopause begins one year after the last menstrual period. Symptoms often begin in the perimenopausal years.Incidence/prevalenceIn the United Kingdom the mean age for the menopause is 50 years 9 months. The median onset of the perimenopause is between 45.5 and 47.5 years. One Scottish survey (of 6096 women aged 45 to 54 years) found that 84% had experienced at least one of the classic menopausal symptoms, with 45% finding one or more symptoms a problem.¹

Interventions

• Beneficial:OestrogensTibolone

• Likely to be beneficial:ProgestogensClonidine

• Unknown effectiveness:Phyto-oestrogensTestosteroneAntidepressants

PrognosisMenopause is a physiological event. Its timing may be genetically determined. Although endocrine changes are permanent, menopausal symptoms such as hot flushes, which are experienced by about 70% of women, usually resolve with time.² However, some symptoms, such as genital atrophy, may remain the same or worsen.AimsTo reduce or prevent menopausal symptoms, and to improve quality of life with minimum adverse effects.OutcomesFrequency and severity of vasomotor, urogenital, and psychological symptoms; quality of life.MethodsClinical Evidence search and appraisal December 1999. We included only randomised controlled trials (RCTs) and systematic reviews that met Clinical Evidence quality criteria.BenefitsVasomotor symptoms: We found no systematic review. We found over 40 RCTs comparing oestrogen versus placebo and various preparations and/or routes against each other. Most found that oestrogen reduced vasomotor symptoms (data from one RCT in 875 women: odds ratio 0.53, 95% confidence interval 0.31 to 0.93).³ Two RCTs found that transdermal oestrogen at a low dose of 25 μg daily reduced severity of vasomotor symptoms compared with placebo.^4,5 Urogenital system: We found one systematic review (search date 1995) and three subsequent RCTs. The review pooled data from six RCTs.⁶ It found that oestrogen improved urogenital symptoms regardless of the route of administration (no figures available). One subsequent RCT (n=136) found that low dose transdermal oestrogen (25 μg daily) combined with norethisterone acetate significantly reduced vaginal dryness and dyspareunia compared with placebo over six months.⁴ Two other RCTs (n=192) found that local administration of oestrogen using a silicone oestradiol releasing vaginal ring over 24-36 weeks improved vaginal oestrogenisation and pH compared with placebo.^7,8 One of these trials also found a significant reduction in incidence of urinary tract infection in treated women (P=0.008).⁷ Psychological symptoms: We found one systematic review (search date 1995, 14 RCTs, 12 cohort studies), which found that oestrogen reduced depressed mood among menopausal women.⁹ Duration of treatment ranged from one month to two years. Data pooling for oestrogen versus placebo (10 studies) found that oestrogen reduced depressive symptoms (no figures available). We found no RCTs of oestrogen treatment in women with clinically proved depression. We found one systematic review (search date 1996, 10 controlled trials, 9 observational studies) of the effects of oestrogen on cognitive function in postmenopausal women and women with Alzheimer''s disease.¹⁰ Studies were too weak to allow reliable conclusions. An additional crossover RCT (n=62) found a beneficial effect of oestrogen on sleep quality compared with placebo over seven months.¹¹ Quality of life: We found no systematic review. We found four RCTs (639 women, 3 RCTs placebo controlled, 3 versus progestogen), which found significant improvement in quality of life in women treated with oestrogen compared with baseline or placebo.^12–15 The largest RCT (242 women) found that oestrogen improved quality of life (P=0.0003) and wellbeing (P=0.003) compared with placebo over 12 weeks.¹²HarmsMany RCTs have found that oestrogen causes weight gain and breast tenderness in the short term. Although many women report an increase in weight when starting oestrogen, we found no evidence from RCTs that oestrogen causes significant weight gain in the long term. The most important long term adverse effects are increased risk of venous thromboembolic disease, endometrial cancer, and breast cancer.