Medical Anthropology

This article examines five common misunderstandings about case-study research: (a) theoretical knowledge is more valuable than practical knowledge; (b) one cannot generalize from a single case, therefore, the single-case study cannot contribute to scientific development; (c) the case study is most useful for generating hypotheses, whereas other methods are more suitable for hypotheses testing and theory building; (d) the case study contains a bias toward verification; and (e) it is often difficult to summarize specific case studies. This article explains and corrects these misunderstandings one by one and concludes with the Kuhnian insight that a scientific discipline without a large number of thoroughly executed case studies is a discipline without systematic production of exemplars, and a discipline without exemplars is an ineffective one. Social science may be strengthened by the execution of a greater number of good case studies.

Key Words health outcomes, Hispanic, assimilation, health behaviors, health care use ■ Abstract This chapter provides an overview of the concept of acculturation and reviews existing evidence about the possible relationships between acculturation and selected health and behavioral outcomes among Latinos. The effect of acculturation on Latino health is complex and not well understood. In certain areas-substance abuse, dietary practices, and birth outcomes-there is evidence that acculturation has a negative effect and that it is associated with worse health outcomes, behaviors, or perceptions. In others-health care use and self-perceptions of health-the effect is mostly in the positive direction. Although the literature, to date, on acculturation lacks some breadth and methodological rigor, the public health significance of findings in areas in which there is enough evidence justifies public health action. We conclude with a set of general recommendations in two areas-public health practice and research-targeted to public health personnel in academia, community-based settings, and government agencies.

Back cover text: If the new fin de siècle marks a recurrence of the real, Bent Flyvbjerg’s Rationality and Power epitomizes that development and sets new standards for social and political inquiry. The Danish town of Aalborg is to Flyvbjerg what Florence was to Machiavelli: a laboratory for understanding the real workings of power, and for grasping what they mean to our more general concerns of social and political organization. Politics, administration, and planning are examined in ways that allow  a rare, in-depth understanding. The reader witnesses, firsthand, the classic and endless drama which defines what modernity and democracy are and can be.

Associations between intimate partner violence (IPV) and poor physical and mental health of women have been demonstrated in the international and national literature across numerous studies. is paper presents a review of the literature on this topic. e 75 papers included in this review cover both original research studies and those which undertook secondary analyses of primary data sources. e reviewed research papers published from 2006 to 2012 include quantitative and qualitative studies from Western and developing countries. e results show that while there is variation in prevalence of IPV across various cultural settings, IPV was associated with a range of mental health issues including depression, PTSD, anxiety, self-harm, and sleep disorders. In most studies, these effects were observed using validated measurement tools. IPV was also found to be associated with poor physical health including poor functional health, somatic disorders, chronic disorders and chronic pain, gynaecological problems, and increased risk of STIs. An increased risk of HIV was reported to be associated with a history of sexual abuse and violence. e implications of the study �ndings in relation to methodological issues, clinical signi�cance, and future research direction are discussed.

As the use of qualitative inquiry increases within the field of social work, researchers must consider the issue of establishing rigor in qualitative research. This article presents research procedures used in a study of autoethnographies that were written regarding the experience of being Jewish. In this project, the researchers utilized reflexivity, audit trail, triangulation by observer, peer debriefing, member check and prolonged engagement in order to manage the threats to trustworthiness as discussed by Padgett (1998). Implications of the project suggest that research procedures utilized by qualitative researchers to establish rigor are an important way to increase our confidence that the voice of the participants is heard, therefore fitting the mission of the social work profession.

This article presents the theoretical and methodological considerations behind a research method which the author calls ‘phronetic planning research’. Such research sets out to answer four questions of power and values for specific instances of planning: (1) Where are we going with planning? (2) Who gains and who loses, and by which mechanisms of power? (3) Is this development desirable? (4) What, if anything, should we do about it? A central task of phronetic planning research is to provide concrete examples and detailed narratives of the ways in which power and values work in planning and with what consequences to whom, and to suggest how relations of power and values could be changed to work with other consequences. Insofar as planning situations become clear, they are clarified by detailed stories of who is doing what to whom. Clarifications of that kind are a principal concern for phronetic planning research and provide the main link to praxis.

