Medical Anthropology (ANG 6737)

The semester is drawing to a close, but strangely, the class blog has gained new life. I’ve added a few new items in the last week, and there’s a new discussion unfolding in the comments on my post about female circumcision.

So here’s the question: how many of you would like to see the blog continue? News related to medical anthropology didn’t end with the semester, of course. If you’d like the blog to keep going, too, leave a comment to let me know.

Traditional medicine — and medicinal plants in particular — have been in the news of late. Two weeks ago, for example, the New York Times reported that “Dragon’s blood” is good for you:

Researchers have discovered that a plant widely used in traditional Chinese medicine contains compounds that slow the growth of the germ that causes most peptic ulcers.

The chemists, led by Weimin Zhao of the Chinese Academy of Sciences, isolated 22 compounds from the treelike plant, Dracaena cochinchinensis, which gives off a dark-red resinous substance called dragon’s blood. They found two that were effective against the ulcer bacterium, Helicobacter pylori, and eight others that worked as blood thinners.

Their report appears in the October issue of The Journal of Natural Products.

Earlier this year, NPR ran a series on “Sacred, threatened plants of the Himalayas.” The series includes a report on Tibetan medicinal plants, which are increasingly endangered by global climate change and by global demand for the plants.

As you read or listen to these stories, keep in mind some of the different perspectives we encountered from medical anthropology this semester. How can we understand the ecological relationships between plant biodiversity and ethnomedical knowledge? What factors at a global and local level influence the use, distribution, and ownership of medicinal plants? How do U.S. media outlets depict traditional healing practices and the medicinal plants, relative to Western biomedicine? What values underlie the standards of evidence used to evaluate the efficacy of traditional healing practices?

Two weeks ago class was cancelled while I was in Washington, DC for the annual meeting of the American Anthropological Association. The antropologi.info is running a series of posts summarizing a few of the hundreds of sessions that took place at the AAA. The latest post features a debate at AAA over female genital cutting:

Is female circumcision violence against women or a feminist act? Are critics of this practice guilty of cultural imperialism? Those questions were debated at the American Anthropological Association’s annual meeting in Washington – among others by African anthropologists who have undergone the procedure themselves.

I didn’t see the original session, so I don’t know all the details. But it has been getting lots of coverage, including a feature in two posts (1, 2) by New York Times blogger John Tierney. In the second post, Tierney reproduces a detailed response to a reader’s question from University of Chicago anthropologist Richard Shweder.

Several of you wrote about female circumcision in your research papers. What’s your take on the discussion in the blogosphere, based on your research in writing the paper? Would you change anything about your paper, based on the issues Shweder raises? How does the issue of female circumcision relate to the concepts of cultural relativism and ethnocentrism?

By next Wednesday, most of you will have left town for the break; those of you left behind may be studying for finals. But if you’re here and need a study break, here’s something to consider. The narrative medicine group at the College of Medicine will hold a discussion of A Closer Walk, a documentary about the global AIDS epidemic, which aired on PBS last year. See more about the film and related resources on its website.

The discussion will take place at noon on Wednesday, December 12, in room CG-041/42 (the communicore building at the College of Medicine).

Today the Boston Globe reports on a debate between scientists over whether climate change is associated with the spread of infectious disease. The debate took place during a workshop on global climate change at the Institute of Medicine, the health-related branch of the National Academy of Sciences.

The skeptical voice, according to the Globe, was Donald S. Burke, Dean of the Graduate School of Public Health at the University of Pittsburgh. Burke argued that there remains a lot we don’t know about the effects of climate change on health. He expressed caution about limits to existing data and argued that we can’t yet establish a causal relationship between climate change and increasing rates of infectious diseases like dengue fever, influenza, and West Nile virus.

Paul R. Epstein, from the Center for Health and the Global Environment at Harvard, disagreed. He argued that climate change was involved in changing disease ecologies related to the spread of infectious disease.

The Globe article points out that the scientific debate parallels debate between the Bush administration and several states, and that it relates to policy deliberations on Capitol Hill and around the world. What are some of the different ways that medical anthropologists might approach this debate?

As we discussed in class on Tuesday, you are required to read and provide constructive feedback on the drafts of research papers written by members of your peer response group. Your feedback is due to members of your group and to me by Tuesday, Nov. 20.

Here I am posting the form you should use in reviewing each other’s work. Most word processing software can open this file. If you have problems, please post a comment below.

For each paper you review, please add your comments in response to each question and send the final version to the author and to me as an email attachment by Nov. 20.

