Literature Review
I apologize for falling behind a bit with the Literature Reviews. Formatting problems in attempting to cut and paste abstracts has proven to be more difficult and more time-consuming than I had anticipated.
Today's Review will collate articles from:
Journal of Law, Medicine, & Ethics
J. Law, Medicine, & Ethics, Vo.. 34, no. 3 (Fall 2006)
The Fall 2006 issue of the JLME featured a Symposium on uses of racial and ethnic categories in biomedical research. Abstracts are included where available.
Wolf, Susan M.
Introduction: debating the use of racial and ethnic categories in research.
Duster, Troy.
Lessons from history: why race and ethnicity have played a major role in biomedical research.
Cho, Mildred K.
Racial and ethnic categories in biomedical research: there is no baby in the bathwater.
Abstract:
The use of racial categories in biomedicine has had a long history in the United States. However, social hierarchy and discrimination, justified by purported scientific differences, has also plagued the history of racial categories. Because "race" has some correlation with biological and genetic characteristics, there has been a call not to "throw the baby out with the bathwater" by eliminating race as a research or clinical category. I argue that race is too undefined and fluid to be useful as a proxy for biology or genetics.
Bhopal, Raj.
Race and ethnicity: responsible use from epidemiological and public health perspectives.
Abstract:
While the concepts of race and ethnicity have been abused historically, they are potentially invaluable in epidemiology and public health. Epidemiology relies upon variables that help differentiate populations by health status, thereby refining public health and health care policy, and offering insights for medical science. Race and ethnicity are powerful tools for doing this. The prerequisite for their responsible use is a society committed to reducing inequalities and inequities in health status. When this condition is met, it is irresponsible not to utilize these concepts.
Foster, Morris W.
Analyzing the use of race and ethnicity in biomedical research from a local community perspective.
Abstract:
Lost in the debate over the use of racial and ethnic categories in biomedical research is community-level analysis of how these categories function and influence health. Such analysis offers a powerful critique of national and transnational categories usually used in biomedical research such as "African-American" and "Native American." Ethnographic research on local African-American and Native American communities in Oklahoma shows the importance of community-level analysis. Local ("intra-community") health practices tend to be shared by members of an everyday interactional community without regard to racial or ethnic identity. Externally created ("extra-community") practices tend to be based on the existence of externally-imposed racial or ethnic identities, but African-American and Native American community members show similar patterns in their use of extra-community practices. Thus, membership in an interactional community seems more important than externally-imposed racial or ethnic identity in determining local health practices, while class may be as or more important in accounting for extra-community practices.
Brewer, Rose M.
Thinking critically about race and genetics.
Abstract:
We must critically rethink race and genetics in the context of the new genetic breakthroughs and haplotype mapping. We must avoid the slippery slope of turning socially constructed racial categories into genetic realities. It is a potentially dangerous arena given the history of racialized science in the United States and globally. Indeed, the new advances must be viewed in the context of a long history of racial inequality, continuing into the current period. This is more than a question of how carefully we use categories of analysis such as race. Justice and equity must be core to our considerations. There is a community stake in this work that must be seriously considered and included in decision making. A progressive and critical analysis is in order.
Winker, Margaret A.
Race and ethnicity in medical research: requirements meet reality.
Abstract:
Race and ethnicity are commonly reported variables in biomedical research, but how they were determined is often not described and the rationale for analyzing them is often not provided. JAMA improved the reporting of these factors by implementing a policy and procedure. However, still lacking are careful consideration of what is actually being measured when race/ethnicity is described, consistent terminology, hypothesis-driven justification for analyzing race/ethnicity, and a consistent and generalizable measurement of socioeconomic status. Furthermore, some studies continue to use race/ethnicity as a proxy for genetics. Research into appropriate measures of race/ethnicity and socioeconomic factors, as well as education of researchers regarding issues of race/ethnicity, is necessary to clarify the meaning of race/ethnicity in the biomedical literature.
Roberts, Dorothy E.
Legal constraints on the use of race in biomedical research: toward a social justice framework.