^16–18 The relation between oestrogen (as hormone replacement therapy) and breast cancer was reviewed in a reanalysis of 51 studies of more than 160 000 women.¹⁹ The review found that the risk of breast cancer increased by 2.3% (1.1% to 3.6%) each year in women using hormone replacement therapy. Five or more years after hormone replacement therapy was stopped, there was no significant excess of breast cancer.¹⁹CommentMany studies used selected populations such as women attending hospital clinics, who may be different in their behaviour, personality, and symptom profile to women of the same age seen in primary care or those who do not seek medical advice. Option: ProgestogensSummary We found good evidence from RCTs that progestogens reduce vasomotor symptoms. We found no good quality evidence on other outcomes, including quality of life.BenefitsWe found no systematic review. Vasomotor symptoms: We found five RCTs (257 women, all trials less than a year long), which found that women taking progestogens experienced a significant reduction in vasomotor symptoms compared with placebo.^20–24 The single RCT comparing oestrogen alone with progestogen (150 mg of depot medroxyprogesterone for 25 days a month) found that over three months, 18% of women taking oestrogens and 33% taking progestogen reported no vasomotor symptoms.²¹ One RCT (n=102) found that transdermal progesterone cream 20 mg daily improved vasomotor symptoms compared with placebo (P<0.001) but had no beneficial effect on bone density.²⁵ Urogenital system: We found no RCTs evaluating the effects of progestogens alone on urinary incontinence, the lower genital tract, or sex life. Psychological symptoms: We found no RCTs. Quality of life: One RCT of cyclical progestogen plus oestrogen for six months found no evidence of an effect on quality of life.²⁶ We found no studies of progestogen alone on quality of life.HarmsWe found two RCTs that evaluated harms of progestogens. The first compared continuous progestogen (norgestrel) and placebo in 321 women who had undergone hysterectomy and were already taking conjugated oestrogen. It found no difference in symptoms (including weight gain and bloating).²⁷ The second RCT (875 women) compared various oestrogen-progestogen combinations over three years.³ It found that additional progestogen increased breast discomfort (odds ratio 1.92, 1.16 to 3.09). Neither trial found evidence of an effect on cardiovascular events.CommentProgestogen is seldom given alone, which makes it hard to isolate its effects. When it was given without oestrogen, doses of progestogens were high, the lowest dose being 20 mg medroxyprogesterone acetate per day. Option: TiboloneSummary RCTs found that tibolone significantly improved vasomotor symptoms, libido, and vaginal lubrication.BenefitsWe found no systematic review. Vasomotor symptoms: We found three RCTs, two of tibolone versus continuous combined oestrogen/progestogen treatment over 48 and 52 weeks (672 women with menopausal symptoms)^28,29 and one versus placebo over 16 weeks (82 women with menopausal symptoms).³⁰ The first RCT found a slightly greater reduction in hot flushes with the combined regimen than with tibolone over 48 weeks (P=0.01). The second trial found a significant reduction in vasomotor symptoms from baseline in both groups (67/72 women on HRT and 58/68 women on tibolone, P<0.001) but no significant difference between groups. The third trial found tibolone reduced vasomotor symptoms by 39% compared with placebo (P=0.001). Urogenital system: We found two RCTs. The first RCT found no significant difference between tibolone and combined hormonal treatment in terms of subjective reports of vaginal lubrication; both interventions improved lubrication compared with baseline.²⁸ The second RCT (437 women) found that tibolone improved sexual satisfaction compared with oestradiol plus norethisterone (P<0.05).