Taken together, the works of Jurgen Habermas and Michel Foucault highlight an essential tension in modernity. This is the tension between the normative and the real, between what should be done and what is actually done. Understanding this tension is crucial to understanding modern democracy, what it is and what it could be. It has been argued that an effective way of making democracy stronger is to strengthen civil society. This article contains a comparative analysis of the central ideas of Habermas and Foucault as they pertain to the question of democracy and civil society. More specifically, the discourse ethics of Habermas is contrasted with the power analytics and ethics of Foucault evaluating their usefulness for those interested in understanding, and bringing about, democratic social change.

Increases in immigration have led to an enormous growth in the number of cross-linguistic medical encounters taking place throughout the United States. In this article the role of hospital-based interpreters in cross-linguistic, internal medicine `medical interviews' is examined. The ...

The finding that expressed emotion is associated with the course of psychiatric disorder has generated a great deal of clinical and research interest in expressed emotion as an important
risk factor. Theoretical elucidation of the construct of expressed emotion has lagged considerably behind this interest, however. The authors contribute to a dialogue on what is inside the "black box'' called expressed emotion. They argue that cross-cultural research can provide an empirical basis for the theoretical grounding of expressed emotion factors. A comparative
approach reveals that the construct of expressed emotion is essentially cultural in nature. The constellation of emotions, auitudes, and behaviors that are indexed by the expressed emotion method represent cross-culturally variable features of family response to an ill relative. Questions surrounding the cultural validity of the construct of expressed emotion, the qualitative dimensions of expressed emotion, and statistically significant cross-cultural variations in expressed
emotion profiles are discussed. Finally, the authors provide an outline of diverse (cultural, psychobiological, social-ecological) features of expressed emotion. Anthropological analysis of expressed emotion reveals that although expressed emotion indexes a Pandora's box of diverse features, culture provides the context of variation through which these factors are most productively analyzed.
(AMJ Psychiatry 1992; 149:9-21)

Sucrose-phosphate synthase SPS; (EC 2.4.1.14) from maize (Zea mays L. cv. Pioneer 3184) leaves was partially purified and kinetically characterized. Maize SPS was activated by glucose-6-phosphate (G-6-P) due to an increase in Vmax and a decrease in the Km for UDP-glucose. The UDP-glucose saturation profile was biphasic; thus two Km values for UDP-glucose were calculated. Inhibition by inorganic phosphate was observed only in the presence of G-6-P. Chromatography of partially purified maize leaf extracts on hydroxyapatite resolved two forms of SPS activity, which differed in their affinity for UDP-glucose and in the degree of activation by G-6-P. SPS was partially purified from maize leaves that were harvested in the light and in the dark. The light enzyme had a higher specific activity than the enzyme isolated from dark harvested leaves, and this difference persisted during enzyme purification. The apparent molecular weight (Stokes radius) of the light enzyme was 547 kDa, which was greater than that of the dark enzyme (457 kDa). Light and dark SPS differed in their affinities for UDP-glucose in the absence G-6-P. Both the light and the dark SPS were activated by G-6-P; the Km for UDP-glucose of the light enzyme was lowered by G-6-P, while the Km for UDP-glucose for the dark enzyme remained unchanged. These results suggest that light activation involves a conformational change that results in differences in maximum velocity, substrate affinities and regulation by metabolites. Chromatography of either the light or dark SPS on hydroxyapatite yielded two peaks of enzyme activity, suggesting that the occurrence of the two activity peaks was not due to an interconversion of the light and dark forms.