Abstract:
This article addresses three questions concerning the legal regulation of the use of race as a category in biomedical research: how does the law currently encourage the use of race in biomedical research?; how might the existing legal framework constrain its use?; and what should be the law's approach to race-based biomedical research? It proposes a social justice approach that aims to promote racial equality by discouraging the use of "race" as a biological category while encouraging its use as a socio-political category to understand and investigate ways to eliminate disparities in health status, access to health care, and medical treatment.
Lillquist, Erik, and Charles A. Sullivan.
Legal regulation of the use of race in medical research
Abstract:
In this article, we discuss current legal restrictions governing the use of race in medical research. In particular, we focus on whether the use of race in various types of research is presently permitted under federal law and the federal constitution. We also discuss whether federal restrictions on the use of race in research ought to be expanded, and whether federal policies that encourage the use of race ought to be abandoned.
Cohn, Jay N.
The use of race and ethnicity in medicine: lessons from the African-American heart failure trial.
Abstract:
Race or ethnic identity, despite its imprecise categorization, is a useful means of identifying population differences in mechanisms of disease and treatment effects. Therefore, race and other arbitrary demographic and physiological variables have appropriately served as a helpful guide to clinical management and to clinical trial participation. The African-American Heart Failure Trial was carried out in African-Americans with heart failure because prior data had demonstrated a uniquely favorable effect in this subpopulation of the drug combination in BiDil. The remarkable effect of the drug in reducing mortality in this study has illuminated an important new mechanism of therapy for heart failure. Application of these findings need not be confined to the population studied, but the observation highlights the need for more precise ways to identify individual responsiveness to therapy.
Bloche, M. Gregg.
Race, money and medicines.
Magnusson, Roger S.
The devil's choice: re-thinking law, ethics, and symptom relief in palliative care.
Abstract:
Health professionals do not always have the luxury of making "right" choices. This article introduces the "devil's choice" as a metaphor to describe medical choices that arise in circumstances where all the available options are both unwanted and perverse. Using the devil's choice, the paper criticizes the principle of double effect and provides a re-interpretation of the conventional legal and ethical account of symptom relief in palliative care.
Clark, Peter A.
Medical ethics at Guantanamo Bay and Abu Ghraib: the problem of dual loyalty.
Weinfurt, Kevin P., Joelle Y. Friedman, Michaela A. Dinan, Jennifer S. Allsbrook, Mark A. Hall, Jatinder K. Dhillon, and Jeremy Sugarman.
Disclosing conflicts of interest in clinical research: views of institutional review boards, conflict of interest committees, and investigators.
Grady, Christine, Elizabeth Horstmann, Jeffrey S. Sussman, and Sara Chandros Hull.
The limits of disclosure: what research subjects want to know about investigator financial interests.
Sayeed, Sadath A.
The marginally viable newborn: legal challenges, conceptual inadequacies, and reasonableness.
Abstract:
Decisions to provide life-sustaining medical care for marginally viable newborns present a unique set of morally complex challenges for providers and parents in the United States. This article examines recent legal trends that restrict discretionary decision-making, and critiques commonly employed ethical justifications offered to support permitting such discretion.
Bharucha, Ashok J., Alex John London, David Barnard, Howard Wactlar, Mary Amanda Dew, and Charles F. Reynolds III.
Ethical considerations in the conduct of electronic surveillance research.
Abstract:
The extant clinical literature indicates profound problems in the assessment, monitoring, and documentation of care in long-term care facilities. The lack of adequate resources to accommodate higher staff-to-resident ratios adds additional urgency to the goal of identifying more cost-effective mechanisms to provide care oversight. The ever expanding array of electronic monitoring technologies in the clinical research arena demands a conceptual and pragmatic framework for the resolution of ethical tensions inherent in the use of such innovative tools. CareMedia is a project that explores the utility of video, audio and sensor technologies as a continuous real-time assessment and outcomes measurement tool. In this paper, the authors describe the seminal ethical challenges encountered during the implementation phase of this project, namely privacy and confidentiality protection, and the strategies employed to resolve the ethical tensions by applying principles of the interest theory of rights.
DeCoster, Barry.
Avian influenza and the failure of public rationing discussions.
Schwartz, Robert.
When doing the right thing means breaking the law - what is the role of the health lawyer?
Falit, Benjamin P.
