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Odds and ends: risk, mortality, and the politics of contingency.

Medical anthropology's cogent rethinking of conventional biomedical categories has largely overlooked the core problems of one key concept of both biomedical and social scientific analysis: risk. In particular, the use of the term in medical anthropology (and the social sciences more generally) frequently rests on two assumptions: (1) that contingency necessarily constitutes a threat to individual experience or social order; and (2) that a risk management paradigm that relies on a model of statistical probability is the ontologically preeminent way of engaging chance. Other approaches which do not take risk as the starting point for understanding contingency also have problems; they too assume that contingency is necessarily cause for crisis. These problematic root assumptions lead social analysts to miss how individual actors and local communities variously engage, rather than minimize, contingency. I suggest a new approach that instead aims to treat contingency as normatively neutral and as arising in four domains of experience. Conventional approaches also miss how attempts to account for unexpected events themselves involve struggles between competing paradigms (or tropes) of chance. This contest over accountability I call here the politics of contingency, and I seek thereby to signal the need to renovate our language of uncertainty in order to address its political dimensions. I trace the literature to identify some sources of these terminological problems, and through an examination of the life and death of a close contact in Chania, Crete, I explore his own approach to chance and the different, competing interpretations of his death. I thereby demonstrate the importance of revamping the conventional approach to understanding the contingent nature of human life.

Attitude to Death↗

Fragile castles: the paradox of research politics, scientific progress, and the mutation of medical knowledge.

This paper is based on fieldwork done from 1996-1999 in different locations among village communities from Central Anatolia afflicted with the deadly malignancy of mesothelioma. Medical research has long established the relationship between mesothelioma and the environment; yet in earlier work correlations deduced through my genealogies provide evidence of a possible genetic cofactor causing these cancer deaths. This paper illustrates how medical research becomes an arena for local and global political interests and how the disruption of the doctor-cancer patient relationship impedes medical research. Methods include illness and clinical narratives, kinship charts and pedigrees, and observation of involved doctors and patients in multiple sites and geographical locations. Under focus are the anthropologist's involvement in global biomedical research and her interconnectedness with its political events.

Air Pollutants↗

[The cholera epidemics and the development of public health in Meiji Japan. 2. Strength and weakness of public health politics].

We present here the beginnings of public health politics in Meiji Japan (1868-1912). Due to a two century isolation of Japan, public health concepts developed in the West from the end of the 18th century were foreign in premodern Japan. Due to its isolation, Japan was also relatively preserved from some acute infectious diseases such as cholera. In this paper, we investigate the role of cholera epidemics in the emergence of public health concepts in the peculiar context of Meiji Japan. We show that chronic diseases such as tuberculosis and leprosy were neglected for a long time and that the Meiji government set priority on acute infectious diseases that were considered as long as they disturbed public order. Nevertheless, some physicians and government officials considered issues of welfare and poverty. We also review some emerging concepts of social medicine. We try to show that in Japan as well as in western nations public health politics were not exempt of contradictions and paradoxes and a permanent tension existed between coercitive policies and conceptions of welfare and rights to health.

Cholera↗

Outlining social physics for modern societies-locating culture, economics, and politics: The Enlightenment reconsidered.

A groundwork is laid for a formulation of the modern human social system as a field continuum. As in a simple material physical field, the independent implied relationships of materials or processes in flux have to be based on local conservations of mass, energy, and momentum. In complex fields, the transport fluctuations of momentum are transformed into action modes (e.g., [unk] pdq = SigmaH(i) = H, a characteristic quantum of action over a characteristic cycle time). In complex living systems, a fourth local conservation of population number, the demographic variable, has to be added as a renormalized variable. Modern man, settled in place via agriculture, urbanized, and engaged largely in trade and war, invents a fifth local conservation-value-in-trade, the economic variable. The potentials that drive these five fluxes are also enumerated. Among the more evident external and internal physical-chemical potentials, the driving potentials include a sheaf of internal potential-like components that represent the command-control system emergent as politics. In toto, culture represents the social solvent with the main processes of economics and politics being driven by a social pressure.

Journal Article↗

The ACT heroin trial: intellectual, practical and political challenges.

An array of intellectual, practical and political challenges will be faced both if the Australian Capital Territory "heroin trial" does or does not eventuate. The intellectual challenges include the development of new methodologies and analytical tools for some of the outcome measures; the further development of a research process which involves all the relevant disciplines and interest groups; and capitalizing on an unprecedented opportunity to investigate the pharmacokinetics of heroin. The practicalities of setting up a trial also present a number of challenges, as does incorporating a health development approach. Political challenges include getting a sensible decision made about the trial, avoiding capture of the debate by supporters or opponents of drug law reform and avoiding unrealistic expectations. The major challenge if the trial does not go ahead is to implement other well-considered proposals which can be carefully evaluated.