No single method exists for discovering a new drug. Each process of drug invention and each research team have their own way of working and a different number of molecules to test, depending on their methods and aims. Researchers can also build on “previous empirical discoveries” (in the case of Hoffman’s synthesis of aspirin, for example), on “chance observations” (in the case of penicillin, for example) and on “clinical observations” (in the case of the first psychotropic drug). Innovation is the result of diverse processes. In order to understand the genesis and development of a drug, it is therefore necessary to assess the innovation process as a whole, from the conditions for identifying and evaluating molecules to the development of drugs through the pharmaceutical industry’s investment in R&D and patent strategy.

In this paper we argue that the use of the communicative theory of Jürgen Habermas in planning theory is problematic because it hampers an understanding of how power shapes planning. We posit an alternative approach based on the power analytics of Michel Foucault which focuses on ‘what is actually done’, as opposed to Habermas’s focus on ‘what should be done’. We discuss how the Foucauldian stance problematises planning, asking difficult questions about the treatment of legitimacy, rationality, knowledge and spatiality. We conclude that Foucault offers a type of analytic planning theory which offers better prospects than does Habermas for those interested in understanding and bringing about democratic social change through planning.

Editors | João Biehl & Byron J. Good & Arthur Kleinman

Contributors | Amélie Oksenberg Rorty, Arthur Kleinman and Erin Fitz-Henry, Veena Das, Ranendra K. Das, Paul Rabinow, Stephen Greenblatt, Allan Young, Nancy Scheper-Hughes, Byron J. Good, Subandi, Mary-Jo DelVecchio Good, Ellen Corin, Anne M. Lovell, Evelyn Fox Keller, Eric L. Krakauer, João Biehl, Michael M. J. Fischer

About the Book | This innovative volume is an extended intellectual conversation about the ways personal lives are being undone and remade today. Examining the ethnography of the modern subject, this preeminent group of scholars probes the continuity and diversity of modes of personhood across a range of Western and non-Western societies. Contributors consider what happens to individual subjectivity when stable or imagined environments such as nations and communities are transformed or displaced by free trade economics, terrorism, and war; how new information and medical technologies reshape the relation one has to oneself; and which forms of subjectivity and life possibilities are produced against a world in pieces. The transdisciplinary conversation includes anthropologists, historians of science, psychologists, a literary critic, a philosopher, physicians, and an economist. The authors touch on how we think and write about contingency, human agency, and ethics today.

Will to Live tells how Brazil, against all odds, became the first developing country to universalize access to life-saving AIDS therapies–a breakthrough made possible by an unexpected alliance of activists, government reformers, development agencies, and the pharmaceutical industry. But anthropologist João Biehl also tells why this policy, hailed as a model worldwide, has been so difficult to implement among poor Brazilians with HIV/AIDS, who are often stigmatized as noncompliant or untreatable, becoming invisible to the public. More broadly, Biehl examines the political economy of pharmaceuticals that lies behind large-scale treatment rollouts, revealing the possibilities and inequalities that come with a magic bullet approach to health care.

By moving back and forth between the institutions shaping the Brazilian response to AIDS and the people affected by the disease, Biehl has created a book of unusual vividness, scope, and detail. At the core of Will to Live is a group of AIDS patients–unemployed, homeless, involved with prostitution and drugs–that established a makeshift health service. Biehl chronicled the personal lives of these people for over ten years and Torben Eskerod represents them here in more than one hundred stark photographs.

Ethnography, social medicine, and art merge in this unique book, illuminating the care and agency needed to extend life amid perennial violence. Full of lessons for the future, Will to Live promises to have a lasting influence in the social sciences and in the theory and practice of global public health.

Princeton University Press

AWARDS
2008 Wellcome Medal for Anthropology as Applied to Medical Problems, Royal Anthropological Institute of Great Britain and Ireland.

2008 Diana Forsythe Prize of the Committee on Science, Technology and Computing and the Society for the Anthropology of Work, American Anthropological Association.