³¹ We found no RCTs examining effects on urinary incontinence. Psychological symptoms: We found no RCTs. Quality of life: We found no RCTs. Bone density: We found nine RCTs, which found that tibolone increased bone density over periods from 6 to 36 months compared with baseline or placebo.³²HarmsWe found no evidence on adverse effects from RCTs. One non-randomised controlled trial found that the main unwanted effect of tibolone was breakthrough bleeding, which occurred in about 10% of users.³³ We found no good evidence of androgenic adverse effects such as hair growth and greasiness of the skin. Two RCTs of short term use found a 33% reduction in plasma high density lipoproteins with tibolone,^34,35 although the long term effects on cardiovascular disease are unknown.CommentNone. Option: Phyto-oestrogensSummary Limited evidence from small RCTs suggests that soy flour, which contains phyto-oestrogens, may relieve vasomotor menopausal symptoms.BenefitsWe found no systematic review. Vasomotor symptoms: We found three placebo controlled RCTs. Two evaluated soy supplements, which contain phyto-oestrogen, using double blind designs; the other, which was not blinded, evaluated isoflavone. The first RCT (58 postmenopausal women) compared soy flour versus wheat flour for 12 weeks and found that hot flushes were reduced significantly more in the group of women using soy flour (40% v 25% reduction).³⁶ The second RCT used a crossover design to evaluate six weeks'' administration of 34 mg soy protein daily. It found reduced severity but not frequency of vasomotor symptoms.³⁷ The third RCT (n=51) used a crossover design to compare isoflavone 40 mg daily with placebo. It found benefit from placebo compared with baseline, but not with isoflavone.³⁸ Urogenital system: We found no RCTs. Psychological symptoms: We found no RCTs. Beneficial effects of treatment on quality of life: We found no RCTs.HarmsWe found no evidence of significant adverse effects.CommentNone. Option: ClonidineSummary Two RCTs found that clonidine reduced vasomotor symptoms.BenefitsWe found no systematic review. Vasomotor symptoms: We found two RCTs.^39,40 One crossover RCT (66 women) found that clonidine reduced the mean number of flushing attacks in the 14 days after crossover compared with placebo (56.8 v 64.3, P<0.05).³⁰ The second RCT (30 women) found that more women taking clonidine reported reduced flushes at 8 weeks (12/15 v 5/14, P<0.04).⁴⁰ Psychological symptoms: We found no RCTs. Quality of life: We found no RCTs.HarmsThe two RCTs found no significant difference in the incidence of unwanted effects between placebo and active treatment groups.^39,40CommentNone. Option: TestosteroneSummary We found evidence from RCTs that testosterone improves sexual enjoyment and libido. We found no studies evaluating effects on other commonly experienced menopausal symptoms.BenefitsWe found no systematic review. Vasomotor symptoms: We found no RCTs evaluating testosterone alone in women with menopausal symptoms. We found one RCT (93 postmenopausal women) comparing oestrogen alone and oestrogen plus methyltestosterone. This concluded that addition of a small dose of methyltestosterone reduced the dose of oestrogen needed to control menopausal symptoms.⁴¹ Urogenital system: We found two RCTs, one in 40 women and one crossover study in 53 women. Both found benefit from exogenous testosterone on self reported sexual enjoyment, desire, and arousal.^42,43 Psychological symptoms: We found no RCTs. Beneficial effects of therapy on quality of life: We found no RCTs.HarmsWe found no evidence from RCTs or other controlled studies on the incidence of androgenic adverse effects with testosterone.CommentNone. Option: AntidepressantsSummary We found insufficient evidence on the effects of antidepressants on menopausal symptoms.BenefitsWe found no systematic review or RCTs that specifically addressed the effects of antidepressants on menopausal symptoms or quality of life in menopausal women.HarmsWe found no evidence on adverse effects in postmenopausal women. Antidepressants as a group can cause many central nervous system adverse effects, including sedation and agitation, as well as urinary and vision problems, liver dysfunction, and cardiac dysrhythmias.⁴⁴CommentNone.     