Peer response form

A few weeks ago, we discussed a paper published in 2005 showing that people who are defined as overweight (BMI of 25-<30) actually have the lowest risk of mortality. Today, a new paper sheds more light on the association between BMI and mortality by looking at specific causes of death.

It turns out that people who are officially defined as overweight have a lower overall risk of mortality because they are less likely to die from diseases like Alzheimer’s, infections, and lung disease. At the same time, being overweight (but not obese) does not appear significantly to increase the risk of dying from cancer or heart disease.

In a New York Times story about this paper, several observers echoed some of our discussion in class:

Some who studied the relation between weight and health said the nation might want to reconsider what are ideal weights.

“If we use the criteria of mortality, then the term ‘overweight’ is a misnomer,” said Daniel McGee, professor of statistics at Florida State University.

“I believe the data,” said Dr. Elizabeth Barrett-Connor, a professor of family and preventive medicine at the University of California, San Diego. A body mass index of 25 to 30, the so-called overweight range, “may be optimal,” she said.

But as some of you suggested in class, mortality isn’t the only relevant outcome. Others argue that people who are overweight are more likely to develop heart disease, diabetes, and other conditions even if they are not more likely to die prematurely as a result.

On that note, another paper in today’s issue of JAMA examined self-reports of disability among people of varying weights at two points in time. They show that people defined as obese (BMI ? 30) are more likely to be disabled and that the disability gap between people in the obese and normal-weight categories has increased over time. But this finding appears to hold only for the obese category. People with BMIs in the range of 25-30—officially overweight—do not report higher levels of disability.

Causes of Death Are Linked to a Person’s Weight – New York Times

Earlier this month, Paul Farmer delivered a keynote address at the Heller School for Social Policy and Management at Brandeis University. The Heller School has posted a video of Farmer’s speech online, so you can see it too.

The talk focuses on the policy implications of global inequities in health. You will recognize the core arguments from our discussion of Infections and Inequalities, but the examples and evidence come largely from Farmer’s work since that book was published. (Those of you who attended Tracy Kidder’s talk two weeks ago will also recognize some of the photos.)

The best part, if you ask me, is the question and answer period — so hang in there through the end. What aspects of the talk do you find most compelling? In what ways does Farmer draw on his training in anthropology, not just in medicine?

Paul Farmer keynote address at the Heller School

In class this week, we briefly discussed the recent paper by Lauderdale and colleagues, which compared rates of preterm delivery for all births in California during six months before and after September 11, 2001. For women with Arabic names — and only for women with Arabic names — the risk of having a low birth weight baby increased 34% in the six months after 9/11.

Now, a new paper in the journal Human Reproduction reports that the trauma of September 11 also had an impact on the distribution of birthweight in New York City. Eskenazi and colleagues analyzed birth certificate data for all births in NYC and in upstate New York between January 1996 and December 2002. They found an increase in the number of babies born with low birth weights in the week following Sept. 11 in NYC, but not in upstate New York. They also found an increased risk of low birthweight for infants born around the New Year and for those born 33-36 weeks after Sept. 11. The first group would have been in the first or second trimester of gestation on Sept. 11; the second would have been conceived on or around Sept. 11.

The authors interpret these patterns in terms of the stress process. For women living in NYC, the World Trade Center disaster would have been a particularly traumatic event. The physiological response to such an acute stressor may have led to early birth and lower birthweight for some infants. Eskenazi and colleagues are not able to test the hypothesis thoroughly, because they did not have access to high quality data on gestational age. But in the context of other work on the stress process and pregnancy outcomes, the hypothesis is certainly plausible.

Of course, the acute trauma of September 11 is altogether different from the chronic stressors of everyday life. What significance do you think this new study has for our understanding of social inequalities in birth outcomes?

Romantic relationships can fill you with happiness, but these same relationships can also be a significant source of stress in daily life. The results of a new study, recently published in the Archives of Internal Medicine, suggest that relationship difficulties can quite literally break your heart.

In examining data from a long-term cohort study of British civil servants, the authors find that negative interactions in close relationships increase risk for incident coronary heart disease. This relationship exists even when controlling for sociodemographic characteristics, biological and psychosocial factors, and health-related behaviors. The results suggest that negative interactions are more likely to occur in women and lower-income civil servants; however, negative interactions produce similar effects on heart disease regardless of sex or social position.

Does this interaction seem to you like a human universal, a product of our shared evolutionary heritage? Or is this more likely the product of Western society? In light of your recent readings on the interaction of stress, human biology, and culture, how might we examine Western notions of romantic love and the meaning of negative interactions in a cross-cultural comparison to explore these questions?