Energy capture and conversion is fundamental to human existence, and over the past three decades anthropologists have used a number of approaches which incorporate energetics measures in studies of human ecology. In particular, measures of community-level energy balances and flows have been used to study human subsistence within the adaptability framework. Recent advances in energetics methodology are considerable, making measurements more practicable and accurate. They include the following: the development of less invasive methods for the measurement of energy expenditure in the field; improvements in, and re-evaluation of, older techniques for energy expenditure measurement; and an improved understanding of the physiological basis of adaptation to high and low energy intakes. This article describes and evaluates field methods currently available for estimating energy intake, expenditure, and storage. All three types of method can be used to examine energy balance over periods of more than a month, and energy nutritional stress in individuals and communities. Energy intake measures are the least accurate and most time-consuming, while anthropometric body composition methods are the most robust in a wide variety of field conditions. Energy expenditure methods are intermediate in accuracy, but they can be used to address issues of work output, physical performance, and metabolic adaptation, as well as short-term energy balance.

This article provides an answer to what has been called the biggest problem in theorizing and understanding planning: the ambivalence about power found among planning researchers, theorists, and students. The author narrates how he came to work with issues of power and gives an example of how the methodology he developed for power studies—phronetic planning research—may be employed in practice. Phronetic planning research follows the tradition of power studies running from Machiavelli and Nietzsche to Michel Foucault and Pierre Bourdieu. It focuses on four value-rational questions: (1) Where are we going with planning? (2) Who gains and who loses, and by which mechanisms of power? (3) Is this development desirable? (4) What should be done? These questions are exemplified for a specific instance of Scandinavian urban planning. The author finds that the questions, and their answers, make a difference to planning in practice. They make planning research matter.

A range of digitised health promotion practices have emerged in the digital era. Some of these practices are voluntarily undertaken by people who are interested in improving their health and fitness, but many others are employed in the interests of organisations and agencies. This article provides a critical commentary on digitised health promotion. I begin with an overview of the types of digital technologies that are used for health promotion, and follow this with a discussion of the socio-political implications of such use. It is contended that many digitised health promotion strategies focus on individual responsibility for health and fail to recognise the social, cultural and political dimensions of digital technology use. The increasing blurring between voluntary health promotion practices, professional health promotion, government and corporate strategies requires acknowledgement, as does the increasing power wielded by digital media corporations over digital technologies and the data they generate. These issues provoke questions for health promotion as a practice and field of research that hitherto have been little addressed.

The Aalborg Project may be interpreted as a metaphor of modern politics, modern administration and planning, and of modernity itself. The basic idea of the project was comprehensive, coherent, and innovative, and it was based on rational and democratic argument. During implementation, however, when idea met reality, the play of Machiavellian princes, Nietzschean will to power, and Foucauldian rationality-as-rationalization resulted in the fragmentation of the project.

In this article, I examine the codification of an Italian work-related illness caused by mobbing, a type of psychological harassment that emerged at the moment neoliberal policies transformed Italy's historically protectionist labor market. I trace how the medicalization of mobbing has expanded workers’ access to compensation, resources, and discursive tools for criticizing neoliberal labor conditions, even as it has produced new structures of surveillance. I unravel the neoliberal politics of a state that protects workers’ health yet governs worker–citizens through an apparatus of medical experts. I find that workers’ labor problems are experienced and managed as bodily problems in ways important to remaking Italian citizenship. [neoliberalism, state, labor, biopolitics, citizenship, bodies, Italy]

The current North American successful aging movement offers a particular normative model of how to age well, one tied to specific notions of individualist personhood especially valued in North America emphasizing independence, productivity, self-maintenance, and the individual self as project. This successful aging paradigm, with its various incarnations as active, healthy and productive aging, has received little scrutiny as to its cultural assumptions. Drawing on fieldwork data with elders from both India and the United States, this article offers an analysis of cultural assumptions underlying the North American successful aging paradigm as represented in prevailing popular and scientific discourse on how to age well. Four key themes in this public successful aging discourse are examined: individual agency and control; maintaining productive activity; the value of independence and importance of avoiding dependence; and permanent personhood, a vision of the ideal person as not really aging at all in late life, but rather maintaining the self of one's earlier years. Although the majority of the (Boston-area, well-educated, financially privileged) US elders making up this study, and some of the most cosmopolitan Indians, embrace and are inspired by the ideals of the successful aging movement, others critique the prevailing successful aging model for insufficiently incorporating attention to and acceptance of the human realities of mortality and decline. Ultimately, the article argues that the vision offered by the dominant successful aging paradigm is not only a particular cultural and biopolitical model but, despite its inspirational elements, in some ways a counterproductive one. Successful aging discourse might do well to come to better terms with conditions of human transience and decline, so that not all situations of dependence, debility and even mortality in late life will be viewed and experienced as "failures" in living well.

