OUTLINE OF LECTURE TOPICS - SPRING TERM



Ant 348y

THE ANTHROPOLOGY OF HEALTH, 2005-2006

OUTLINE OF LECTURE TOPICS - SPRING TERM

JANUARY-APRIL 2006

Professor Richard B. Lee

T.A.s: Lauren Classen, Adrienne Kitchin, Emma Varley

NOTE: TERM TESTS WRITTEN WED. DEC. 7TH WILL BE RETURNED IN CLASS, WED. JAN. 11. MAKEUP TESTS WILL ALSO BE ARRANGED ON THAT DAY.

NOTE: READINGS PACKAGE CAN BE PURCHASED AFTER JAN. 11, FROM QUALITY CONTROL COPY CENTRE 333 BLOOR ST. W. (SOUTH SIDE, JUST WEST OF ST. GEORGE.)

LECTURES AND READING ASSIGNMENTS

1. JAN. 11th ENVIRONMENTAL HEALTH AND JUSTICE I.

READ: Gibbs, Lois Marie (2004) Happening Now: Focus on PVC. And More PVC Facts. CHEJ News Fall 2004 Pp. 1, 9-10. [READINGS PACKAGE #1]

REC: Girdner, Eddie and Jack Smith 2002. Killing Me Softly: Toxic Waste, Corporate Profit, and the Struggle for Environmental Justice. New York: Monthly Review Press.

FILM: “Blue Vinyl” by Judy Helfand. The filmmaker is a DES daughter who became an environmental health activist. The film chronicles her pathway to ecological and then political awareness as she makes the connection between the economic and marketing forces that in the 1950s and 60s, gave millions of pregnant women in the U.S. and Canada the cancer-causing drug Diethylstibestriol (DES), and reliance of modern industry on products as seemingly innocuous as Vinyl siding for the exterior of residential buildings.

2.. JAN. 18th ENVIRONMENTAL HEALTH AND JUSTICE: 2

READ:-Rosenberg, H. 1997. From Trash to Treasure. In J. Schneider and R. Rapp eds. Articulating Hidden Histories. Berkeley: University of California Press. [READINGS PACKAGE #2]

-Fowlkes, M. R. and P. Y. Miller (1984). Unnatural disaster at Love Canal. In Charles and Choon eds. Crisis Management: A Casebook. [READINGS PKG. #3]

-Orkin, Jenna (2004) The lingering cloud of 9/11. from World Trade Center Environmental Organization. website. [READINGS PKG. #4]

REC. - Carson, Rachel 1994 [1962] Silent Spring. New York: Houghton Mifflin.

-Colburn, Theo et. al. 1996. Our Stolen Future. New York: Dutton.

-Steingraber, Sandra 1997. Living Downstream: An Ecologist looks at Cancer

and the Environment. Reading Mass.; Addison-Wesley.

-Gibbs, Lois Marie 1998. Love Canal: The Story Continues. Gabriola Island, B.C. New Society Publishers.

-Gibbs, Lois Marie and the Citizen’s Clearinghouse on Hazardous Wastes 1995. Dying from Dioxin: A Citizens’s Guide to Reclaiming our Health and Rebuilding Democracy. Boston: South End Press.

FILM. Everyday Carcinogens (1999) [An address by renowned ecology activist, poet, and cancer-survivor, Sandra Steingraber, presenting an insightful analysis into the serious contemporary epidemic of environmentally-induced cancers. A speech to have been given at the McMaster University Medical School. The references to the dioxin problems in Hamilton Ontario refer to the Plastimet fire, a Hamilton plastics factory that burnt to the ground unleashing unknown quantities of dioxin into the atmosphere. (35 minutes)]

One of the most vital sectors of medical anthropology in recent years has been the area of environmental health and the environmental justice movement. There is now increasingly conclusive evidence linking many forms of cancer, asthma, and birth defects to industrialization and capitalist expansion. This section of the course will explore the everyday exposure to chemicals such as dioxin, and rising rates of a variety of conditions. It will also look at community mobilization for environmental justice in the face of industries and governments that are often indifferent if not hostile to the claims of citizen’s groups and grass-roots organizations. In a little known twist, the World Trade Center site after 9-11, has become the source of major pollution causing illness in thousands of residents and rescue workers, all covered up by U.S. government agencies responsible for the environment.