Different fatty acids in the egg, blood and feces of laying hens fed a diet containing "Toprina"

Total lipids (TL, phospholipids (PL) and fatty acid composition of TL and PL (the latter in blood and eggs only) were estimated in Candida lipolytica cultivated on n-alkanes by industrial method ("Toprina") in 0%, 10% and 15% "Toprina" diets and in eggs, blood and faeces of laying hens fed these diets. With increasing concentrations of dietary "Toprina" 15:0 and 17:0 fatty acids increased, 17:1 and 17:2, typical of the product, appeared and increased in diets, eggs, blood and faeces. Other fatty acid values were not affected by dietary yeast.     

Parent-offspring conflicts, "optimal bad motherhood" and the "mother knows best" principles in insect herbivores colonizing novel host plants

SPECIALIZATION OF INSECT HERBIVORES TO ONE OR A FEW HOST PLANTS STIMULATED THE DEVELOPMENT OF TWO HYPOTHESES ON HOW NATURAL SELECTION SHOULD SHAPE OVIPOSITION PREFERENCES: The "mother knows best" principle suggests that females prefer to oviposit on hosts that increase offspring survival. The "optimal bad motherhood" principle predicts that females prefer to oviposit on hosts that increase their own longevity. In insects colonizing novel host plants, current theory predicts that initial preferences of insect herbivores should be maladaptive, leading to ecological traps. Ecological trap theory does not take into account the fact that insect lineages frequently switch hosts at both ecological and evolutionary time scales. Therefore, the behavior of insect herbivores facing novel hosts is also shaped by natural selection. Using a study system in which four Cephaloleia beetles are currently expanding their diets from native to exotic plants in the order Zingiberales, we determined if initial oviposition preferences are conservative, maladaptive, or follow the patterns predicted by the "mother knows best" or the "optimal bad motherhood" principles. Interactions with novel hosts generated parent-offspring conflicts. Larval survival was higher on native hosts. However, adult generally lived longer on novel hosts. In Cephaloleia beetles, oviposition preferences are usually associated with hosts that increase larval survival, female fecundity, and population growth. In most cases, Cephaloleia oviposition preferences follow the expectations of the "mothers knows best" principle.     

Editorial: "crossing boundaries: stem cells, materials, and mesoscopic sciences"

"Crossing Boundaries: Stem Cells, Materials, and Mesoscopic Sciences". This Special Issue, edited by Prof. Anthony Ho and Prof. Norio Nakatsuji, comprises review articles on the interdisciplinary study of stem cells and material science and is a celebration of the friendship and collaboration between Heidelberg University and Kyoto University in Germany and Japan, respectively.     

Chinchilla "big" and "little" gastrins

Gastrin heptadecapeptides (gastrins I and II which differ in the presence of sulfate on the tyrosine of the latter) have been purified and sequenced from several mammalian species including pig, dog, cat, sheep, cow, human and rat. A 34 amino acid precursor ("big" gastrin), generally accounting for only 5% of total gastrin immunoreactivity, has been purified and sequenced only from the pig, human, dog and goat. Recently we have demonstrated that guinea pig (GP) "little" gastrin is a hexadecapeptide due to a deletion of a glutamic acid in the region 6-9 from its NH2-terminus and that GP "big" gastrin is a 33 amino acid peptide. The chinchilla, like the GP, is a New World hystricomorph. This report describes the extraction and purification of "little" and "big" gastrins from 31 chinchilla antra. Chinchilla "little" gastrin is a hexadecapeptide with a sequence identical to that of the GP and its "big" gastrin is a 33 amino acid peptide with the following sequence: (See text)     

Opossum (Didelphis virginiana) "little" and "big" gastrins

1. "Little" gastrins from most mammalian species are 17 amino acid peptides and the precursor "big" gastrins are 34 amino acid peptides. 2. "Little" gastrins of the New World hystricomorphs, guinea-pig and chinchilla, are 16 amino acid peptides due to deletion of a glutamic acid in the region 6-9 from their NH2-terminus and the corresponding "big" gastrins are 33 amino acid peptides. 3. Antral gastrins from the opossum, a New World marsupial, have a glutamic acid deletion in the same region as the hystricomorph gastrins. 4. Opossum "big" gastrin is a 33 amino acid peptide with the following sequence: less than ELGPQDLPYLTADLSKKQGPWLEEEEAYGWMDF#.     

"p53: Twenty Years On" in Trieste, Italy, May 20-22, 1999.

Study of the p53 tumor suppressor has blossomed into a field of its own. From analysis of its mutations in several different cancers to deciphering the function of the protein in human cells, publications describing research on p53 annually number in the thousands. In the interest of presenting the most up-to-date information on the progress of cancer research involving p53, the workshop "p53: Twenty Years On" was organized in Trieste, Italy over May 20-22, 1999. The meeting highlighted some of the most exciting basic and clinical scientific findings on p53 within the last year.     

Proteolytic Digestion Patterns of "Soluble"and "Detergent-Soluble"Bovine Caudate Nucleus Acetylcholinesterases

Abstract: The structures of purified "soluble"and "detergent-soluble"bovine caudate nucleus acetylcholinesterases were compared by peptide mapping on polyacrylamide gels. The digestion products generated from the two acetylcholinesterases on proteolysis by a given protease ( Staphylococcus aureus V8 protease, α-chymotrypsin, or papain) are remarkably similar as judged from the electrophoretic band patterns. We conclude that the "soluble"and "detergent-soluble"acetylcholinesterases from bovine caudate nucleus share a common evolutionary origin.