Employee voice has largely been examined as a universal concept in unionized and non-unionized settings, with insufficient attention to diversity of workers (Rank, 2009). As invisible minorities, gay, lesbian, bisexual, and transgender employees provide a valuable focal point from which to examine employee voice mechanisms. Positing that gay, lesbian, bisexual, and transgender (GLBT) employees are often silenced by what is perceived as “normal” in work organizations, this paper considers some of the negative consequences of this silencing, and proposes ways in which voices of GLBT employees and other invisible minorities may be heard. With its relevance to policies and practices in other organizations, the “don’t ask, don’t tell” policy of the U.S. military is used as a lens through which to analyze voice, silence, and GLBT employees. Specific recommendations are provided for HR managers to facilitate the expression of voice for GLBT employees in today’s increasingly diverse organizations.

This is the pilot study for our new project of the same name. The paper asks questions about the resilience of radical
gynaecological surgeries, such as hysterectomy and oophorectomy,
from the moment of their widespread use in Western European
and American practices of the late nineteenth century, to their
renewed increase in the Indian subcontinent and Africa into our
own time.

Background: Viewed through the micro focus of an interpretive lens, medical anthropology remains mystified because interpretivist explanations seriously downplay the given context in which individual health seeking-behaviours occur. This paper draws upon both the interpretivist and political economy perspectives to reflect on the ethno medical practices within the Korean-Australian community in Sydney.

McMath (2105) argues that while a child’s interest in future autonomy should generally be respected in relation to his own interests, the well-being of other parties may require that his autonomy be overridden in the interests of public health. At the same time, McMath seems conflicted about whether the seriousness of the threat of HIV, especially in developed countries, can in fact justify the sacrifice of individual freedom that is entailed by circumcision in infancy or early childhood (that is, the freedom to make one’s own decision about whether to undergo an elective genital surgery at an age of understanding). In this context, McMath’s discussion about the child’s interest in making decisions that reflect his mature preferences and values when he is older is compelling. But when considering arguments for paternalism in the name of public health, we suggest that McMath moves too quickly from certain empirical premises to associated policy proposals, skipping over gaps in evidence as well as important questions of value.

The continual process of mental disease classification in U.S. psychiatry is assumed to reflect advancing professional knowledge of these disorders. To date, the American Psychiatric Association has developed four standard classifications, or nosologies, called Diagnostic and Statistical Manuals ('DSMs').

Drawing on the tenets of critical medical anthropology, this article illustrates the relation between violence, drug use, prostitution, and HIV risk in a group of 35 impoverished women living in inner-city Hartford, Connecticut. The study presented here provides an illustration of the role prostitution plays in the SAVA (Substance Abuse, Violence, and AIDS) syndemic as conceptualized by Singer (1996). By focusing on the life experiences of women engaged in streetlevel prostitution, this article attempts to fill the gaps in research that deals simultaneously with these mutually reinforcing epidemics. It shows that streetwalkers' continuous exposure to violence, both as victims and as witnesses, often leaves them suffering from major emotional trauma. In the absence of adequate support services, women who have been victimized may turn to drug use in an attempt to deal with the harsh realities of their daily lives. In turn, the need for drugs, coupled with a lack of educational and employment opportunities, may lead women into prostitution. Life on the street increases women's risk for physical, emotional, and sexual abuse as well as their risk for

Abstract. Purpose of review: To survey recent arguments in favor of preserving the genital autonomy of children—female, male, and intersex—by protecting them from medically unnecessary genital cutting practices. Recent findings: Nontherapeutic female, male, and intersex genital cutting practices each fall on a wide spectrum, with far more in common than is generally understood. When looking across cultures and comparing like cases, one finds physical, psychosexual, and symbolic overlaps among the three types of cutting, suggesting that a shared ethical framework may be needed. Summary: All children have an interest in genital autonomy, regardless of their sex or gender.

