An Anthropology of Biomedicine is an exciting new introduction to biomedicine and its global implications. Focusing on the ways in which the application of biomedical technologies bring about radical changes to societies at large, cultural anthropologist Margaret Lock and her co-author physician and medical anthropologist Vinh-Kim Nguyen develop and integrate the thesis that the human body in health and illness is the elusive product of nature and culture that refuses to be pinned down. Introduces biomedicine from an anthropological perspective, exploring the entanglement of material bodies with history, environment, culture, and politics Develops and integrates an original theory: that the human body in health and illness is not an ontological given but a moveable, malleable entity Makes extensive use of historical and contemporary ethnographic materials around the globe to illustrate the importance ofthis methodologicalapproach Integrates key new research data with more classical material, covering the management of epidemics, famines, fertility and birth, by military doctors from colonial times on Uses numerous case studies to illustrate concepts such as the global commodification of human bodies and body parts, modern forms of population, and the extension of biomedical technologies into domestic and intimate domains

An Anthropology of Biomedicine

In this paper, we discuss the Charles et al. approach to shared treatment decision-making (STDM) as applied to patients with chronic conditions and their clinicians. We perceive differences between the type of treatment decisions (e.g. end-of-life care, surgical treatment of cancer) that generated existing approaches of shared decision-making for acute care conditions (including the Charles et al. model) and the treatment decisions that patients with chronic conditions need to make and revisit on an ongoing basis. For instance, treatment decisions in the chronic care setting are more likely to require a more active patient role in carrying out the decision and to offer a longer window of opportunity to make decisions and to revisit and reverse them without important loss than acute care decisions. The latter may require minimal patient participation to realize, are often urgent, and may be irreversible. Given these differences, we explore the applicability of the Charles et al. model of STDM in the chronic care context, especially chronic care that relies heavily on patient self-management (e.g. diabetes). To apply the Charles et al. model in this clinical context, we suggest the need to emphasize the patient–clinician relationship as one of partners in making difficult treatment choices and to add a new component to the shared decision-making approach: the need for an ongoing partnership between the clinical team (not just the clinician) and the patient. In the last section of the paper, we explore potential healthcare system barriers to STDM in chronic care delivery. Throughout the discussion we identify areas for further research.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1369-7625.2006.00359.x

A shared treatment decision-making approach between patients with chronic conditions and their clinicians: the case of diabetes.

Gender Matters: An Integrated Model for Understanding Men's and Women's Health

While biomedicine has successfully created and hoarded a body of technical knowledge to call its own, its knowledge and practices draw upon a background of tacit understandings that extend far beyond medical boundaries The biological reductionism by which modern medicine is frequently characterized is more theoretical than actual; in its effects, biomedicine speaks beyond its explicit reductionist reference through the implicit ways it teaches us to interpret ourselves, our world, and the rela-tionships between humans, nature, self, and society It draws upon and projects cosmology (ways of ordering the world), ontology (assumptions about reality and being), epistemology (assumptions about knowledge and truth), understandings of personhood, society, morality, and religion (what is sacred and profane) Although biomedicine both constitutes and is constituted by society, this interdependency is nevertheless denied by biomedical theory and ideology which claim neutrality and universality

Tenacious Assumptions in Western Medicine

Somatization, the reporting of somatic symptoms that have no pathophysiological explanation, appears to be increasing as sociocultural currents reduce the public's tolerance of mild symptoms and benign infirmities and lower the threshold for seeking medical attention for such complaints. These trends coincide with a progressive medicalization of physical distress in which uncomfortable bodily states and isolated symptoms are reclassified as diseases for which medical treatment is sought. Somatization and medicalization are likely to become more problematic in the era of managed care. Under capitation, providers will have greater incentives to reduce utilization, and somatizing patients may feel forced to express their "dis-ease" in more urgent and exaggerated terms in order to gain access to the physician. In addition, prepaid subscribers will suffer little financial disincentive to seek medical attention for relatively minor complaints; therefore, they are likely to increase the demand for physician consultation. This situation suggests an urgent need to improve the management of somatizing patients. Innovative consultative, behavioral, and educational interventions are now available. In addition, medical professionals should greet the process of medicalization with considerable caution and educate the public more about the normative presence of symptoms and bodily distress in healthy people. Additional research is needed into somatization and its relationship to the demand for medical care. In an era of managed care, increased attention should be devoted to understanding and controlling the demand for care, a large portion of which is symptom driven. (JAMA. 1995;274:1931-1934)

Lorna R. Amarasingham

Papers

Social Contexts of Health, Illness, and Patient Care.

Social Contexts of Health, Illness, and Patient Care