Patients and Healers in the Context of Culture: An Exploration of the Borderland Between Anthropology, Medicine, and Psychiatry

Buried in the pedantic pages of this book is a pointed challenge to medicine. Simply stated, Freidson's view is that the medical profession has become too autonomous and too powerful for the good of society, and that it must therefore be regulated. Like the prominent medical sociologist he is, the author develops his argument through an exhaustive theoretical analysis. He begins with the formal organization of the profession and proceeds to the ways in which the performance of its work is organized and regulated. He denies that the knowledge required for clinical practice is so esoteric that it cannot be questioned by lay persons. The "clinical mentality" he finds to be characterized by action orientation and pragmatism. Physicians, he concedes, do have a service orientation as well, but he believes it to be not prominent and not a sufficient basis for claims to professional autonomy. Physicians expect to be allowed

Profession of Medicine: A Study of the Sociology of Applied Knowledge

John Ioannidis argues that problem base, context placement, information gain, pragmatism, patient centeredness, value for money, feasibility, and transparency define useful clinical research. He suggests most clinical research is not useful and reform is overdue.

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Why Most Clinical Research Is Not Useful

Inclusion: The Politics of Difference in Medical Research

BACKGROUND\nAlthough increased attention has been paid to sex and racial differences in the management of myocardial infarction, it is unknown whether these differences have narrowed over time.\n\n\nMETHODS\nWith the use of data from the National Registry of Myocardial Infarction, we examined sex and racial differences in the treatment of patients who were deemed to be \"ideal candidates\" for particular treatments and in deaths among 598,911 patients hospitalized with myocardial infarction between 1994 and 2002.\n\n\nRESULTS\nIn the unadjusted analysis, sex and racial differences were observed for rates of reperfusion therapy (for white men, white women, black men, and black women: 86.5, 83.3, 80.4, and 77.8 percent, respectively; P<0.001), use of aspirin (84.4, 78.7, 83.7, and 78.4 percent, respectively; P<0.001), use of beta-blockers (66.6, 62.9, 67.8, and 64.5 percent; P<0.001), and coronary angiography (69.1, 55.9, 64.0, and 55.0 percent; P<0.001). After multivariable adjustment, racial and sex differences persisted for rates of reperfusion therapy (risk ratio for white women, black men, and black women: 0.97, 0.91, and 0.89, respectively, as compared with white men) and coronary angiography (relative risk, 0.91, 0.82, and 0.76) but were attenuated for the use of aspirin (risk ratio, 0.97, 0.98, and 0.94) and beta-blockers (risk ratio, 0.98, 1.00, and 0.96); all risks were unchanged over time. Adjusted in-hospital mortality was similar among white women (risk ratio, 1.05; 95 percent confidence interval, 1.03 to 1.07) and black men (risk ratio, 0.95; 95 percent confidence interval, 0.89 to 1.00), as compared with white men, but was higher among black women (risk ratio, 1.11; 95 percent confidence interval, 1.06 to 1.16) and was unchanged over time.\n\n\nCONCLUSIONS\nRates of reperfusion therapy, coronary angiography, and in-hospital death after myocardial infarction, but not the use of aspirin and beta-blockers, vary according to race and sex, with no evidence that the differences have narrowed in recent years.

Sex and Racial Differences in the Management of Acute Myocardial Infarction, 1994 through 2002

Most studies on global health inequality consider unequal health care and socio-economic conditions but neglect inequality in the production of health knowledge relevant to addressing disease burden. We demonstrate this inequality and identify likely causes. Using disability-adjusted life years (DALYs) for 111 prominent medical conditions, assessed globally and nationally by the World Health Organization, we linked DALYs with MEDLINE articles for each condition to assess the influence of DALY-based global disease burden, compared to the global market for treatment, on the production of relevant MEDLINE articles, systematic reviews, clinical trials and research using animal models vs. humans. We then explored how DALYs, wealth, and the production of research within countries correlate with this global pattern. We show that global DALYs for each condition had a small, significant negative relationship with the production of each type of MEDLINE articles for that condition. Local processes of health research appear to be behind this. Clinical trials and animal studies but not systematic reviews produced within countries were strongly guided by local DALYs. More and less developed countries had very different disease profiles and rich countries publish much more than poor countries. Accordingly, conditions common to developed countries garnered more clinical research than those common to less developed countries. Many of the health needs in less developed countries do not attract attention among developed country researchers who produce the vast majority of global health knowledge—including clinical trials—in response to their own local needs. This raises concern about the amount of knowledge relevant to poor populations deficient in their own research infrastructure. We recommend measures to address this critical dimension of global health inequality.