In this paper, I firstly situate the current rise of interest in epigenetics in the broader history of attempts to go “beyond the gene” in twentieth-century biology. In the second part, after a summary of the main differences between epigenetic and genetic mutations, I consider what kind of implications the sui generis features of epigenetic mutations may have for the social sciences. I focus in particular on two sites of investigation: (a) the blurring of the boundaries between natural and social inequalities in theories of justice and their possible implications for public policy and public health and (b) a deepening of the notion that the constitution of the body is deeply dependent on its material and socially shaped surroundings (“embodied constructivism”). In conclusion, I advance some cautionary reflections on some of the (known and unprecedented) problems that the circulation of epigenetics in wider society may present.

Ethanopharmacological relevance: The process of formation or appearance of a urinary stone anywhere in the
renal tract is known as urolithiasis. It is a longstanding health problem, known to exist since early age of
civilization. Records about symptoms, signs and treatment strategies of urinary stones diseases are found in the
several ancient texts of traditional medicines such as Ayurveda, Traditional Chinese Medicine (TCM), Siddha
and Unani. In Ayurveda, urolithiasis has been considered as one of the eight most troublesome diseases.
Ayurvedic management and cure of urinary stone involves herbal formulas, alkaline liquids and surgical
procedures. Whereas, TCM recommends polyherbal drugs, acupuncture and mexibustion for treatment of the
urinary stones. Among these therapies, herbal remedies are in practice till today for the treatment and cure
urinary stone diseases.
Materials and methods: A comprehensive review of the scientific literature about pathophysiology of urinary
stones and antiurolithiatic plants was undertaken using the following bibliographic databases: MEDLINE/
PubMed, Scopus, Web of Knowledge and Google Scholar. The search was conducted from publications from all
years until Dec., 2015 by combination of the search terms and Boolean operators; ‘urinary stone’ OR ‘kidney
stone’ AND ‘plant’ OR ‘medicine’ OR ‘antiurolithiatic plants’. Outputs were restricted to those completed studies
only published in English. In this review, literatures about plants which are used as diuretic and/or in treatment
urinary tract infections have not also been considered. The Plant List and Royal Botanical Garden, Kew
databases were used to authenticate botanical names of plants. Books and monographs published in English
were used to collect information about historical records of antiurolithiatic plants.
Results: Recent pharmacological interventions accredited ancient antiurolithiatic claims to several plants and
their formulations. The majority of antiurolithiatic plants were found to either dissolve the stones or inhibit the
process of urinary stone formation. Plants such as Phyllanthus niruri L. and Elymus repens (L.) Gould, as well
as herbal products including ‘Wu-Ling-San’ formula, ‘Cystone’ and ‘Herbmed’ have been proved their utility as
promising antiurolithiatic medicines in the different phases of clinical trials. In addition, some of the isolated
phytochemicals such as berberine, lupeol, khelin, visnagin, 7-hydroxy-2′,4′,5′-trimethoxyisoflavone and 7-
hydroxy-4′-methoxyisoflavone were reported to have potent antiurolithiatic activity.
Conclusion: In ancient medicinal texts, antiurolithiatic potential has been ascribed to several plants and their
formulations. Present scientific studies provide scientific evidences for few of these claims however, they are
insufficient to establish many of these plants and herbal formulations as therapeutic remedies for the treatment
and management of urinary stones. Conversely, findings of pre-clinical and clinical studies about some plants
and herbal formulations are promising, which underlines the utility of herbal remedies as alternative medicines
for the treatment and management of urinary stones in the future.