This lecture will also focus on the famous case of Love Canal, a toxic waste site in Niagara Falls, N.Y., the subsequent major health problems suffered by the children, and the efforts of the housewife-activist residents to save their families and their community. We will chronicle the career of Lois Gibbs, and her emergence as a leading health and environmental activist, director of the Center for Health Environment and Justice in Washington DC.

3. JANUARY 25th THE SOCIAL AND ECONOMIC DETERMINANTS OF HEALTH: I

READ:- Cockerham, Wm. (1998) Medical Sociology chapter 3 “The social demography of health.” Pp. 34-61. [READINGS PACKAGE #5]

- Freund, Peter and Meredith McGuire (1999). Health, Illness and the Social Body: A Critical Sociology. Pp. 26-37. [READINGS PACKAGE #6]

Poverty is one of the best predictors of poor health. One of Medical Anthropology’s prime directives is to understand health and illness not only cross-culturally but also across lines of class. The lecture examines in more detail how overall health and life-expectancy are affected by socio-economic status. The Cockerham and Freund/McGuire readings examine variables such as age and gender and then go on to explore issues of race, primarily in the U.S. context, highlighting the significantly poorer life chances of African-Americans, particularly males.

4. FEBRUARY 1ST THE SOCIAL AND ECONOMIC DETERMINANTS OF HEALTH: 2

READ: --Hertzman, Clyde (2001) Health and human society. American Scientist 89: 538-45. [READINGS PACKAGE #6]

-Bezruchka, Stephen (2001) Is our society making you sick? Newsweek Feb. 26, 2001. [READINGS PACKAGE #7]

-Bezruchka, Stephen (2004) U.S.A.: RICHEST nation, BIG GAP civilization, SICKEST population. Website: Population Health Forum. [READINGS PACKAGE #8]

- Bezruchka, Stephen (2003) Inequality and population health: The case of post-war Japan. APHA. [READINGS PACKAGE #9]

Further inquiry into the topic of population health brings us to the work of two Canadian social epidemiologists. Hertzman, at the UBC writes about the correlation between health and social inequality and finds direct correlations between high income disparities and higher death rates between US states and Canadian provinces. Bezruchka, at the University of Washington, in two short and one longer reading, presents his intriguing theories on why the US with the world’s largest health care budget ranks 28th in life expectancy, and what factors make Japan first in longevity and other quality-of-life indices (despite much higher levels of smoking).

5. FEBRUARY 8TH HOUR 1: THE REAL WORLD OF POVERTY AND HEALTH: A STUDY OF ‘DEATH WITHOUT WEEPING’

READ: Scheper-Hughes, Nancy. Culture, scarcity and maternal thinking: Maternal detachment and infant survival in a Brazilian shantytown. In UAMA, pp. 375-87.

REC: Scheper-Hughes, Nancy 1992 Death without Weeping. Berkeley CA: University of California Press.

Farmer, Paul 2001. Infections and Inequalities: The Modern Plagues. Berkeley: University of California Press.

Farmer, Paul 2003. Pathologies of Power: Health, Human Rights, and the New War on the Poor. Berkeley: University of California Press.

This reading approaches basic questions in medical anthropology in unorthodox and innovative ways. In a now-classic study, Scheper-Hughes reported on her work in a Brazilian slum, where poverty was so deep and the struggle for survival so intense, that families were unable to care for all the children born. Mothers were forced to decide which of their children they would feed and which they would quietly allow to waste away and die. The apparent “detachment” of the mothers referred to in Scheper-Hughes’ title, led some middle-class observers to question the mothers’ very humanity. Scheper-Hughes brings a more sympathetic analysis of their plight and directs attention to the true inhumanity, the larger society’s persistent indifference to the desperate plight of the poor.

FEBRUARY 8TH HOUR 2: WORKSHOP ON ESSAY TOPICS

In this session the class will divide up according to essay topics and students will compare notes about what materials they are using and what approach they are taking to the subject. Prof. Lee and the T.A.s will circulate from group to group and offer suggestions concerning resources available. Some of the more interesting results may be posted on the ANT. 348 website.

6. FEBRUARY 15TH THE CULTURE OF FAT AND THIN.

READ: -Dettwyler, Katherine A. The biocultural approach in nutritional anthropology: Case Studies of malnutrition in Mali. In UAMA pp. 389-400.