The Bush Administration's health care proposal: the proper establishment of a consumer-driven health care regime.
Sclar, David.
U.S. Supreme Court ruling in Gonzales v. Oregon upholds the Oregon Death with Dignity Act.
Medical Anthropology Quarterly, Vol. 20, no. 3 (Sept. 2006)
Kunitz, S.J.
Life-Course Observations of Alcohol Use among Navajo Indians: Natural History or Careers?
Abstract:
In this article, I describe changes in patterns of alcohol use and abuse among Navajo Indians from the mid-1960s to the late 1990s. The prevalence of alcohol dependence continues to be higher than in the general U.S. population, but remission is also common, as it was in the 1960s and previously. Men have substantially higher rates of alcohol dependence than women. The former engage in heavy drinking largely in response to the heavy drinking of those around them. The latter drink excessively largely as a response to psychiatric disorders, depression, and abuse by a partner or husband. As increasing numbers of people have moved to reservation and border towns, a youth culture has developed in which alcohol use is initiated by teenagers with their peers rather than, as in the past, with older kinsmen. Alcohol use has thus been freed from the constraints imposed by both isolation and family obligations.
Wynn, L.L.
The Social Life of Emergency Contraception in the United States: Disciplining Pharmaceutical Use, Disciplining Sexuality, and Constructing Zygotic Bodies
Abstract:
This article is an examination of the FDA hearing on a proposal to permit nonprescription access to the emergency contraceptive pill Plan B. Participants debated the drug's impact on female and young adult sexuality, illustrating how the rhetoric over disciplining pharmaceutical use in the American public is a displaced language for talking about disciplining women's and girls' sexuality. Debate over Plan B also focused on its mechanism of action and whether or not it was abortifacient, revealing a medical technology characterized not only by moral but also by marked scientific ambiguity. The scientific framing of the politics of emergency contraception is testament to the powerful authority of biomedicine to narrate and thus produce ideologies of bodies (individual, embryonic, social, and political), sexuality, and selves. The discourse on access to Plan B in the United States demonstrates how women's bodies are sites of control where the politics of sexuality, discourses on public health, and medical constructions of biological processes intersect.
Root, R.
"Mixing" as an Ethnoetiology of HIV/AIDS in Malaysia's Multinational Factories
Abstract:
Minah Karan, the stigmatizing label appended to Malay factory women in the 1980s, signaled a dangerous female sexuality that risked spreading beyond the factory gates and infecting Malaysia's idea(l)s of its traditional kampung culture. This article narrates how Minah Karan, as the former antihero of development, was reconstituted in the 1990s, with the government's labeling of factories as "high-risk settings" for HIV/AIDS. This is an ethnoetiology based not on any evidential epidemiological data but on the racial and gendered "mixing" that transpires behind factory walls: a fear that the "mixing of the sexes" means ipso facto "sexual mixing" among the races. The article demonstrates how importation of the high-risk label articulates at the local level the new and contested linkages, economic, religious, and scientific, constitutive of globalization. The pragmatic nature and imperatives of this high-risk process are discerned in factory women's accounts of how they negotiate the interactional imperatives of factory work, because transnational structures of productivity violate the social boundaries that have long connoted political stability, moral integrity, ethnic community, and individual safety. The article concludes by questioning whether ethnoetiologies, especially when they concern sexual networks, become social etiologies, because this would locate ethnoetiologies as central to conventional public health praxis rather than as ethnographic exotica in the margins.
Inhorn, M.C.
Defining Women's Health: A Dozen Messages from More than 150 Ethnographies
Abstract:
Although the women's health research agenda has been largely defined by Western biomedicine and public health, anthropology has much to offer in terms of defining and understanding women's health from the perspective of women themselves. Through the in-depth qualitative tradition of ethnography, anthropologists have documented women's health concerns around the globe, producing a large and constantly expanding literature that is rich and provocative. This article summarizes a dozen major messages about women's health that emerge from the ethnographic literature, now consisting of more than 150 volumes. These volumes are listed in the article, and some primary examples are described as representative of anthropology's contribution to knowledge production in women's health.
Henry, D.