Journal Article↗

Epidemiologists explain pellagra: gender, race, and political economy in the work of Edgar Sydenstricker.

Between 1900 and 1940, at least 100,000 individuals in the southern United States died of pellagra, a dietary deficiency disease. Although half of these pellagra victims were African-American and more than two-thirds were women, contemporary observers paid little attention to these gender and racial differences in their analyses of disease. This article reviews the classic epidemiological studies of Joseph Goldberger and Edgar Sydenstricker, who argued that pellagra was deeply rooted in the political economy of cotton monoculture in the South. The methods that Sydenstricker brought to epidemiology from early work on political economy obscured the role of gender inequalities in pellagra, and his focus on economic underdevelopment led him to ignore the prominent role of African-Americans as pellagra's principal victims. Research methods and traditions, no less than more overt ideologies, played a role in maintaining the subordinate social position of women and African-Americans in the southern United States.

Black People↗

Prelude to the plague: public health and politics at America's Pacific gateway, 1899.

San Francisco played a crucial in the formulation of American immigration policy vis-à-vis Asia in the late nineteenth and early twentieth centuries. During this period, it was often difficult to differentiate political struggles over the exclusion of Asians from other conflicts. This article examines one such arena: an acrimonious, well-documented argument in 1899 between Federal and various State and local authorities over the arrival of a Japanese passenger liner that may--or may not--have been carrying bubonic plague. Six months later, the plague unquestionably arrived, resulting in the well-known San Francisco plague epidemic of 1900 in which more that 110 people died. Reviewing the 1899 prelude, the public attitudes of the various health authorities, and the way the press reported health issues, collectively give some sense of that historical space where the regulation of public health, politics, and the immigration industry intersected and were fiercely contested.

China↗

The reality of political ethical conflicts. Nurse manager dilemmas.

Losing sleep and deciding your administrative job is not worth the pressures you feel could be symptoms that you are struggling with a political ethical conflict. The authors describe a variety of political ethical conflicts and how they can arise, giving examples of dilemmas experienced by nurse managers and offering suggestions for developing successful coping strategies.

Aged↗

Co-operation despite disagreement: from politics to healthcare.

Political interaction among citizens who hold opposing moral views commonly requires reaching beyond toleration, toward actual co-operation with policies one opposes. On the more personal level, however, regarding (e.g.) interactions between healthcare providers and patients, several authors emphasize the importance of preserving integrity. But those who oppose any 'complicity in evil' often wrongly conflate instances in which the other's position is (and should be) totally rejected with instances of legitimate, although deep, disagreement. Starting with a striking example from the context of a particular tradition, I argue generally that in the latter sort of disagreements, talk of 'complicity' should be largely replaced with a more co-operative moral stance, grounded in a pluralistic framework. Co-operation Despite Disagreement (CDD) should be sought either for institutional reasons--akin to the political--or for relational reasons. CDD involves sharing another's perspective and sometimes calls for adopting another's moral judgements in preference to one's own. I seek to identify some of the conditions and circumstances that would justify such a shift, particularly in scenarios involving assistance, such as physician-assisted suicide (PAS) or the role of an anaesthesiologist in abortion. This discussion is meant to provide examples of the kind of second-order reasons appropriate for determining the terms for CDD-- in distinction from first-order considerations (e.g., the much-contested 'active/passive' distinction) which are likely to be the subject of the initial disagreement and hence cannot serve to resolve it.

Abortion, Induced↗

The politics of gender in family therapy.

This article provides an overview of the political implications of various approaches to gender within the clinical literature. It emphasizes the process of therapy within the social context of gender relations and identifies the political consequences of various clinical responses. Issues surrounding the appropriate role and stance of therapists relative to gender are identified, ethical issues such as neutrality and client welfare are re-examined, and suggestions for practice are addressed.

Culture↗

Death in Jonestown: techniques of political control by a paranoid leader.

Jim Jones and Jonestown are discussed from a "political control" point of view. Seven basic techniques of political control are identified: Control of property and income, weakening of family ties, a sociopolitical caste system, control of egression (escape), control of verbal expression, cognitive control and emotional control. Jonestown is identified as a mini-totalitarian state ruled by a delusional and paranoid person.

Famous Persons↗

Bio-policy and the place of institutionalised ethics in political decision making.

Questions concerning moral problems caused by the life-sciences and concerning the adequate methods and instruments to solve these are timely and urgent; especially in the face of intense debates on the acceptability of research on human embryonic stem cells and preimplantation diagnostics, to name only two applications developed from research on the life-sciences. Unfortunately, the constant and accusing demand that life-scientists must behave morally does not give us a clue on how ethics may help in establishing guidelines for moral behaviour. In this heated situation the foundation of ethics-committees seems to be the motto of the day. But instead of functioning as necessary and fruitful scientific advisory boards, these committees run the risk of being misused as a fashionable (and soon forgotten) weapon in the battle for political opinion-leadership. In the following article, the view is defended that ethics is a scientific enterprise and has an important role to play in political decision making on life-sciences issues.