-Brown, Peter J. and Melvin Konner, An anthropological perspective on obesity. In UAMA, pp. 401-13.

-Evenson, Brad (2003) When rich and poor kids eat the same diet, the poor ones get fatter. Source Dennis.Raphael@mail.atkinson.yorku.ca. from National Post. [READINGS PACKAGE #10].

Two contrasting studies throw into marked relief facets of the human condition at the turn of the Millennium. In many parts of the Third World, simply finding enough food is the primary preoccupation of life; while in the developed world the problem is exactly the opposite: the superabundance of food and the problem of overweight and obesity-related diseases. The lecture will also examine the medicalization of weight control in North America and a host of social and psychological issues surrounding it: body image, eating disorders, the fast food industry, diet books, and changes in the production and marketing of food. Finally the question of the relation between class and obesity will be addressed.

**********READING WEEK***************

7. MARCH 1st : THE PLACEBO EFFECT: A STUDY OF THE MEANING RESPONSE AND HEALING.

READ: Moerman, Daniel e. 2002. Medicine, Meaning and the Placebo Effect. Pp. 9-31 [READIN PKG. # 11].

One of the most intriguing phenomena under study by medical anthropologists and related disciplines is the so-called “placebo effect. In a randomized double-blind drug trial among those receiving the actual drug 60 % experienced improvement, whereas among those receiving the placebo the improvement was only 45 %, thereby proving the “efficacy” of the drug and leading to its approval for the market. Few observers stop to ponder the significance that almost half the subjects experienced improvement without any drug at all. Daniel Moerman has pioneered the study of the meaning response in healing and has uncovered some remarkable facts. Moerman presents a theoretical framework for comprehending these difficult to account-for phenomena. The goal of the lecture is to better understand the role of the mind in health and illness and to explore and clarify the bold but enigmatic assertion that “All healing is biological.”

8. MARCH 8TH WOMEN’S HEALTH: THE WORK OF EMILY MARTIN AND RAYNA RAPP AND THE “SCIENCE AS CULTURE PERSPECTIVE.”

READ: -Martin, Emily. Medical metaphors of women’s bodies: menstruation and menopause. In UAMA, pp. 345-56.

-Rapp, Rayna Accounting for Amniocentesis. In UAMA, pp. 366-74.

REC: Martin, Emily (1988) The Woman in the Body. A Cultural Analysis of Reproduction. New York: Beacon.

Rapp, Rayna (1999) Testing Women, Testing the Fetus. London: Routledge.

Sontag, Susan (1988) Illness as Metaphor

McMurtry, John (1998) The Cancer Stage of Capitalism.

It is appropriate that on International Women’s Day, we draw on the pioneering work of Emily Martin and Rayna Rapp to examine the feminist perspective on cultural roots of western biomedicine. While it claims to uphold the highest scientific principles, under closer analysis western biomedicine is not culture-free; it carries with it considerable cultural and ideological baggage drawn from the culture in which it developed. This section of the course will explore feminist standpoint theory and “science as culture” perspectives.

9. MARCH 15th CONTEMPORARY PSYCHIATRY: MENTAL HEALTH AT HOME AND ABROAD IN THE 21ST CENTURY

READ: - Medawar, Charles and Anita Hardon 2004 Medicines out of Control? Antidepressants and the Conspiracy of Good Will. Amsterdam: Aksant Academic Publishing. [READINGS PACKAGE #12]].

WEBSITE: .uk

Please consult the ANT 348 website for more information about the Social Audit, a British-based website directed by Charles Medawar, documenting the underreporting of adverse drug reactions to anti-depressants. Other topics include lax drug testing and suicidality for SSRIs and other anti-depressants.

REC: Healey, David 1997. The Anti-depressant Era.

Healey, David 2003. Let Them Eat Prozac:

Fifty years ago the medical speciality of psychiatry had few methods of treatment at its disposal beyond psychotherapy and a few anti-psychotic drugs offering temporary relief for serious cases. Since then there has been a revolution in the treatment of mental illnesses based on an array of new drugs including the MAOI and SSRI anti-depressants now prescribed for millions of patients. This lecture will explore the conditions of modernity and post-modernity that have created the stresses and strains which the new drugs are designed to alleviate. It will then go on to look at critiques of this pharmaceutical “revolution” in psychiatry. Dr. David Healey and health activist Charles Medawar ask the question: how much of modern treatments are responses to human suffering and how much are driven by the profit-seeking motives of the major drug companies?