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Attention to Local Health Burden and the Global Disparity of Health Research

To provide East Asian evidence to the relationship between the use of complementary and alternative medicine (CAM) and the use of biomedicine, this article examines the institutionalization of traditional East Asian medicine (EM) in China, Korea, and Japan and how it affects the relationship between EM use and biomedicine use. It uses the 2010 East Asian Social Survey. Logistic regressions specify the statistical association between EM use and biomedical physician visits. These models show that the high institutional acceptance of EM promotes the concurrent use of EM and biomedicine. In addition, since these countries feature different ways of institutionalizing EM (unification in China, equalization in Korea, and subjugation in Japan), the concurrent use is more obvious under the Chinese and the Korean system than the Japanese system. It concludes that the CAM use can be complementary to biomedicine, depending on how CAM and biomedicine are institutionalized in medical systems.

http://journals.sagepub.com/doi/pdf/10.1177/1010539515613411

The Relationship Between the Use of Complementary and Alternative Medicine and the Use of Biomedical Services Evidence From East Asian Medical Systems

Complementary and alternative medicine (CAM) has been one of the popular strategies for health promotion. Traditional East Asian medicine (TEAM) is one of the most popular CAM practices in the world and there are suggestions that its holistic utilization is important for users to gain its effects for health promotion. In this context, this study investigates the extent to which TEAM users in East Asian countries utilize various modalities of TEAM holistically. It provides a model that explains cross-national differences in the extent of the holistic use of TEAM between China, Japan, Korea and Taiwan. Using the 2010 East Asian Social Survey, regression models specify the relationship between the holistic use of TEAM and the geographical location (country). The presence of TEAM doctors who hold the comprehensive and exclusive practice rights over TEAM is found to be conducive to the holistic utilization of various TEAM modalities. Thus, Taiwanese and Koreans use TEAM more holistically than Chinese and even more so than Japanese. The result suggests that the manner in which TEAM is institutionalized affect the extent to which TEAM users utilize various TEAM modalities together and potentially the health promotion effects of TEAM.

Cross-national differences in the holistic use of traditional East Asian medicine in East Asia

Objective:To investigate patterns of complementary and alternative medicine (CAM) use disclosure across medical and sociobehavioral factors and to provide a model that takes into account factors in explaining those patterns.Subjects:A total of 21,849 CAM use episodes from 7347 respondents in the 200

Patterns of user disclosure of complementary and alternative medicine (CAM) use

Objective To investigate differences in self-rated health (SRH) between web and mail questionnaires in a mixed mode survey and to provide a model that explains those differences. Subjects A total of 15,200 mail respondents and 17,829 web respondents from the 2008 US National Health Survey conducted by the Gallup Panel. Research design Respondents were recruited using random digit dialing and assigned to one of the two survey modes (web or mail). Respondents with household Internet connection and frequent Internet usage were invited to complete the survey through the web mode. Respondents who had no Internet connection or who used the Internet infrequently were invited to the mail mode. Thus, respondents with better Internet access used the web mode. Measures Respondents completed a questionnaire that asked about SRH status, objective health conditions, health behaviors, and other socioeconomic variables. Statistical associations were analyzed with ordered Logit and negative binomial models. Results Web respondents reported better SRH than mail respondents. This difference is in part reflective of variability in objective health status between these two groups, and in part attributable to the effects of survey mode. These results maintained with age controlled. Conclusions The alignment between survey mode selection, Internet access, and health disparities, as well as genuine survey mode characteristics, leads to web-mail differences in SRH. Unless the digital divide and its influences on survey mode selection are resolved and differential genuine mode effects are fully comprehended, we recommend that both modes be simultaneously used on a complementary basis.

Jae-Mahn Shim

Papers

Attention to Local Health Burden and the Global Disparity of Health Research

The Relationship Between the Use of Complementary and Alternative Medicine and the Use of Biomedical Services Evidence From East Asian Medical Systems

Cross-national differences in the holistic use of traditional East Asian medicine in East Asia

Patterns of user disclosure of complementary and alternative medicine (CAM) use

Self-rated health assessed by web versus mail modes in a mixed mode survey: the digital divide effect and the genuine survey mode effect.