Advisory Committees↗

Harry and Louise go to Washington: political advertising and health care reform.

Political advertising by interest groups trying to influence public policy has proliferated recently. Formerly the preserve of election campaigns, advertising has spread to policy arenas, such as abortion, trade, and health care. This article examines group lobbying for and against President Clinton's health care reform plan. Using a study of advertisements, a content analysis of news coverage, interviews with half a dozen leading figures in the debate during the spring of 1995, and an analysis of three national public opinion surveys designed to gauge the public response to health care ads, we investigate the media campaign on health care. Ads directed against the Clinton plan played a crucial role in the public's attaching negative connotations to some of its key elements. Grassroots campaigns can work either by mobilizing public opinion or by persuading political leaders that grassroots opposition exists to a particular program.

Advertising↗

The politics of risk: a human rights paradigm for children's environmental health research.

A human rights paradigm for environmental health research makes explicit the relationship between poor health and poverty, inequality, and social and political marginalization, and it aims at civic problem solving. In so doing, it incorporates support for community-based, participatory research and takes seriously the social responsibilities of researchers. For these reasons, a human rights approach may be better able than conventional bioethics to address the unique issues that arise in the context of pediatric environmental health research, particularly the place of environmental justice standards in research. At the same time, as illustrated by disagreements over the ethics of research into lead abatement methods, bringing a human rights paradigm to bear in the context of environmental health research requires resolving important tensions at its heart, particularly the inescapable tension between ethical ideals and political realities.

Child↗

The historical and political background to the proposals for local commissioning of primary dental care by primary care trusts.

This paper provides a background to the changes that are about to occur in the system for primary oral healthcare delivery in the NHS. This is part of a far wider reform programme involving all public sector services. The challenges that the Government faces are not unique: all countries are striving to alter their care systems to address the changing expectations of the electorate while attempting to control both the costs and inequalities. What is unique to the United Kingdom is the historical legacy of the NHS and its political importance, which should not be underestimated. An overview of the agenda for change in all parts of the health sector is presented. This is followed by a more detailed analysis of the proposals for future delivery of primary oral care in the NHS and the subsequent issues arising. A consistent theme running throughout the Government's agenda is devolution. Indeed, the detailed programme discussed in this paper applies only to England and Wales. The fact that Scotland has different plans highlights the importance of the political and cultural setting to any reform programme.

Community Dentistry↗

In the high court of South Africa, case no. 4138/98: the global politics of access to low-cost AIDS drugs in poor countries.

In 1998, 39 pharmaceutical manufacturers sued the government of South Africa to prevent the implementation of a law designed to facilitate access to AIDS drugs at low cost. The companies accused South Africa, the country with the largest population of individuals living with HIV/AIDS in the world, of circumventing patent protections guaranteed by the intellectual property rules that were included in the latest round of world trade agreements. The pharmaceutical companies dropped their lawsuit in the spring of 2001 after an avalanche of negative publicity. Yet, despite the government's victory, AIDS drugs remain very expensive in South Africa, and the government still refuses to provide antiretroviral therapy to adults. These events have shone a spotlight, not only on the possibilities for coordinated political activism in the era of instant global communications, but also on the tangled social, economic, and political dimensions of AIDS treatment in poor countries.

Acquired Immunodeficiency Syndrome↗

[Evaluation and design of a political-pedagogical project for nursing undergraduate programs].

This work presents the results of an experience which aimed primarily at the evaluation of the Political-Pedagogical Project--PPP of the nursing undergraduate program from UNIOESTE (Cascavel town Campus) and at pondering on a new curricular proposal for that program. Thus, a research project was designed to be used by all professors teaching that program, with the participation of students, former students, and professionals working on the health care delivery network, where field work can be carried out through practical activities and training periods for the students. The data gathered by them have been used as subsidies for a proposal to build a new political-pedagogical project, that was took effect in the year 2003. Besides designing a new pedagogical proposal, strategies for a continued evaluation of the PPP implantation process have been defined. This evaluation is to be performed at the end of each term.

Brazil↗

[Participation in the design of a political pedagogical project in nursing].

This paper reports an experience tracing the route of the academic community pursuing a Nursing Degree at Federal University of Santa Maria, while designing their Political-Pedegogical Project. The methodology used for creating this project was the promotion of seminars, which brought together professors, students, civil servants, and nurses who work in practice classes and supervised internships. For the organization of the project, referential, conceptual, and structural landmarks have been used, adapted from Saupe and Alves. This nursing undergraduate program is on the process of designing its framework, and is planning on seminars to discuss teaching methodology, besides designing a follow-up and evaluation plan for the implementation of their Political Pedagogic Project, as well as for the improvement of faculty competency.

Brazil↗