10. MARCH 22nd BIG PHARMA, DRUG TESTING AND MARKETING AND THE PEOPLE’S HEALTH

READ: - Angell, Marcia 2004. The truth about the drug companies. New York Review of Books 51(12): pp. 1-13. [READINGS PACKAGE #13].

---Moynihan, Ray and Allan Cassells 2005. Selling Sickness. Introduction and Prologue pp. vii-xx; ch. 1, “Selling to everyone: high cholesterol, pp. 1-21. [READINGS PKG. # 14]

--Anon. 2004. Placebon-T: The New Miracle Drug? news/story/7850667 [READING PKG #15]

REC: Angell, Marcia (2004). The Truth about the Drug Companies: How they Deceive us and What to do about it. New York: Random House.

-Silverstein, Ken 1999. Millions for Viagra, pennies for diseases of the poor. The Nation July 19, 1999, pp. 13-18. [READINGS PKG #16].

-Mokhiber, Russell and Robert Weissman 2002. Stripping Away Big Pharma's Figleaf, Download from Focus on the Corporations website, pp. 1-4. [READINGS PKG #17].

In many ways this may be the most important lecture of the course. Critical Medical Anthropology is committed to looking at the power relations behind today’s medical theories and practices and explore how these relate to the health of the population and the social construction of illness. In last week’s lecture we looked at David Healey’s and Charles Medawar’s critique of the marketing and (mis)uses of SSRI drugs for the treatment of depression. In this session we study the pharmaceutical industry as a whole: the search for new drugs, their resting and approval and the ways they are marketed. The accounts of insiders like Marcia Angell and Allan Cassels reveal an industry in which the search for profits often overrides the primary commitment to drug safety and the people’s health.

NOTE: MAJOR ESSAYS WILL BE DUE TODAY: A SCHEDULE OF LATE PENALTIES WILL BE POSTED. SINCE PAPERS WILL BE RETURNED AFTER THE END OF TERM, STUDENTS SHOULD PROVIDE A STAMPED SELF-ADDRESSED ENVELOPE. Be sure to affix sufficient postage to cover 15+ pages.

11. MARCH. 29th ALTERNATIVE MEDICINE AND MEDICAL PLURALISM

READ: TBA

REC: TBA

ASSIGNMENT: Go to any Health Food store and pick up a copy of the current issue of Vitality: Toronto’s Monthly Wellness Journal or similar publication. Study the diversity of alternative medical modes on offer. Choose one mode and interview one practitioner or obtain a brochure about the mode and come to class prepared to talk about its underlying theory, methods of treatment, and claimed results. Be aware of your own sympathies and prejudices (pro and con). You may also choose one or more modes with which you have had personal experience. Students might also try to obtain a copy of the Jan. 16, 2000 Toronto Star article evaluating the claims of herbal remedies.

This class will be an experimental interactive session on the subject of alternative medicine and therapies. After a introduction by Prof. Lee, members of the class who have volunteered will speak very briefly (2-4 minutes) about their experiences with various modes. This will open up into a general discussion of the efficacy of alternative modes and their relationship to conventional biomedicine. Come to class prepared to contribute to the discussion based on your own experiences or the research that you have done.

12. APRIL 5th CLOSING LECTURE: BIOMEDICINE AND SOCIAL ETHICS: IS THERE A RAPPROCHMENT?

READ: -Haggenhougen, H. Kristian. The epidemiology of functional apartheid and human rights. In UAMA, pp. 434-38.

- Horton, Richard (2004). The Dawn of McScience. New York Review of Books, 51(4). [A review essay on Sheldon Krimsky’s book Science in the Private Interest: Has the Lure of Profits Corrupted Biomedical Research? ] [READINGS PACKAGE # 18].

This lecture will review the material covered in the course from September onward, and attempt to draw together the various themes in an effort to identify major schools and key trends in the field of medical anthropology. We will conclude with a consideration of the readings which strengthen some of the insights of the Critical Medical Anthropology approach.

13. APRIL 12th SECOND TERM TEST IN CLASS

Marking Scheme:

Fall Test: 25%

Spring Test 25%

Major Spring Essay 40%

Class Participation 10%

100%

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