Violence and the Body: Somatic Expressions of Trauma and Vulnerability during War
Abstract:
Drawing on ethnographic research conducted along the Sierra Leone–Guinea border during wartime, this article explores the contested nature of the body and bodily illness during times of spectacular political violence. For both perpetrators and survivors of conflict, the body and bodily illness became tools over which each sought to control definitions of Self and identity. Finally, the article considers emic interpretations and contested meanings of the local illness hypertension, or haypatnsi, that occurred among the displaced. I document how discussions of haypatnsi allowed horrific subjective experiences to become mediated, enabling conflict survivors to understand and express the pain of their trauma and vulnerability, and begin recourse toward reestablishing order and control over their lives. Even these discussions of illness, however, involved competition over control of meanings and prescriptive models with medical practitioners. Haypatnsi thus reveals how lived, traumatic experiences and their cultural representations within illness are linked.
Tapias, M.
Emotions and the Intergenerational Embodiment of Social Suffering in Rural Bolivia
Abstract:
In this article, I take the embodied manifestations of distress across generations as the lens from which to illustrate the subtle articulations between the political restructuring of the Bolivian state and the private anxieties women experience under enduring political and economic instability. Emotions such as rage and sorrow generated by economic hardship, domestic violence, and social conflict played a fundamental role in how market- and working-class women perceived not only their own health problems but also many of the health problems that affected their infants. Mother's bodies and emotions are seen as the vectors through which gestating babies and breastfeeding infants develop transient and enduring ailments and debility.
J. of Medical Humanities Vol. 27, no. 3 (Sept. 2006).
Fisher, J.A.
Playing Patient, Playing Doctor: Munchausen Syndrome, Clinical S/M, and Ruptures of Medical Power
This article deploys sadomasochism as a framework for understanding medical practice on an institutional level. By examining the case of the factitious illness Munchausen syndrome, this article analyzes the operations of power in the doctor-patient relationship through the trope of role-playing. Because Munchausen syndrome causes a disruption to the dyadic relationship between physicians and patients, a lens of sadomasochism highlights dynamics of power in medical practice that are often obscured in everyday practice. Specifically, this article illustrates how classification and diagnosis are concrete manifestations of the mobilization of medical power.
Koerber, A.
From Folklore to Fact: The Rhetorical History of Breastfeeding and Immunity, 1950-1997
Abstract:
This article examines the recent construction of human milk's immune-protective qualities as scientific fact, demonstrating that long-standing controversies about human milk's immune-protective effects have not been resolved by a particular scientific discovery. Rather, experts' consensus on how to respond to this uncertainty has been transformed, and this transformation has had as much to do with a change in the metaphor that governs interpretation of evidence about immune protection as it has with discovering new evidence about either human milk or the antibodies in it.
Spoel, P., James, S.
Negotiating Public and Professional Interests: A Rhetorical Analysis of the Debate Concerning the Regulation of Midwifery in Ontario, Canada
Abstract:
This article investigates the uneasy process of integrating midwifery's alternative, women-centered model of childbirth care within the medically-dominated healthcare system in Canada. It analyses the impure processes of rhetorical identification and differentiation that characterized the debate about how to regulate midwifery in Ontario by examining a selection of submissions from diverse health care groups with vested interest in the debate's outcome. In divergent ways, these groups strategically appeal to the value of the "public interest" in order to advance professional concerns. The study considers the implications of this rhetorical process for re-defining midwifery's distinctive professional identity in relation to other health professions, to the state, and to the women for whom midwives care. Likewise, it suggests the relevance of rhetorical analysis for understanding the discursive formation and re-formation of health models, values, and professions in Western culture.
Gibson, B.
Disability, Connectivity and Transgressing the Autonomous Body
Abstract:
This paper explores the interconnectedness of persons with disabilities, technologies and the environment by problematizing Western notions of the independent, autonomous subject. Drawing from Deleuze and Guattari's reconfiguration of the static subject as active becoming, prevailing discourses valorizing independence are critiqued as contributing to the marginalization of bodies marked as disabled. Three examples of disability "dependencies" -- man-dog, man-machine, and woman-woman connectivities -- are used to illustrate that subjectivity is partial and transitory. Disability connectivity thus serves a signpost for an expanded understanding of subjectivity and suggests a radically altered ethics that is no longer premised on individual rights.
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